Feline diabetes mellitus

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Feline diabetes mellitus is a common disorder in cats characterized by high blood sugar levels. This chapter covers prevalence, risk factors, symptoms and treatment options. The use of different types of insulin is discussed and guidelines are provided for adjusting insulin doses based on blood glucose concentrations. A section on oral hypoglycaemic agents introduces the emerging use of sodium-glucose co-transporter (SGLT) 2 inhibitors, which represent the biggest breakthrough in management of diabetic cats since insulin. The importance of home monitoring is recognized together with the benefits of achieving diabetic remission.

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24.1 Cat with plantigrade stance. (Reproduced from , with permission from the publisher.)
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24.5 Blood glucose concentrations in a cat on a 1-hour car ride and then after arriving home, as measured by a continuous glucose monitor (iPro) and with a glucometer calibrated for feline blood. Stress hyperglycaemia confounds diagnosis of diabetes in cats. In most cases, if the cat is left quietly in a cage and blood glucose is measured 3–4 hours later from an ear sample with the cat in the cage, the stress hyperglycaemia will have resolved.
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24.6 The Abbott AlphaTRAK meter is calibrated for feline blood, and requires only a 0.3 µl sample, making it ideal for measuring blood glucose concentrations in paw pad or ear samples. (Courtesy of Zoetis)
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24.7 (a) Taking a blood sample from the pisiform (carpal) pad. (b) Sampling the main paw pad is well tolerated in many cats. (a, Courtesy of S. Ford; b, Courtesy of W. Milledge)
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24.8 Measuring blood glucose from an ear sample. Best results are obtained if the area is rubbed or warmed first to increase blood supply. (Courtesy of S. Ford)
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24.9 (a) Sensor for a continuous glucose monitor (iPro) mounted on the skin of a cat using tissue glue. (b) Attaching the reader to the sensor. It is not recommended to wear gloves when placing the sensor and attaching the reader, because gloves can stick to the tissue glue, leading to the sensor being accidentally dislodged. The iPro requires calibration three times daily by measuring blood glucose with a meter calibrated for feline blood. Anecdotally, it is more accurate, particularly in the low range, than the Freestyle Libre, which does not need calibration. Implantation of the sensor in the interstitium is simple and well tolerated by most cats without sedation.
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