Diabetic ketoacidosis in the cat: Recognition and essential treatment

Abstract

Any veterinarian that cares for cats in urgent and emergency situations should understand the pathophysiology of DKA in order to address an individual's clinical signs and metabolic derangements. Evidence base: This review draws evidence from the peer-reviewed literature as well as the author's personal clinical experience.

Glargine versus regular insulin protocol in feline diabetic ketoacidosis

“…The results of our study in cats with naturally occurring DKA corroborate the findings of Marshall et al, 8 who showed that the basal‐bolus administration of glargine insulin is a safe and effective alternative to the regular insulin CRI protocol currently used by most experts in the field 3,4,36,37 . Furthermore, as already shown by Gallagher et al, 5 the application of this simplified basal‐bolus protocol decreased time to improvement of hyperglycemia and to discharge, without affecting survival rate or incidence of adverse events.…”

“…The results of our study in cats with naturally occurring DKA corroborate the findings of Marshall et al, 8 who showed that the basal‐bolus administration of glargine insulin is a safe and effective alternative to the regular insulin CRI protocol currently used by most experts in the field. 3 , 4 , 36 , 37 Furthermore, as already shown by Gallagher et al, 5 the application of this simplified basal‐bolus protocol decreased time to improvement of hyperglycemia and to discharge, without affecting survival rate or incidence of adverse events. Although it could be argued that this more rapid decrease in glucose concentrations, likely caused by the higher insulin concentrations achieved within the first hours in the glargine group, would increase the risk of serious complications such as cerebral edema, several studies in dogs and cats suggest that this concern is unwarranted.…”

“…Interestingly, Shankar et al 51 proposed that the positive effects are caused by yet to be described mechanisms, other than just increased total daily insulin dose. Based on evidence in human and feline patients, some veterinary specialists are combining IV regular insulin infusions with twice‐ daily SC glargine insulin injections 37 . Prospective randomized studies are required to more conclusively estimate the benefit of adding SC insulin glargine to DKA protocols for cats.…”

“…Based on evidence in human and feline patients, some veterinary specialists are combining IV regular insulin infusions with twice‐ daily SC glargine insulin injections. 37 Prospective randomized studies are required to more conclusively estimate the benefit of adding SC insulin glargine to DKA protocols for cats.…”

Insulintherapie bei der Katze – Tipps für die richtige Insulindosis

“…Mischinsuline werden bei der Katze nicht verwendet und sind hier daher nicht weiter beschrieben. Informationen zu Normalinsulinen, die zur Be-handlung der diabetischen Ketoazidose gebraucht werden, sind anderen Literaturquellen zu entnehmen [1]. Man sollte sicherstellen, dass der Besitzer weiß, … ▪ wie Insulin aufzubewahren ist (aufrechtstehend im Kühlschrank, nicht in der Kühlschranktür), ▪ wie lange das Insulin-Fläschchen nach dem Anbruch haltbar ist (für Hersteller-Angaben siehe ▶ Tab.…”