ABSTRACT
PRACTICAL RELEVANCE: Diabetes mellitus is a common endocrine disorder in feline practice, affecting approximately 1 in 200 cats. The majority of diabetic cats have type 2 diabetes mellitus, which results from a combination of peripheral insulin resistance and a progressive reduction in insulin production. CLINICAL CHALLENGES: While usually easy to diagnose, management of diabetes mellitus presents a number of challenges for practitioners and clients alike. Practitioners must decide on diet, insulin type and dose, monitoring method and intensity, and concomitant therapy, which will vary based on individual patient and client needs, and geographic location. Practitioners may also encounter patients with diabetic ketoacidosis or other diabetic complications, and patients with multiple concurrent diseases. Clients may be challenged by the substantial time and financial commitment involved in owning a diabetic cat. AUDIENCE: Understanding the pathophysiology, optimal treatment protocols and current goals of diabetes management will benefit practitioners managing diabetic cats. This article reviews the most current management plans for feline diabetics. It places particular emphasis on best practice for achieving diabetic remission, which is an attainable goal in the majority of newly diagnosed diabetic cats. EVIDENCE BASE: The information in this article is drawn from the recent human and veterinary literature, including prospective and retrospective studies. The body of prospective clinical data on the use of newer, long-acting insulins (glargine and especially detemir) in cats is limited, but growing.
Subject(s)
Cat Diseases/drug therapy , Diabetes Mellitus, Type 2/veterinary , Hypoglycemic Agents/therapeutic use , Insulin, Long-Acting/therapeutic use , Animals , Cats , Diabetes Mellitus, Type 2/drug therapy , Diabetic Ketoacidosis/veterinary , Drug Administration Schedule/veterinary , Insulin Detemir , Insulin GlargineABSTRACT
Diabetic nephropathy is a well-recognized clinical consequence of both type 1 and type 2 diabetes mellitus in humans. Major risk factors include poor glycemic control, hypertension, and microalbuminuria, as well as genetic factors. In both type 1 and 2 diabetics with nephropathy, structural changes occur in the kidneys before overt clinical disease. Studies suggest that some of the risk factors and structural renal changes of human diabetes also exist in diabetic dogs and cats. This article assembles existing information on the presence of risk factors, laboratory and histologic findings, and consequences of human diabetic nephropathy as applied to cats.
Subject(s)
Cat Diseases/diagnosis , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/veterinary , Kidney/pathology , Animals , Cat Diseases/urine , Cats , Diabetic Nephropathies/urine , Diagnosis, Differential , Humans , Proteinuria/veterinary , Risk Factors , Species SpecificityABSTRACT
Hemodialysis is a life-saving medical modality that cleanses the blood using an artificial kidney, called a dialyzer. Hemodialysis uses contact between the patient's blood and the semipermeable membrane of the extracorporeal dialyzer to remove compounds such as blood urea nitrogen, creatinine, electrolytes, minerals, anions, cations, certain drugs and toxins, and excess fluid from the bloodstream. The extracorporeal dialyzer distinguishes hemodialysis from peritoneal dialysis, which uses a patient's peritoneum as the dialysis membrane. There are 2 main types of hemodialysis: intermittent hemodialysis and continuous renal replacement therapy. This article focuses on intermittent hemodialysis for acute and chronic kidney injury.
