Glargine versus regular insulin protocol in feline diabetic ketoacidosis.

OBJECTIVES: To determine whether basal-bolus administration of glargine insulin is a safe and effective alternative treatment compared to the standard continuous rate infusion (CRI) protocol. DESIGN: Prospective randomized clinical trial. SETTING: University teaching hospital. ANIMALS: Twenty cats diagnosed with diabetic ketoacidosis (DKA). INTERVENTIONS: The cats were block-randomized to either a CRI protocol using regular insulin (CRI-group; n = 10) or a basal-bolus SC and IM glargine protocol (glargine-group, n = 10). Baseline blood gases, electrolytes, glucose, and ß-hydroxybutyrate (ß-OHB) concentrations were measured at the time of admission and later at predefined intervals until reaching the primary endpoint of the study, defined as a ß-hydroxybutyrate concentration < 2.55 mmol/L. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was time (h) to resolution of ketonemia. Secondary outcome measures were time until first improvement of hyperglycemia and ketonemia, decrease of glucose to ≤13.9 mmol/L (250 mg/dL), resolution of acidosis, consumption of first meal, and discharge from hospital. Additionally, occurrence of treatment-associated adverse events and death were compared. Seventeen cats (85%) survived to discharge, with no difference in survival between groups (P = 1.0). Median times to ß-OHB < 2.55 mmol/L were 42 (CRI-group) and 30 (glargine-group) hours, respectively (P = 0.114). Median times to first improvement of hyperglycemia (glargine-group: 2 h; CRI-group: 6 h; P = 0.018) and until discharge from hospital (glargine-group: 140 h; CRI-group: 174 h; P = 0.033) were significantly shorter in the glargine-group. No significant differences were observed in any other parameter under investigation (P > 0.05). CONCLUSIONS: Basal-bolus administration of glargine insulin appears to be an effective and safe alternative to the current standard CRI-protocol for the management of DKA in cats. The positive outcomes and simplicity make it a viable option for the treatment of feline DKA.

Ki-67/CD3 ratio in the diagnosis of chronic inflammatory enteropathy in dogs.

BACKGROUND: T cells play a key role in the pathogenesis of chronic inflammatory enteropathy (CIE) in dogs. Cluster of differentiation 3 (CD3) antigen serves as a marker for T cells. In human medicine, Ki-67 is an indicator for cell growth but there are only a few studies in dogs with CIE. OBJECTIVE: To investigate Ki-67 in relation to T cells as a marker for CIE in dogs. ANIMALS: Eleven dogs with CIE and 6 healthy beagle controls (CO). METHODS: Retrospective case-control study. Dogs were clinically assessed by the Canine Chronic Enteropathy Clinical Activity Index (CCECAI). Duodenal mucosal biopsy samples were endoscopically obtained for histopathologic examination by means of the World Small Animal Veterinary Association score. Double-labeled immunofluorescence was used to investigate colocalization of Ki-67 and CD3 in epithelium and lamina propria (LP) of villi and crypts. RESULTS: Dogs with CIE had significantly higher clinical score (median, 5.0; interquartile range [IQR], 3-7) compared to CO (all 0; P < .001). The Ki-67/CD3 double-positive cells were significantly increased in the LP of the crypt region of CIE dogs (0.63 cells/mm2 ; IQR, 0-0.54) versus CO (0.08 cells/mm2 ; IQR, 0-0.26; P = .044). A significant correlation was found between CCECAI and the Ki-67/CD3 ratio in the LP of the crypt region (r = 0.670; P = .012) in dogs with CIE. CONCLUSIONS AND CLINICAL IMPORTANCE: The Ki-67/CD3 ratio is upregulated in the LP crypt region of dogs with CIE and it correlates with clinical severity. Therefore, Ki-67/CD3 could be a useful tool for detection of CIE.

Alternative sampling site for blood glucose testing in cats: giving the ears a rest.

UNLABELLED: BACKGROUND AND STUDY RATIONALE: Home monitoring is an important part of the long-term management of diabetic cats. Despite the extensive use of glucometers in this species, up until now only the pinna of the ear has been validated as a testing site. This cross-sectional study investigated the feasibility and validity of sampling from the metacarpal/metatarsal pads in hospitalised cats with various diseases. INVESTIGATIONS: The large pads were compared with the ear as a sampling site in 75 cats. Lancing the pads was tolerated very well. If the initial drop of blood was too small, an adequate volume of blood was almost always achieved by squeezing the pads. No significant differences were observed in first-attempt success rate or glucose values between the two sites. Due to the inability to obtain an adequate volume of blood or struggling, no measurement was possible in four cats. PRACTICAL RELEVANCE: While further work is necessary to assess the utility of this technique, especially in the home environment, the results indicate that the metacarpal pads, in particular, may offer a viable alternative testing site for the measurement of blood glucose concentrations, especially if ear sampling fails.