I have spent a lot of time with the vet – it is a long story, but I was fascinated in the way they managed a cat with diabetes.
Of course diabetes in animals is very similar to humans – it starts with an inability to manage post prandial glucose and leads to insulin resistance and ultimately pancreatic failure. The diagnosis is through a mixture of blood tests, urinalysis (clean dry gravel in the litter tray) and the typical signs – ravenous appetite, weight gain, always thirsty and peeing often. No GGT or HbA1c in the vet. Treatment is also similar with diet manipulation, weight control, exercise stimulation and some medicines.
The fat cat sat on the mat. As it purred gently it had a continuous glucose monitor attached. It hardly noticed as it was fixed in place. Free feeding was replaced with fixed meals and five days later the data was downloaded. The little machine had measured glucose concentrations every five minutes for 5 days – that’s 288 measurements a day and nearly 1,500 measurements over the 5 days. The line appeared showing the peaks and toughs in use.
The baseline glucose level was abnormal and the peaks showing the post-prandial glucose levels were also abnormal. These peaks were then compared to the diet chart and most peaks were explained through the three meals. Well apart from three which were biscuits – your cat eats biscuits? Yes we sometimes sit together in the evening and we share a biscuit – should have guessed really.
I think that we could identify the calorie content of everything that passed that cats lips over the five days – just amazing. Nowhere to hide that little titbit or mouse or latte and muffin.
The owner left with a greater understanding of the influence of diet, a refined diet plan and some medicines. The medicines were initially targeted towards reducing the basal glucose and the vet was sure that this would help to make the cat feel a little better and ‘get out more’.
The owner was told that the cat should come in for another review and that the vet will do another 5 days of glucose monitoring. The vet warned the informed that an improvement in the basal glucose was expected, but the next stage would be adding in another medicine that effected basal glucose or if the post prandial glucose hadn’t improved then a refinement of the diet and a medicine that targeted post prandial glucose. The vet didn’t want to start insulin, but that was firmly on the cards with a twice daily mixture at the two main meals. This all seemed quite rational to me.
I am sure that you want to know about the biscuits. They were changed to either a reduced amount of the high sugar variety or an increased amount of a low sugar variety. The owner understood this and went away with a list of biscuits and their calorie contents printed from the internet. Actually I didn’t know how bad custard creams were – must cut these down myself.
I asked the vet where continual glucose monitoring had come from and why she used it. Well it would seem that it is an adaptation of the equipment used in humans that transferred to vetinary practice about 5 years ago. She felt it was the only way that she could get the information to guide her advice and treatment. The 5 day 5 minute readings linked perfectly to the diet plan and the owner had no doubt what was right or wrong. Obviously, I asked if the vet used blood glucose testing and she almost laughed in my face. Cats don’t like it and the information is hardly very useful in discussion with the owners and agreeing a management strategy. I had to agree with her.
The management of diabetes in cats is particularly important. The complications, particularly peripheral neuropathy can be particularly nasty and hypoglycaemia a real issue, however they aren’t affected by cardiovascular complications to the same degree. If the diabetes is controlled well and the cat loses weight then they may improve to the point that they don’t require treatment – fascinating.
If I should get diabetes, perhaps I will visit my vet first. Well perhaps until the NHS uses continuous glucose monitoring and follows good vetinary practice in targeting treatment appropriately.