What Is Somogyi Effect in Diabetes and How to Deal With It in Cats
THE HARD TO REGULATE CAT
The goal in long-term management of diabetes mellitus is the alleviation of unpleasant clinical signs (constant thirst, weight loss, etc.) and prevention of dangerous secondary conditions (infections, ketoacidosis, etc.). To accomplish this, claret sugar levels should exist regulated between 250 mg/dl and eighty mg/dl. This is not as proficient as the body's natural regulation, merely it is a fair and achievable goal in most cases.
Some patients just seem completely unaffected past even loftier doses of insulin, and information technology is of import to take a step-by-step program to rule out causes of insulin resistance so that regulation tin can exist achieved.
Insulin resistance is divers as requiring more than
1 unit of insulin per pound of body weight for regulation
or
All carbohydrate levels for the mean solar day >300 gm/dl despite half dozen - 8 units per dose of insulin.
STEP I: Rule OUT INSULIN Administration RELATED FACTORS
| | This may seem very basic merely the basics are crucial. Confirm that the amount of insulin being drawn into the insulin syringe is correct, that the injection technique is right and that the patient is really receiving the injection. Insulin needles can be very short and may non be going deep enough for proper insulin assimilation, specially in very long haired cats. Rule out any snacking or changes in the patient's feeding schedule. Remember, soft-moist treats tend to be high in saccharide and diets not meant for diabetic cats may exist too high in carbohydrates, which convert to sugars. It may be time to optimize the diet. For instance, in about cases, canned food is lower in saccharide than dry out food and many specialists feel diabetic cats should non exist fed dry. Review Feline Diabetic Diet. |
Be certain the bottle of insulin is not expired and that it has been properly stored. If the insulin is being given twice daily, are the injections being given 12 hours apart or close to it? Are yous using any medications on the true cat that the medico might non know virtually? This includes supplements and topicals.
To review insulin storage and handling click here.
All these issues are easily corrected and information technology turns out that the well-nigh common causes for difficulty regulating a diabetic cat are those listed above. Subsequently all the nuts have been covered, we demand to come across exactly what these glucose levels are doing.
STEP Two: DETERMINE FOR Certain THAT THE PATIENT IS INSULIN RESISTANT
A glucose curve is needed to distinguish the following 3 situations:
Somogyi Overswing
In the instance of Somogyi Overswing, the insulin dose is too high and drives the blood sugar low for office of the day. When the claret sugar is depression, other hormones such as cortisone or adrenalin are released to raise claret carbohydrate. These hormones tin can have a prolonged upshot (many hours) thus creating hyperglycemia (high blood sugar). The bend will show the blood sugar start very high and then drib depression then ascension up very high. If a pattern like this is seen, the insulin dose needs to be reduced to keep the glucose levels from dropping so low (and rebounding and then high). A new curve will be needed in a week or 2 to see how things are going.
Rapid Insulin Metabolism
In this example, the insulin but isn't lasting long enough to create sustained normal blood sugar levels. If the curve shows that the insulin effect is wearing off too before long, twice a day administration of the insulin may solve this trouble or a longer acting insulin may be needed.
True Insulin Resistance
Here no significant drop in blood saccharide level (levels stay greater than 300 mg/dl) is seen in response to the insulin dose used. Unremarkably there is a history of prior increases in insulin dose all met with minimal response.
We shall continue assuming that the patient has truly insulin resistance on the glucose curve.
Footstep Iii: ARE There MEDICATIONS Existence USED THAT COULD Elevate Claret SUGARS?
The obvious medication would be a member of the cortisone (corticosteroid) family unit. This might be a pill, a shot, an asthma inhaler, or even a topical ointment, spray or ear cleaner. Always continue your veterinarian informed about products you are using.
Progestins (female hormones) were previously used frequently for behavior problems as well every bit pare diseases in cats. These medications were famous for inducing and promoting diabetes mellitus. If the true cat is licking a hormone-containing topical medication from the owner's skin, this is also of import to report. Likewise, if the diabetic cat is female and non spayed, her natural hormones could exist the problem and spaying may solve everything.
Pace FOUR: Dominion OUT OTHER CONCURRENT DISEASES
Concurrent affliction increases the patient's stress level and leads to glucocorticoid hormone release. All these extra steroid hormones interfere with insulin and raise blood carbohydrate levels and then it is important to check the true cat for infections, heart disease, liver disease, pancreatic inflammation and any other condition that could crusade a trouble.
Diabetic animals are at special run a risk for developing float infections since they have then much saccharide in their urine. Stress of any kind will contribute to high claret saccharide and infection would lead to stress. A urine civilization should exist done to rule out bladder infection plus the teeth and skin should exist inspected for infection in these areas. If infection per se is not found, the patient should be screened for other chronic illnesses that might plant a stress. A basic blood console would be a logical starting point.
If infection, or other stress is immune to go unchecked, ketoacidosis, an especially life-threatening complexity of diabetes mellitus can develop so regular screening is a good thought even if the cat is regulated.
If the concurrent illnesses described above do not announced to exist present and insulin resistance is confirmed, it is fourth dimension to consider a 2d hormone imbalance.
HYPERADRENOCORTICISM ("CUSHING'S Affliction")
This condition is relatively common in the canis familiaris merely less and so in the cat. In short, this status involves an backlog in "cortisone"-type hormones either from over-production inside the trunk by mode of a hormone secreting tumor or over-treatment with a corticosteroid medication as described higher up. Cortisone (more accurately referred to every bit "cortisol"), raises blood sugar in grooming for a fight or flight situation. If excessive cortisol is present in a diabetic cat, the cortisol effects may be overwhelming the insulin and creating insulin resistance. If the excess cortisone situation is resolved, information technology is possible that the diabetes will as well resolve.
Most 10% of dogs with Cushing's illness are also diabetic. About 80% of cats with Cushing'due south illness are also diabetic. Testing for Cushing's illness cannot proceed until some degree of diabetic command has been accomplished and the patient is not ketoacidotic.
For more information on Cushing'southward disease and its treatment please visit our Cushing's Affliction Information Middle.
HYPERTHYROIDISM (CATS Only)
Thyroid hormone is another hormone that alters glucose metabolism. While hyperthyroidism is a common condition of older cats, less than 1% of hyperthyroid cats are also diabetic. Yet, when a diabetic cat becomes hyperthyroid, control of the thyroid disease generally leads to meliorate regulation of the diabetes.
For more than information on Feline Hyperthyroidism please visit our Feline Hyperthyroidism Information Middle.
ACROMEGALY
Acromegaly results from an over-secretion of the pituitary hormone known equally "growth hormone." This hormone usually is responsible for one's growth from infancy to adulthood. When adulthood is achieved, its secretion dramatically slows, bone growth plates shut, and growth essentially stops. If for some reason, this hormone begins secreting again, growth resumes but not generally in normal proportions as the limb bones accept airtight their growth areas.
One of the effects of growth hormone is interference with tissue insulin receptors. This makes the tissues resistant to insulin and is the main reason why animals with acromegaly are frequently diabetic.
The prognosis and treatment for acromegaly is very unlike between dogs and cats. Dogs generally develop acromegaly due to excess progesterone secretion (as would occur from an ovarian cyst). Canine patients are thus usually older unspayed females and spaying may be curative depending on the remaining ability of the pancreas to secrete insulin.
The feline situation more closely approximates the human situation. Cats (and people) develop acromegaly when they develop a growth hormone secreting pituitary tumor. Over 90% of acromegalic cats are male (though there is no sex predisposition in humans.)
The diagnosis of acromegaly can be very difficult. There are some characteristic visual clues such as enlargement of the lower jaw, proliferation of the gum tissue in the mouth, and a full general broadening of the head (which is subtle unless compared to photos of the same cat at a younger historic period). Blood testing is needed to become a better thought of what is happening with regard to growth hormone. 1 might think only checking a growth hormone level and seeing if information technology is elevated or non would be plenty merely information technology turns out the growth hormone is secreted in pulses through out the twenty-four hours which means in that location is a lot of overlap between what is normal, what is low, and what is elevated. A better examination is the "IGF-1 Assay." IGF-1 stands for Insulin-like Growth Factor-i (previously this hormone was called "somatomedin C") and is a hormone produced past the liver in response to growth hormone. Information technology is secreted in a more steady mode thus making for a more reliable test.
When all is said and washed, the best way to confirm the diagnosis is to actually paradigm the pituitary gland and look for enlargement and this requires CT or MRI equipment. This type of imaging is relative expensive and the equipment is highly specialized.
Treatment of feline acromegaly is very difficult and may involve radiotherapy of the pituitary tumor causing the trouble. Unfortunately, this status seems to be more mutual than previously had been thought and enquiry is on-going.
ANTIBODIES AGAINST INSULIN
When a patient is treated with insulin from another species, the immune system recognizes the introduction of the foreign poly peptide and generates antibodies. Information technology was because of this phenomenon that about commercial insulin available is genetically engineered human insulin so that the globe's homo diabetics no longer demand to worry about making insulin antibodies against pork or beefiness origin insulin.
Merely where does this exit dogs and cats? It leaves them making antibodies against human insulin, that's where.
Ane would think this would pose a big problem but in fact insulin antibodies are not always bad. Most of the time the antibodies but interfere with removal of the insulin leading to a longer acting insulin than would be accomplished with the aforementioned type of insulin made from the native species. For example, Humulin N (man insulin) will final longer in the dog than Canine Insulin N. This may be desirable depending on the patient; changing the species of origin of the insulin is one fashion to get the insulin to final a bit longer.
To become insulin resistant from antibodies, ane must lose 70% or more of the insulin injection to antibiotic binding. This is very unusual just possible and should not exist forgotten as a possible cause of insulin resistance. Blood tests to mensurate insulin antibodies are available in some areas. Insulin can be switched to a species of origin more closely related to the species desired.
IF A CAUSE CANNOT BE Found:
If a crusade cannot be institute or if treatment for that crusade is not practical or possible, the good news is that multiple loftier doses of insulin can generally overcome the resistance. Sometimes combinations of short and long-interim insulins are used together to accomplish reasonable regulation. Some of the oral agents listed in the section on Controlling Diabetes Without Insulin may be helpful. Information technology may be necessary to consult an internal medicine specialist.
To discover an internal medicine specialist near you, visit:
Vetspecialists.com
Page posted: 1/xx/2010
Page final updated: 2/9/2022
Source: https://www.marvistavet.com/the-hard-to-regulate-cat.pml
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