Retrospective comparison of early‐ versus late‐insulin therapy regarding effect on time to resolution of diabetic ketosis and ketoacidosis in dogs and cats: 60 cases (2003–2013)

DiFazio, Jillian; Fletcher, Daniel J.

doi:10.1111/vec.12415

Cited by 16 publications

(16 citation statements)

References 22 publications

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“…Finally, further limitations are the absence of randomisation and the heterogeneity of the population with regard to the presence of concurrent disorders. However, our population’s characteristics were very similar to those in other studies of feline DKA, 27–31 suggesting that this small population is representative of cats with spontaneous DKA.…”

Section: Discussionsupporting

confidence: 83%

Use of lispro insulin for treatment of diabetic ketoacidosis in cats

Malerba

Mazzarino

Baldo

et al. 2018

Journal of Feline Medicine and Surgery

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Objectives The aim of this study was to evaluate the efficacy and safety of lispro insulin for the treatment of feline diabetic ketoacidosis (DKA). Times to resolution of hyperglycaemia, ketosis and acidosis were compared between cats treated with continuous rate infusion (CRI) of lispro insulin and cats treated with CRI of regular insulin. Methods Client-owned cats with naturally occurring DKA, newly diagnosed with diabetes mellitus (DM) or already receiving treatment for DM, were included. Diagnosis of DKA involved the presence of at least two clinical signs consistent with DKA (eg, polyuria/polydipsia, anorexia, severe lethargy, vomiting and dehydration), blood glucose (BG) concentration >13.9 mmol/l (>250 mg/dl), blood beta hydroxybutyrate (BHB) concentration >2.5 mmol/l and venous pH <7.3 or bicarbonate <15 mEq/l. Cats were treated with a standard protocol of an intravenous (IV) CRI of regular insulin (group R) or lispro insulin (group L). The time to resolution of DKA was defined as the time interval from when the IV CRI of insulin began until marked hyperglycaemia (BG >13.9 mmol/l [>250 mg/dl]), ketosis (BHB concentration >1 mmol/l) and acidosis (venous pH <7.3 and/or bicarbonate <15 mEq/l) resolved. Results Eighteen DKA cases (nine per group) were enrolled into the study. There were no significant differences in the median time to resolution of three variables (hyperglycaemia, ketosis and acidosis) between the two groups. Two cats in group R developed hypoglycaemia during the CRI of insulin. One cat in group L and three cats in group R developed hypophosphataemia, which required phosphate supplementation. Conclusions and relevance IV CRI of lispro insulin has few side effects and appears to be as effective as IV CRI of regular insulin in the treatment of cats with DKA.

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Section: Discussionsupporting

confidence: 83%

Use of lispro insulin for treatment of diabetic ketoacidosis in cats

Malerba

Mazzarino

Baldo

et al. 2018

Journal of Feline Medicine and Surgery

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“…In a previous study, the resolution time for DKA therapy was 16.91 ± 4.223 hours. [ 16 ] In this study, the whole DKA median resolution time was 16.25 hours, which was similar with the previous study. However, we illustrated the DKA resolution time for different groups with various severity.…”

Section: Discussionsupporting

confidence: 90%

Clinical characteristics and outcomes of patients with diabetic ketoacidosis of different severity

Ying

Wu²,

Su³

et al. 2020

Medicine

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To analyze the influencing factors and outcomes of the different severity of diabetic ketoacidosis (DKA). A total of 50 children with DKA admitted to the Department of Pediatrics, Tianjin Medical University General Hospital from January 2009 to December 2018 were included in this study. The patients were divided into mild group, moderate group, and severe group according to the severity of the disease. We then analyzed the clinical characteristics and outcomes of the 3 groups. Compared to mild and moderate DKA groups, patients with severe DKA were more likely to present chest tightness, and higher levels of blood osmotic pressure, urea, and creatinine ( P < .05). Logistic regression analysis showed that blood osmotic pressure, creatinine, and chest tightness were independent factors for severity of DKA. There was a significant difference in the resolution time of DKA among the 3 groups (mild vs moderate: 9.0 hours vs 15.25 hours; moderate vs severe: 15.25 hours vs 24.5 hours, P < .001). There were statistical differences in the decline of Glasgow score among 3 groups ( P = .004). Patients with severe DKA showed higher osmotic pressure and creatinine, as well as dyspnea. The children with severe DKA were more likely to present progression of neurological symptoms, which was necessary to pay attention to the presence of brain edema.

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“…9 However, a retrospective study in 60 dogs and cats with DKA or diabetic ketosis showed that a delay to insulin therapy of >6 h significantly delayed resolution of ketonemia (by 19 h, on average), and no difference in complications was observed. 10…”

Section: Icu Managementmentioning

confidence: 99%