Treatment options for feline patients with diabetes

Photo: Нина Дроздова/Adobe Stock

In her lecture on feline diabetes, at the Fetch dvm360 conference in Atlantic City, New Jersey, Renee Rucinsky, DVM, DABVP, owner of Mid Atlantic Cat Hospital and Mid Atlantic Feline Thyroid Center, talked about methods for managing feline diabetes.¹ Rucinsky began by explaining that the goals of treatment are not to create a perfect blood glucose level or to achieve the “textbook” blood glucose curve. Instead, the goals of treatment are to improve the glycemic control, patients’ clinical signs, and to improve the quality of life of the patient and the owner.¹

Insulin therapy

One treatment method that Rucinsky discussed was insulin therapy. The insulin that is most likely to put a cat into remission is Insulin Glargine, or percutaneous coronary intervention (PCI), explained Rucinsky. Insulin determir can also be utilized, she said. Unlike in dogs, felines only require 1 unit twice a day, regardless of their weight.¹

Administered in an appropriate dose, insulin, in combination with a diet change—which includes a reduction in carbohydrates, an increase in protein, and a strict calorie plan—has a high success rate for remission, lectured Rucinsky.

However, a drawback of insulin may include challenges with clients who may not administer the drug correctly. Moreover, issues with staff may arise, creating another drawback for using insulin as a treatment for diabetes. In her session, Rucinsky explained that front desk staff are often faced with critical decision making when clients call and ask for advice on a situation with their diabetic pets.

“…you're relying on [front desk staff] to make a decision, ‘do I get the technician?’ ‘Do I leave a note for the doctor?’ Maybe that person doesn't get a call back until 5 o'clock. So you have to train your staff to know [how to respond to] all these things… all that stuff makes insulin a potentially really, really scary drug,” emphasized Rucinsky.

During her lecture, Rucinsky also hinted at a potentially new insulin for cats that may be coming to the market in the future. She shared that the new product recently finished the pilot phase and is in the beginning stages of a pivotal clinical trial. The product would be a once-a-week insulin therapy for cats. Currently, there are 18 cats in the pilot trial, and of those, 40% have gone into remission on the drug, shared Rucinsky.¹

“I'm excited for this drug. It's been…really, really cool, and stay tuned on that, because for the cats that do require insulin, I think that might be a pretty cool option when it comes out,” said Rucinsky.

SGLT2 inhibitors

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a new treatment option for felines with diabetes. This treatment works by blocking the reabsorption of glucose in the kidneys, leading to normal glycemia. In her lecture, Rucinsky explained that this treatment option should be used on cats with diabetes that are otherwise healthy.

Both Bexacat or Senvelgo SGLT2is are given once a day, do not need to go in the fridge, are mixed in the cat’s food, and are relatively palatable, said Rucinsky.

“The challenge with using SGLT2 inhibitors is that it's new, right? It's a new way of thinking about things. It's a completely different mechanism of action that we have to understand, and then we have a different way of monitoring as well. So you know, once we start these, they're not hyperglycemic at all. They're not going to get hypoglycemic. So how do we know if they've gone into remission?” inquired Rucinsky.

Patients taking SGLT2is should see a weight increase; less polyuria and polydipsia (PU/PD) polyphagia, blood glucose curves, fructose amine, glucosuria, and A1C. “Looking at ketonemia would be better,” explained Rucinsky, “blood ketones are going to be better than urine ketones.”

When using SGLT2is, it is crucial to measure patients’ ketones. Rucinsky highly recommended to veterinarians that do not have blood ketone meters in their hospital, to obtain one.

“Yes, you can do it on urine ketones, but it's better to do it on blood ketones. You're monitoring these guys with blood glucose anyway, you're already getting a blood sample. A handheld ketone meter looks just like your handheld glucometer, [and it’s only] $50. There's no reason for you not to have it in the hospital. It's not a different slide that you put in your AIDEX machine. It's not a whole other machine. If you send out blood ketones, that's great. You can do that, but you don't need that answer tomorrow. You need that answer today. So having a $50 piece of equipment seems like a no brainer,” emphasized Rucinsky.

Reference

Rucinsky R. Feline diabetes: What now? Treatment choices - diet, insulin, and SGLT2i. Presented at: Fetch Coastal; October 14-16, 2024; Atlantic City, NJ.