Steph Sorrell

Hi Ilse,

Great questions! Sorry for the late reply- I have been on annual leave and just back 🙂

So

1) I would always go twice daily. the duration of action can be as short as 4hr in some cats with caninsulin, so its really rare for them to only need once daily and I personally have always used twice daily wether using caninsulin, PZI of glargine.

2) I have never heard there being an issue with glargine being given in the scruff and would always give it that way if going SQ. There is a paper looking at IM glargine for DKA’s. For a DKA patient, I would not give SQ as absorption is poor, but for general use I would give SQ and see no reason why the scruff couldnt be used.

3)Wet food may help with higher protein, but for me it is all about consistency with diet. There is a study going on at RVC looking at low carbohydrate diets in feline diabetics so hopefully we will have more information in the future.

4) Hypoglycaemia can be difficult to detect. I usually get owners to check urine dipsticks a couple times a week to see if cats are going into remission. I would expect that most of the time, cats glucose is above the renal threshold, so if they are persistently getting negative glucose on urine dipstick this may suggest the cat is having hypoglycaemic episodes.

5) really difficult to know and we can see cases with pancreatitis subsequently developing diabetes, and vice versus. I would always want to have an ultrasound supportive of pancreatitis and clinical signs supportive of it as we know in diabetic dogs they can have increased cPLi and we dont know if this is clinically significant.

6) Chronic stress/anxiety can lead to hyperglycaemia so may lead to poorly controlled diabetes.

7) Stem cell therapy definitely has the potential to be a game changer and I know there is research also in CKD patients. I am not aware of any peer reviewed papers on diabetic cats but its an interesting area of research for sure!

8) I use the flank but put a medical tshirt on as well so it cant be ripped off. I get the cats to get used to the t shirt first and make sure they arent stressed. I have had some where I then dont place the shirt on and see how they get on with it, but always have a shirt to hand in case they look like they may want to rip it off!

9) neutral insulin is also known as regular insulin and is a really short acting IV insulin used for DKA patients

10) For DKA patients they are often dehydrated and have poor absorption of insulin if given SQ and therefore we give it IV or IM instead to facilitate absorption.

11) Missing one or two doses is not a big deal. As long as its not a regular occurrence and only very occasional then it should not affect control.

Best wishes,
Steph

Hi Emma,

Great questions. Ideally we would base the diagnosis on biopsies, but most often in practice it is based on clincial suspicion; large, adhered goitre, irregular outline and refractory/poorly controlled with medical treatment.

We can see a response to medical treatment with carcinomas, but often they need higher and higher doses of treatment and we can see some cases being refractory and uncontrolled despite high doses. As we are not treating the underlying cause with medical treatment, we do expect that over time patients will require higher doses so this alone doesn’t equate to a carcinoma, but can raise suspicion particularly if we have a large adhered goitre.

I have used high doses off licence and as Dechra have said I would monitor for side effects closely, particularly in the first 3-6months when they are more common.

Best wishes,
Steph

Hi,

Great question. So I have only very rarely done pyelocentesis.

Pyelonephritis can often be diagnosed based on clinical signs; lethargy, pyrexia, inappetance, you may see azotaemia and urine culture can be positive or negative. If it is negative but strongly suspected then options include presumptive treatment or pyelocentesis.

Ultrasound is really helpful as we can get changes including renal pelvic and proximal ureteral dilatation, hyperechoic mucosa within the renal pelvis or proximal ureter and changes to the echogenicity of the cortex or medulla.

For treatment, fluroquinolones are advised as they have better renal penetration that potentiated amoxcillin. Treatment would generally last 4-6 weeks.

A fab overview of pyelonephritis is available on the IRIS website and I have added the link below.

http://www.iris-kidney.com/education/pyelonephritis.html

Replying to Louise Tidley 23/08/2022 - 21:51

Hi Louise,

Fab question! Yes in an ideal world we would have histopathology and a definitive diagnosis but where this is not possible I would trial antibiotics first and if no improvement then would presume it is more likely a lymphocytic cholangitis rather than a neutrophilic cholangitis and I would start steroids. I would be wary about starting steroids first as this would make a neutrophilic cholangitis much worse and ideally I wouldn’t start both steroids and antibiotics at the same time as then you do not know which is making the difference!

Best wishes,
Steph

Of course. EMLA is a local anaesthetic cream you can put on the patient before blood sampling. I found it really helpful to put onto the jugular before bleeding the donor cats.

Best wishes,
Steph

Replying to Pauline Brauckmann 16/08/2022 - 15:19

I would wait 3-4weeks after an ex lap before starting prednisolone.

Best wishes,
Steph

So the survival and treatment is the same for severe inflammatory bowel disease and small cell lymphoma. If there is mild inflammatory bowel disease then I would start with diet and prednisolone alone, whereas for severe IBD/small cell lymphoma I would also add in chlorambucil.

Biopsies can be helpful to rule out large cell lymphoma, which would require a COP or CHOP chemotherapy protocol, although usually you see discrete masses with this.

You are quite right though that often biopsies are not required as if there is a poor response to diet and prednisolone, and no discrete masses seen on ultrasound then we assume that there is either a severe IBD or small cell lymphoma and we treat on the basis of this.

Hi,

Yes. If there is a severe hypoalbuminaemia then you can get third spacing as fluid leaves the intravenous space and can move e.g into peritonteal cavity, pleural cavity etc and can see ascites and pleural effusion.

If there is a low albumin then I would treat the underlying condition e.g. gastrointestinal disease and if there is a positive response to treatment then the albumin will increase.

Best wishes,
Steph