What is the recommended management for Diabetes Mellitus in cats and dogs?

Management of Diabetes Mellitus in Cats and Dogs

Insulin therapy combined with appropriate dietary management is the cornerstone of treatment for diabetes mellitus in both cats and dogs, with specific insulin types and protocols differing between species.

Diagnosis and Classification

Diabetes mellitus in pets presents similarly to humans with:

• Polyuria (increased urination)
• Polydipsia (increased thirst)
• Weight loss despite normal or increased appetite
• Lethargy

Treatment Approach for Dogs

Insulin Therapy

• First-line insulin for dogs: Intermediate-acting insulin administered twice daily 1
• Recommended options:
  • NPH insulin at 0.5 U/kg twice daily
  • Lente insulin at 0.5 U/kg twice daily 2
  • Vetsulin/Caninsulin (porcine insulin zinc suspension)

Dietary Management for Dogs

• Consistent carbohydrate meal plans timed with insulin administration
• High-fiber diets are often beneficial
• Maintain consistent feeding schedule and amounts

Treatment Approach for Cats

Insulin Therapy

• First-line insulin for cats: Long-acting insulin analogs administered twice daily 3
• Recommended options:
  • Glargine (Lantus) at 0.5 U/kg once daily or twice daily 2, 3
  • Detemir (Levemir) at 0.5 U/kg twice daily 3
  • PZI (ProZinc) twice daily

Dietary Management for Cats

• High-protein, low-carbohydrate diet is strongly recommended 2
• This dietary approach has been shown to improve glycemic control and may contribute to diabetic remission in cats

Monitoring Methods

Blood Glucose Monitoring

• Home monitoring with portable glucometers calibrated for veterinary use
• Blood glucose curves (16-hour) to assess insulin effectiveness 4
• Target blood glucose range: 100-250 mg/dL for most diabetic pets

Other Monitoring Parameters

• Serum fructosamine concentration (reflects 2-3 week glucose control)
• Clinical signs (thirst, urination, weight, activity level)
• Urine glucose monitoring as an adjunct method

Insulin Administration Techniques

• Traditional insulin vials with syringes or insulin pen devices
• Insulin pens offer improved dose accuracy, especially for low doses 1
• Proper handling requirements:
  • Some insulin preparations can be stored out of refrigeration once in use
  • Priming of pen devices to ensure full dose
  • Hold pen in place for several seconds during injection 1

Special Considerations

Diabetic Remission in Cats

• Up to 30% of diabetic cats may achieve remission with proper treatment
• Factors favoring remission:
  • Early diagnosis and treatment
  • Strict glycemic control
  • High-protein, low-carbohydrate diet 2
  • Use of long-acting insulin analogs like glargine 3

Hypoglycemia Management

• Owners should be educated on signs of hypoglycemia
• Treatment with oral glucose sources (honey, corn syrup)
• Severe cases may require veterinary intervention

Complications and Pitfalls

• Insulin overdose leading to hypoglycemia
• Insulin underdose leading to persistent hyperglycemia
• Somogyi phenomenon (rebound hyperglycemia after hypoglycemia)
• Concurrent diseases affecting insulin sensitivity (infections, pancreatitis, etc.)
• Inconsistent feeding or medication administration

Emerging Treatments

• Insulin glargine U300 shows promise as a once-daily basal insulin for both dogs and cats 5
• Insulin degludec may be effective as a once-daily insulin for dogs 5

Regular veterinary follow-ups are essential for adjusting insulin doses and monitoring for complications or concurrent diseases that may affect diabetes management.