CAT WITH DIABETES

VETE 4305 Pharmacy & Pharmacology

Group 2 Case Study
Jennifer Hranek
Jill Keierleber
Rhonda LaBelle

SCENARIO
Polo, a 7 lb, 10-year-old, male, tabby presented with
polydipsia and polyuria. The owner reported the cat had
begun urinating outside the litter box and was occasionally
vomiting. A review of the patients record showed Polo
weighed 8.1 lbs one year ago. The cat appeared somewhat
unkempt and became very agitated during physical exam.
Vitals
Temperature: 101.2F
Heart rate: 180 beats/minute
Pulse: 42 breaths/minute
Mucous membrane color: pink
Capillary refill time (CRT): 2 seconds
Auscultation, Abdominal palpation: within normal limits (WNL)

DIAGNOSTIC RESULTS
COMPLETE BLOOD COUNT (CBC)
Packed Cell Volume (PCV)
Total Protein
White Blood Cells (WBC)

40%
6 g/dL
10.3 x 10/l

CHEMISTRY PROFILE
Glucose
ALP
ALT

364 g/dl
57 U/l
193 U/l

URINALYSIS

Specific Gravity
Color
Glucose
Ketones
Protein
Sediment Exam

1.035
Yellow
1000+
Negative
Trace
Normal

1. PHYSICAL EXAM ASSESSMENT AND DIAGNOSTIC INTERPRETATION

Physical exam. The physical exam findings are within normal limits.
CBC. The WBC and total protein are within normal limits. The PCV is at the upper range
but still within normal limits. This may be secondary to dehydration and should be closely
monitored.
Chemistry Profile. The chemistry levels reveal an elevated glucose at 364 mg/dl
(64 170 mg/dl). Elevation in glucose levels may be caused by inadequate insulin
treatment of the diabetes. The ALT is also above normal at 193 U/l (10 100 U/l).
ALT is a liver enzyme that leaks if there is damage to liver cells, so an elevated ALT
reading may indicate liver damage (Turner, 2013.).

1. PHYSICAL EXAM ASSESSMENT AND DIAGNOSTIC INTERPRETATION

(continued)
Urinalysis. Glucose is present in the urine at 364 g/dl. The presence of glucose is an
abnormal finding, indicating excess glucose circulating in the blood stream being filtered
and excreted via the kidneys. Glucose is normally reabsorbed by the proximal renal
tubules. When the reabsorption rate is exceeded, and glucose levels exceed 280mg/dl
in cats, the excess glucose is shed in the urine.
The protein levels should also be negative. The presence of protein "is an important
indicator of renal disease" (Saunders, 2012, p. 905). The protein can be lost through
either the glomerulus or due to tubular dysfunction (McCurnin, 2010, p. 452).

2.

ALTERNATE METHODS OF URINE COLLECTION

According to McCurnin (2010), cystocentesis and urinary catheterization are other

methods that may be used to obtain a urine sample when manual expression or free
catch is not available (p. 591-594).

3.

RELATIONSHIP BETWEEN CYSTITIS AND DIABETE MELLITUS

A relationship does exist between diabetes mellitus and urinary tract infections.
McCurnin (2010) states that diabetes mellitus predisposes animals to infections,
especially in the urinary tract, because glucose overloads the kidneys and is spilled into
urine. Glucose is an excellent source of nutrients for bacteria, so animals with diabetes
mellitus are at (higher) risk for urinary tract infections" (p. 1307).

4. HOW MIGHT STRESS SECONDARY TO PATIENT HANDLING

AFFECT DIAGNOSITIC FINDINGS?
When dealing with a stressed animal, it is important to consider the fact that the stress
induced may result in changes to the blood glucose levels. Stress from handling, as
well as being in a strange environment, can cause glucose levels to increase to levels of
160 mg/dL in felines. However, if levels exceed180 mg/dL, it can be presumed that
there is a problem with the body's glucose levels (Foster, n.d.).

5. CLIENT EDUCATION: Can cats develop a concurrent neurologic pathology?

What is the condition called and how does it appear clinically?
There are various abnormalities that can be seen in a cat with Diabetes Mellitus. The
neurologic condition that you are concerned about is called diabetic neuropathy.
Diabetic neuropathy may manifest in the form of movement abnormalities, back leg
weakness, and standing in what is called the plantigrade stance. This is exhibited by a
cat standing with the hocks on the ground, like a rabbit (Saunders, 2012).

www.peteducation.com

6. CLIENT EDUCATION: Insulin care and administration

(storage, replacement times, and administration)
Lantus (insulin glargine) is an ultra-long-acting, recombinant human
type of insulin that is given subcutaneously and is available in a
U-100 concentration. Insulin glargine typically requires a few days
to achieve its level of desired effect. Overdose of insulin is possible
and can result in up to 72 hours of hypoglycemia.
Blood glucose levels may not demonstrate significant change for the
initial 3 days of therapy; therefore, dose increases are not
recommended during the first week of therapy.

www.theodora.com

6. CLIENT EDUCATION: Insulin care and administration (continued)

Lantus (insulin glargine) is appropriate for the use in feline patients due to its prolonged
duration in combination with the predisposition of felines to consume small meals
frequently throughout the day. This form of insulin is generally given twice daily in
12 hour increments and cannot be diluted because its effect is pH dependent (Romich,
2010).
While insulin products are usually stable at room temperature, they are often
refrigerated and not frozen. Extremely low and extremely high temperatures could
permanently degrade insulin products even after short periods of exposure. If an insulin
product becomes discolored or precipitate forms, the insulin should be discarded. Prior
to withdrawing the product from the vial, the insulin should be gently rolled between the
palms in order to mix the product before administration (Romich, 2010).

7. CLIENT EDUCATION: Addressing owner concerns

A. What if Polo wont eat? Should I still give the insulin?
NO! Do NOT administer insulin to the patient if it has not eaten a regular meal
because its blood sugar level after the administration of insulin could drop to a
dangerously low level. Irregular eating habits or anorexia could be indicative of the
need for a checkup with the veterinarian and you should schedule an appointment
as soon as possible (Brooks, 2001).

7. CLIENT EDUCATION: Addressing owner concerns (continued)

B.

Do I need to give two shots a day? Why cant I just give one?
YES! Giving one injection can alter the patients blood glucose to a
dangerously low level if not enough insulin is given or a dangerously high level
if the total daily amount is administered all at once (Brooks, 2001).
Additionally, Lantus has an asymmetric peak of 5 to14 hours, which is why a
12 hour increment for administration is suggested.

7. CLIENT EDUCATION: Addressing owner concerns (continued)

C. Why do I need to inject insulin? Cant I just put it in her mouth like I do with an antibiotic?
NO! Insulin needs to be injected. When given orally, the rate of absorption is much
faster than the subcutaneous route. A slower absorption rate is the best way to control
blood glucose.

8. CLIENT EDUCATION: Oral versus Injectable Treatment for Diabetes Mellitus

Glipizide may be a treatment option for healthy diabetic cats that still
have some capacity to synthesize and secret endogenous insulin
(Feldman & Palm, 2013, p. 408). Glipizide is an oral medication that
prevents hypoglycemia by lowering blood glucose. Possible side effects
include:
Vomiting
Loss of appetite

Liver damage
www.mediahex.com

8. CLIENT EDUCATION: Oral versus Injectable (continued)

Cats on glipizide require close monitoring of blood glucose levels to verify efficacy.
Commitment to long-term oral administration of glipizide is often difficult for
owners, and many cats will eventually require injectable insulin to control diabetes
(Feline Diabetes, 2002).

9. OWNER CONCERN: Insulin Overdose

For the previous month, the owner has been administering 2 units of insulin SQ BID. This
morning both she and her husband administered insulin to Polo. The owner wants to know if
this could cause a problem and what she should do now.
Yes, Polo is in severe danger of developing hypoglycemia (low blood glucose) from
insulin overdose. Signs of hypoglycemia include strange behavior, abnormal gait,
weakness, tremors, lethargy and sleepiness. If Polo is conscious, the owner should feed
him a high carbohydrate meal such as brown rice and chicken, or his regular diet with
corn syrup added to it. If Polo is exhibiting signs of hypoglycemia, the owner should rub
one to two teaspoons of corn syrup along his gums. If Polo responds to treatment, feed
him within five minutes. If unresponsive or minimal response, immediately transport Polo
for veterinary care (Rucinsky, et al., 2010)

REFERENCES
Bassert, J.M., McCurnin, D.M. (2010). McCurnins Textbook for Veterinary Technicians,
7th Edition. Saunders Elsevier:St. Louis, MO
Blood, D.C., Gay, C.C., Studdart, V.P. (2012). Saunders Comprehensive Veterinary
Dictionary, 4th Edition. Saunders Elsevier:St. Louis, MO
Brooks, W.C. (2001). Insulin Administration in Cats. Veterinary Information Network,
Inc., 1 Jan. 2001. Web. 02 Oct. 2014.
Feldman, E.C., Palm C.A. (2013). Oral Hypoglycemics in Cats with Diabetes Mellitus
in Veterinary Clinics of North America: Small Animal Practice Feline Diabetes.
J.S. Rand, Ed. March 2013, Vol 43, No. 2. pp. 407 415.
Foster, R. (n.d.). Chemistry Panels & Tests for Pets. Web: Retrieved 10/01/2014
from http://www.peteducation.com/article.cfm?c=1+2144&aid=989

REFERENCES
Feline Diabetes. Retrieved 10/06/2014 from
http://www.vet.cornell.edu/FHC/health_resources/brochure_diabetes.cfm
Longterm Complications of Diabetes Mellitus in Cats. Retrieved 10/01/2014 from
http://www.peteducation.com/article.cfm?c=1+2130&aid=197
Romich, J.A. (2010). Fundamentals of Pharmacology for Veterinary Technicians, 2nd ed.
Clifton Park, NY: Delmar Cengage Learning. pp. 284-86.
Rucinsky, R., et al. (2010). AAHA Diabetes Management Guidelines for Dogs and
Cats. Retrieved 10/06/2014 from
https://aahanet.org/Library/DiabetesMgmt.aspx
Turner, F. (n.d.). Clinical Pathology II Lecture Notebook. McClennan Community
College:Waco, TX