Today's Veterinary Practice

MAY-JUN 2014

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| Journal Club Today's Veterinary Practice May/June 2014 94 tvpjournal.com intraMusCuLar gLargine witH or witHout ConCurrent subCutaneous adMinistration for treatMent of feLine diabetiC KetoaCidosis Marshall RD, Rand JS, Gunew MN, et al. JVECC 2013; 23(3):286-290. DKa is a life-threatening complication of DM. Current recommendations for treatment of feline DKa have little supporting evidence, and no short-acting insulin is licensed for use in cats. Therefore, use of glargine insulin administered IM to cats with DKa was investigated. In this preliminary retrospective study, the records of 15 cats presented for DKa and treated with IM glargine—with or without SC glargine—were reviewed. • In addition to standard DKa treatments, such as fluid therapy and electrolyte supple- mentation, all cats received glargine, 1 to 2 u/cat iM, as their initial insulin therapy. • The majority (12/15) also received glargine, 1 to 3 u/cat sC. • based on bG monitoring performed Q 2 to 4 H, additional doses of glargine, 0.5 to 1 u/cat iM, were administered Q 2 to 22 H. • Glargine, 1 to 2 u/cat sC Q 12 H, was continued throughout hospitalization and at home following discharge. study results • all 15 cats survived to discharge after a median of 4 days of hospitalization. • Glargine (SC) was used as sole insulin therapy once appetite had returned and dehydration was resolved; median time before sole insulin therapy with glargine (SC) was 24 H. • 2/15 cats had documented hypoglycemia (< 54 mg/dl); none had clinical signs associated with hypoglycemia. • all cats developed hypokalemia; 14/15 received IV potassium supplementation. • 12/15 cats developed hypophosphatemia; 5/12 received IV phosphorus supplementation. Conclusions This study demonstrated that cats with DKa could be effectively managed with IM and SC glargine. Hypoglycemia, hypokalemia, and hypophosphatemia were attributed to ketoacidosis treatment in general, rather than glargine insu- lin specifically. as many primary care practices already stock glargine insulin, use of glargine in feline DKa may allow prompt treatment. Controlled prospective studies are warranted. —Hathaway Fiocchi, DVM, Small Animal Internal Medicine Resident, University of Pennsylvania survivaL tiMe and PrognostiC faCtors in Cats witH newLy diagnosed diabetes MeLLitus: 114 Cases (2000–2009) Callegari C, Mercuriali E, Hafner M, et al. JAVMA 2013; 243:91-95. Previous studies have shown quite varied median survival times in diabetic cats, ranging from 13 to 29 months. 1-3 This retrospective study was conducted to assess survival times and prognostic factors in a specific category of cats with DM—newly diagnosed patients. The authors evaluated records for 114 cats with DM that had not received treatment prior to referral. reviewed data included history, signalment, physical examination findings, hematologic results, and presence of concurrent disease (including DKa). study results • dKa was present in 34% of cats at time of diagnosis; about ⅓ of cats that had dKa survived > 3 years. • Higher creatinine concentrations were associated with a significantly shorter survival time. • Concurrent diseases were identified in 44.7%, including cholangitis (n = 6), lung disease (n = 6), pancreatitis (n = 5), renal/urinary (n = 4), and numerous other diseases each affecting 3 or fewer cats. • Median survival time of diabetic cats was 516 days (range, 1–3468); 70% lived > 3 months, 64% > 6 months, and 46% > 24 months; 95/114 (83.3%) of cats survived to hospital discharge. • an association between presence of concurrent disease and survival time was not confirmed by statistical analysis, although it may become significant if a larger group of cats was studied. Conclusions The results of this study indicate that diabetic cats have a fairly good overall prognosis. Higher creatinine concen- trations were the only factor significantly associated with shorter survival time in multivariate analysis. Interestingly, though the development of ketoacidosis certainly complicates treatment, these results suggest that it may not always be a poor prognostic indicator. —Kristen Kelly, DVM, Small Animal Internal Medicine Resident, University of Pennsylvania 2014-0506_JournalClub-DIabetes.indd 94 5/24/2014 11:02:39 AM

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