Feline diabetes glossary
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- Acromegaly
- Or hypersomatotropism. A condition caused by prolonged exposure to excessive growth hormone in adult cats. Also serum insulin-like growth factor 1 (IGF-1) concentrations are often dramatically increased in acromegalic cats. Acromegalic cats tend to have extreme insulin resistance and develop diabetes mellitus that may require insulin injections of more than 20 units per cat day. Feline acromegaly tends to occur in older (8-14 years) cats and appears to be more common in males. It caused by long-term excessive secretion of growth hormone from a tumor of the pituitary gland in the brain. Outward signs of acromegaly are an enlargement of body size, jaw, tongue, paws, chin and forehead. Unlike cats with Diabetes Mellitus, Type 2, who are usually obese, cats with acromegaly will gain lean body mass.
- Beta-cells
- A type of pancreatic cell representing about 50-80% of the pancreatic islet cells. Beta cells secrete insulin. In human, overt diabetes develops when approximately 80-90% of beta-cell function is lost. Some researchers postulate that hypersecretion of insulin is the primary abnormality in the beta-cells, which in turn induces insulin resistance and beta-cell exhaustion, leading to insulin deficiency and hyperglycemia. Once persistent hyperglycemia occurs, beta-cell damage is further incurred by glucose toxicity.
- Caninsulin
- Porcine lente insulin which is available in many countries as a preparation of 40 iu/ml, which is preferable to 100 iu/ml for use in cats. This insulin needs to be given twice daily in all diabetic cats. Caninsulin provides good to excellent clinical control in the majority of cats, although the occasional cat has very early peak of action (3 h or less).
- Diabetic diet
- Diabetics have energy loss via glucose in the urine, and may have maldigesion and other metabolism problems that prevent them from utilizing nutrients effectively. Therefore their maintenance energy requirements may be higher than in normal cats with the same life style. There are two main diet suggestions for diabetic cats: high fiber (to blunt post-prandial hyperglycemia and decrease appetite in obese cats) and high-protein (more natural carnivore diet). Both diets proved to be beneficial for diabetic cats, however, best diet should be tailored individually for each cat. As the diabetes is stabilized with therapy, bodyweight often increases (confirmed by Pushkin's data - see Pushkin's diary). If this occurs in obese diabetic cats, diet should be changed to a moderately calorie-restricted diet to avoid escalation of insulin resistance and fat accumulation in the body, especially in the pancreas where it can cause further damage to already malfunctioning beta-cells.
- Diabetes Mellitus, Type 1
- Diabetes Mellitus, Type 1 is characterized by insulin deficiency (it is why it is previously called insulin-dependent diabetes). It is manifested by the sudden onset of severe hyperglycemia, rapid progression to diabetic ketoacidosis, and death unless treated with insulin. In humans the disease may occur at any age, but is most common in childhood or adolescence. This type of diabetes is most common in dogs.
- Diabetes Mellitus, Type 2
- Diabetes Mellitus, Type 2 is not insulin-responsive or dependent (NIDDM). It is characterized initially by insulin resistance and hyperinsulinemia; and eventually by glucose intolerance; hyperglycemia; and overt diabetes. This type of diabetes is most common (80-95% cases) in cats.
- Diabetic ketoacidosis
- Diabetic ketoacidosis is a life-threatening complication of diabetes mellitus with severe insulin deficiency and extreme hyperglycemia. It is characterized by excessive lipolysis, oxidation of fatty acids, production of ketone bodies, a sweet smell to the breath (ketosis;) dehydration; and depressed consciousness leading to coma.
- Glucose tolerance
- The ability of an individual to maintain homeostasis of blood glucose. Glucose Tolerance Test includes measuring blood glucose levels in a fasting state and at prescribed intervals before and after oral glucose intake. A recent study recommended an upper limit for normal fasting blood glucose of 9.5 mmol/l (171 mg/dl) for client-owned cats. Criteria for differentiating the intermediate state of impaired glucose tolerance from diabetes have not been defined for cats, although a cutpoint of 12.6 mmol/l (226.8 mg/dl) was suggested based on extrapolation from human values.
- Glipizide
- Oral hypoglycemic drug. Mechanism of action is based on stimulating beta-cells to produce insulin; therefore it is only effective in individuals who still have functional beta-cells. Good control has been reported in about 35-40% of diabetic cats treated with glipizide.
- Hyperglycemia
- Abnormally high blood glucose level. The target for treatment is to achieve a blood glucose concentration of 5.0-9.0 mmol/l (90-162 mg/dl) at nadir. Note: to convert mmol/l of glucose to mg/dl, multiply by 18; to convert mg/dl of glucose to mmol/l, divide by 18 or multiply by 0.055.
- Hypoglycemia
- Hypoglycemia is a syndrome of abnormally low blood glucose level. Clinical hypoglycemia has diverse etiologies. Severe hypoglycemia eventually lead to glucose deprivation of the central nervous system resulting in hunger; impaired mental function; seizures; coma; and even death. In cats hypoglycemic episodes are likely when blood glucose at nadir reaches less than 4 mmol/l (72 mg/dl). Clinical hypoglycemia (extreme lethargy, incoordination, dilated pupils and apparent blindness, seizures, trembling) is a medical emergency. Owner of diabetic cat needs to have maple syrup or other high sugar concentration syrup handy. When cat exhibits signs of hypoglycemia this syrup should be rubbed on cat's gum immediately to quickly raise blood glucose. After this, best course of action would be to call veterinarian.
- Insulin
- Insulin is a 51-amino acid pancreatic hormone that plays a major role in the regulation of glucose metabolism, directly by suppressing endogenous glucose production (glycogenolysis; gluconeogenesis) and indirectly by suppressing glucagon secretion and lipolysis. Native insulin is a globular protein comprised of a zinc-coordinated hexamer. Each insulin monomer containing two chains, A (21 residues) and B (30 residues), linked by two disulfide bonds. Cat insulin is most similar to beef insulin (one amino acid difference), less so to pork (three amino acids difference), and least similar to human (four amino acids difference).
- Insulin resistance
- Insulin resistance is a diminished effectiveness of insulin in lowering blood sugar levels: requiring the use of exogenous insulin (insulin injections) to prevent hyperglycemia or ketosis. It can be caused by the presence of insulin antibodies or the abnormalities in insulin receptors on target cell surfaces. It is often associated with obesity; diabetic ketoacidosis; infection; and certain rare conditions. In insulin resistance, more insulin has to be secreted to produce the same glucose lowering effect, compared to when insulin sensitivity is normal.
- Islets of Langerhans
- Islets of Langerhans are irregular microscopic structures consisting of cords of endocrine cells that are scattered throughout the pancreas among the exocrine acini. Each islet is surrounded by connective tissue fibers and penetrated by a network of capillaries. There are four major cell types. The most abundant beta cells (50-80%) secrete insulin. Alpha cells (5-20%) secrete glucagon. PP cells (10-35%) secrete pancreatic polypeptide. Delta cells (~5%) secrete somatostatin.
- Lente insulin
- Intermediate action insulin that requires twice-daily injections. Caninsulin is most popular lente insulin preparation used for pets in USA.
- NPH insulin
- Insulin, NPH is an intermediate-acting insulin preparation with onset time of 2 hours and duration of 24 hours (in humans). It is produced by crystallizing zinc-insulin-protamines at neutral pH 7. Thus it is called neutral protamine Hagedorn (NPH) for inventor Hans Christian Hagedorn. Requires twice-daily dosage. In many cats, duration of action may be too short (<3 h). Accurate dosing with 100 iu/ml preparation may be a problem.
- Peripheral insulin sensitivity
- Magnitude of the responsiveness of peripheral tissues to insulin.
- Polydipsia
- Excessive thirst manifested in excessive water intake. Water intake in diabetic cats correlates moderately with mean blood glucose providing a useful clinical indicator of diabetic status. Specifically, changes in the water intake in a diabetic cat over time can give clues as to the success (or failure) of treatment. A water intake of less than 20 ml/kg (9 ml/lbs) bodyweight/24 h indicates excellent diabetic control. A water intake less than 80 ml/kg (10-35 ml/lbs) bodyweight/24 h indicates good clinical control.
- Polyuria
- Polyuria is urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. Often, polyuria in cats is manifested in urination outside the litter box and other unwanted urination behavior. This is why it is one of most common reasons why owners bring their cats to veterinary clinic in the first place and how their pets' diseases are getting diagnosed. See more about polyuria in Pushkin's diary.
- Post-prandial
- After a meal. One important species difference between humans and cats is that post-prandial hyperglycemia does not occur in cats fed typical high-protein carnivore diet. Therefore there does not seem any need to match the timing of insulin dose to meals. Pushkin's data suggest that slight peak of post-prandial glucose occurs as late as one hour (or even more) after the meal. See more Pushkin data in Pushkin's treatment diary.
- PZI insulin
- Long-lasting insulin preparation that contain insulin containing the amino acid protamine (PZI). PZI can be used once daily in 50% of cats. In some cats, glycemic control is poor.
- Transient diabetes
- Or diabetic remission occurs in 20-40% of cats. Remission occurs most commonly after 1-3 months of adequate insulin therapy. Research data (Rand J, 1999) suggest that if a nadir blood glucose of 5-9 mmol/l (90-162 mg/dl) is obtained after insulin administration, a substantial number of cats will undergo diabetic remission. Remission can last from weeks to years. If diabetes reoccurs, early treatment in many cats will result in another remission. Possibility of remission has danger in occurrence of hypoglycemic episodes if blood glucose is not monitored. Also, constant monitoring is needed during period of remission so that not to miss the possible re-occurrence of diabetes and to prevent chronic hyperglycemia.
- Transient hyperglycemia
- Or stress hyperglycemia. Diabetes mellitus causes persistent hyperglycemia. Transient hyperglycemia up to 16 mmol/ml (288 mg/dl) can occur in healthy stressed cats, for example, while visiting veterinary clinic. Non-diabetic sick cats have been reported to have blood glucose above 20 mmol/l (360 mg/dl).
