Facing a newly diagnosed diabetic cat can feel overwhelming, but understanding the right treatment path is crucial for their well-being. Dr. Catharine Scott-Moncrieff, a seasoned expert from Purdue University, sheds light on the practical decisions veterinarians face when treating feline diabetes. Let's dive into the essential aspects of managing this condition.
Dr. Scott-Moncrieff emphasizes that the first step is choosing the right treatment. This decision dictates how you'll monitor your cat, whether it's insulin or an SGLT2 inhibitor.
For cats on insulin, the focus is on owner education. This includes learning how to store and administer insulin, recognizing and responding to low blood sugar (hypoglycemia), and coordinating insulin with feeding. Avoiding hypoglycemia is the primary concern with insulin, so understanding the warning signs is vital.
On the other hand, SGLT2 inhibitors offer a simpler approach. These oral medications are given once daily and don't require synchronization with meals. The available formulations (tablet or palatable liquid) are generally well-accepted by cats. But here's where it gets controversial: early monitoring for ketones is critical with SGLT2 therapy. The first 14-30 days are crucial for catching potential ketosis or diabetic ketoacidosis (DKA).
- Note: SGLT2 inhibitors commonly used/approved for cats are bexagliflozin (Bexacat; Elanco) and velagliflozin (Senvelgo; Elanco). Both are once-daily oral agents.
So, how do vets decide between insulin and SGLT2 inhibitors? Dr. Scott-Moncrieff explains that ideally, they'd distinguish between type 1 and type 2 diabetes. However, since a simple in-clinic test isn't available, they look for specific indicators. Most newly diagnosed cats (around 80%) have type 2 diabetes. Vets look for classic diabetic signs like increased thirst and urination, increased appetite, and weight loss, without other underlying health issues.
Before starting an SGLT2 inhibitor, vets must rule out ketosis. If a cat is sick, ketotic, or has other health problems, insulin is the safer option. If the cat is otherwise healthy and not ketotic, an SGLT2 inhibitor is a reasonable choice, but close monitoring is essential.
Are owners more compliant with SGLT2 inhibitors compared with insulin?
Yes, because administration is easier. SGLT2 products are palatable, can be mixed with food or given directly, and only require once-daily dosing. For the first month, the monitoring is similar to insulin, just focusing on different parameters: ketones for SGLT2s versus glucose levels and hypoglycemia risk for insulin. After that, the monitoring requirements for SGLT2-treated cats often decrease.
What influences diabetic remission in cats?
Reported remission rates vary widely, from 15% to 70%, reflecting differences in patient populations and treatments. Factors that increase the chance of remission include addressing underlying diseases, achieving a healthy weight, a low-carbohydrate diet, and, most importantly, good blood sugar control. Dr. Scott-Moncrieff believes that effective glycemic control early in the disease course is more important than the specific insulin type.
Common misconceptions about SGLT2 inhibitors
The major concern is euglycemic diabetic ketoacidosis (euDKA). Cats on SGLT2 inhibitors can become ketotic while appearing to have normal blood sugar levels. This is because these drugs lower blood glucose by promoting glucosuria, making euDKA easy to miss if only blood glucose is checked. It's correct to be concerned, but the incidence appears lower than some fear. In newly diagnosed, previously untreated cats, clinically significant DKA occurs in a minority (around 5%). Appropriate early monitoring can reduce risk by catching ketone accumulation before cats become systemically ill. Nevertheless, vigilance for ketones is essential.
Can a cat treated with an SGLT2 inhibitor go into diabetic remission?
Some cats do, but studies haven't followed cats long enough after stopping therapy to determine the percentage that remain in remission. The key difference compared with insulin is that an excessive insulin dose will cause hypoglycemia and reveal that the cat is producing enough insulin. SGLT2 inhibitors don't cause hypoglycemia the same way, so excellent blood sugar levels on an SGLT2 don't reliably prove remission. The only way to know is to stop the drug and monitor for the return of clinical signs and high blood sugar. That longitudinal, post-withdrawal data for SGLT2-treated cats is limited and an area we need more research on.
What research is being done?
Dr. Scott-Moncrieff and her team are validating ketone meters for cats, comparing the Precision Xtra meter to other meters, and evaluating βHB urine dipsticks. They're also analyzing long-term safety data from SGLT2 studies.
What do you think? Are you more inclined to use insulin or SGLT2 inhibitors for your diabetic cat? Share your experiences and thoughts in the comments below!
