Case 1

Monitoring options

Because some cats can develop stress hyperglycemia, fructosamine levels may be helpful if we are unsure of a diagnosis of diabetes. They can also provide insight into how well our diabetic patients are regulated. However, the downside of fructosamine levels is that they do not tell us important minute-to-minute information such as insulin duration of action or the glucose nadir. This is especially important in patients in which we suspect a Somogyi effect. 

Home monitoring can also be helpful. Owners can be taught how to monitor blood glucose concentrations and perform glucose curves. Most owners (and cats) are very amenable to home monitoring, and it’s much less stressful for the cat.

Three-month recheck

Three months later Felicia comes in because the owner reports that Felicia has been lethargic recently and seems to be spending more and more time by the water dish. Upon physical examination you note that she has lost about 1 lb since her last visit.

QUESTION 5

What is a best explanation for Felicia’s current clinical signs? (Select one answer.)

a) Her insulin requirements have changed and she needs more insulin.

b) There is a problem with insulin handling or administration.

c) Felicia is receiving some other medication that antagonizes the effects of the insulin.

d) She has developed a secondary medical problem that is causing insulin resistance.

e) She is suffering from episodes of hypoglycemia with rebound hyperglycemia (Somogyi effect).

f) All of the above could be a possibility.

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