Welcome to our Autumn/Winter Newsletter. Summer seems to be a distant memory, some may argue it never really happened! It feels as if so much has gone on at the surgery since our last Newsletter. Hollie has joined us as a Registered Veterinary Nurse (RVN) and has moulded in with the team seamlessly. Ffern has started on her nurse training. We are proud to announce that Bethany has qualified as an RVN, congratulations Beth. In addition we have recently welcomed Heidi onto the nursing team, Heidi comes with years of experience and we have no doubt she will contribute new and valuable ideas, to help enhance our nursing practice, alongside the rest of out amazing nursing team.
For this newsletter we have decided provide an update on manging feline diabetes, including a new revolutionary treatment. In addition we thought it would be fun take a seasonal slant on what our cats and dogs really want and need, although not just for Christmas. It is also a good time to remind ourselves/refer back to some previous articles covering some of the issues most relevant to the season including: Management strategies for firework season; Alabama Rot; Christmas pet Perils and Festive Hazards; taking on a new puppy or kitten.
We hope you find our newsletter helpful and informative. Please remember if you have any areas you would like to see covered please let us know. As always our practice team are here to help and support you with all your pets healthcare needs. We wish you all a safe, healthy and Happy Christmas and New Year.
Diabetes Mellitus in cats a new era
Diabetes mellitus (DM) is diagnosed when a cat is found to have persistently high blood glucose and glucosuria (glucose in urine). DM occurs in approximately 1 in 200 cats an is most commonly diagnosed in domestic short haired cats, in the UK Burmese cats are also considered to be at increased risk. Risk factors for development of diabetes include obesity, increasing age (diagnosis most commonly made at 10-13 years of age), physical inactivity and steroid use for allergic or chronic inflammatory conditions. The majority of diabetic cats suffer from type 2 diabetes, non-insulin dependent diabetes. Insulin is produced by an organ called the pancreas. Diabetes in cats can occur for a number of reasons such as: diseases which cause reduced insulin production e.g. pancreatitis (inflammation of the pancreas); diseases that reduce the body’s ability to respond to the insulin that is present (insulin resistance) such as obesity, hormonal conditions such as Hyperadrenocorticism and Acromegaly; DM can also occur secondary to some forms of cancer.
Diabetic Ketoacidosis (DKA)
Most diabetic cats present relatively well in themselves but others can present in a life-threatening state called DKA. The body needs glucose to fuel the cells, for life, in a diabetic patient the body is unable to utilise the glucose normally so looks for alternative fuel sources. One of these fuel sources is fat which is converted by the liver into ketones. Short term ketones are a life saving energy source but excessive/prolonged exposure of the body to ketones they become toxic with potentially fatal consequences if not managed promptly. Not all cats with ketones will be in DKA crisis.
Clinical signs
- Polydipsia (increased thirst) and polyuria (increased urination).
- Polyphagia (increased appetite)
- Weight loss
- Sweet smell on breath, sometimes compared to pear drops (Ketones)
- Anorexia (DKA)
- Vomiting and/or diarrhoea (DKA)
- Dehydration and weakness (DKA)
- Collapse +/- seizures (DKA)
- Plantigrade stance, cat walks low on their hocks due a late-stage diabetic neuropathy. This is a less common symptom. Symptoms may improve with good diabetic management.
Diagnosis
Diabetes is usually diagnosed by a combination of history, clinical examination findings, blood tests and urine tests. Repeatedly high blood glucose identified on multiple blood samples and/or a high blood fructosamine (a blood test which gives an overview of blood glucose levels for the proceeding 2-3 weeks) as well as documentation of glucose in the urine is usually enough to make a diagnosis of DM. The vet will advise the blood sugar is checked as part of a general health profile to help identify any concurrent issues or complications that need to be addressed. Additional blood tests and/or imaging may also be recommended if there is concern that the diabetes may be secondary to hormonal disease or a cancerous process.
Treatment
- Insulin – historically insulin supplementation by injections has been the only safe and consistent way to manage diabetes. In the majority of cases cats with DM have been best managed with twice daily injections with insulin given subcutaneously (under the skin). Currently there are two licensed forms of insulin available for use in cats, however some cats have required us off human preparations used off license. Insulin injections are currently still the mainstay of managing sick DM patients and those with ketones.
- Senvelgo™ is an exciting new treatment for feline diabetics. Given orally once a day this drug works by inhibiting a glucose transporter in the kidney, preventing re-uptake of the majority of glucose excreted. Within about a week of starting on Senvelgo™ the blood glucose of diabetic cats has been found to normalise. This drug can only be used in uncomplicated cases of feline DM. As this drug works at the level of the kidneys it is not recommended for use in cats with concurrent late stage kidney disease.
- Low carbohydrate diet, cats are obligate carnivores and improved diabetic control has been achieved when they are fed a high protein diet, specific diabetic diets are available.
- DKA cats will need to be hospitalised to try and stabilise on fluids, insulin as well as additional treatments to manage any underling complications such as pancreatitis or urinary tract infections.
Monitoring
- Monitoring clinical signs including weight, appetite and thirst are the still the best predictors of DM stabilisation.
- Monitoring blood glucose if a patient does not appear clinically stable this may be achieved in a number of ways. Currently specialist consider continuous blood glucose monitoring (CBGM) to be the most accurate way identify where improvements can be made in stabilising the diabetic patient. A special implant is placed, this may require patient sedation, with a needle going into the skin, the monitor constantly records glucose levels in the fluid in the skin and the reading are recorded to a special app over a 2 week period. As the glucose levels of a patient can fluctuate day to day this method allows the vet to get a clear picture of the patterns of glucose fluctuation and better enable them to determine the most appropriate treatment adjustments if necessary. However, this method is not without issues of cost and patient co-operation/risk of dislodgement, so historical monitoring methods such as blood glucose curves, home blood glucose monitoring by owners, fructosamine assessment and/or spot glucose checks are still frequently used to monitor diabetic patients.
- Urine glucose and ketones. Stable patients on insulin will still usually have some glucose in their urine, repeatedly negative urine samples can raise concern about insulin over treatment. Urine monitoring for ketones is especially important for monitoring cats started on Senvelgo™, with daily checks recommended for the first few days at 7 and 14 days, 4 weeks and then every 3 months. It is important to note that because of the way Senvelgo™ works the urine of treated cats will always contain glucose.
Complications
- Hypoglycaemia (low blood glucose)- this can occur due insulin overdose or diabetic remission. Symptoms of hypoglycaemia can include lethargy, hunger, shaking, seizures, coma and in extreme cases can be fatal. It is advisable that owner of diabetic pets have a form of jam or syrup available to administer onto the gums of their pet if they present with potential low blood sugar, before phoning the vet. We recommend insulin is only administered once the cat has eaten, as if they are inappetant for any reason, the dose can be adjusted down to avoid risk of overdose. Cats who are diagnosed early and stabilised quickly can sometimes go into remission, no longer needing insulin for a variable period of time. For cats in remission insulin will be stopped and the patient monitored for recurring symptoms and high blood glucose. Diabetic remission can also occur in cats treated with Senvelgo™ but it is extremely rare for them to develop low blood glucose, the only way to check if they have gone in to remission is to stop treatment and monitor, under the guidance of the veterinary surgeon.
- Pancreatitis can be a cause or a consequence of DM. Symptoms can include anorexia/inappetance, vomiting, diarrhoea and abdominal pain. Pancreatitis can lead to a previously stable diabetic destabilising and potentially developing DKA.
- Urinary tract infection (UTI) , glucose in the urine of diabetic patients makes for the perfect environment for the development of infection. UTI’s can lead to a previously stable diabetic destabilising and potentially developing DKA.
- DKA a poorly controlled/destabilised diabetic can become critically unwell and need urgent veterinary care.
- Diabetic nephropathy, kidney damage can develop due to unmanaged/poorly controlled diabetes. However, as most diabetic cats are aged it is difficult to differentiate kidney disease present as a consequence of DM or as a concurrent disease.
Prognosis
Diabetes is serious condition which is potentially life threatening, however, well managed diabetic cats can live long and happy lives. With the addition of a new effective oral medication for the management of diabetic cats offering a potentially easier, more accessible/manageable treatment for some owners. Some cats can achieve remission and have periods where treatment is no longer required, however frequently symptoms return and treatment needs to be restarted after a variable period of time.
All I want for Christmas
Cats
Freedom from hunger and thirst – As a cat I need regular and predictable daily access to food, a cat may prefer wet or dry cat food, or a bit of both, fed at set meal times or ad lib., we’ll soon let you know if we like it! I do not like to have my food bowl and water bowl next to each other as I cannot stand it if my water gets contaminated. In multi cat house-holds feeding stations can be an area of competition/confrontation causing anxiety so please make separate feeding stations available for them.
Freedom from discomfort- I like a nice soft, warm and cosy bed to sleep in/on, I may choose to sleep on your bed or up high o top of the wardrobe where I can be left undisturbed. In multi cat households it is important to have a variety of areas each can sleep/rest comfortably.
Freedom from pain, disease and injury - I am careful to try not to show when I am in pain so if you notice a change in my behaviour if I am withdrawn, more vocal, seem aggressive, hunched up, off food, avoid or show hesitation when I am jumping up or down, I am lame or just moving differently please call the vet.
When I am unwell you might notice me losing weight, have a change in my appetite or thirst, have vomiting, diarrhoea, breathing changes or just not be myself, again please speak to my vet. Whilst I know I might not always appreciate going to the vet I know they can give me vaccinations to protect me from diseases and recommend treatment against pesky fleas, ticks and worms which can make me unwell. Regular check-ups with your vet can help recognise any changes in my health which may warrant investigate and/or treatment. They won’t like me saying this but my male counterparts are less likely to fight and wander off if they are castrated.
Freedom to express normal behaviour- I love going outside when I want to climb, run, jump, hunt and scratching (although I am also quite happy to do this on the bedroom carpet!). For my indoor counterparts please give them opportunities to mimic these behaviours, giving them areas to climb and jump (this may be a designated climbing frame or just be access to the top of a wardrobe) toys to mimic hunting, I especially like it when my owner plays with me, a scratch matt may also save your soft furnishings! Please remember whilst many of us cats like to be fussed and/or groomed we like it to be on their terms!
Freedom from fear or distress- experts tell me cats are naturally considered solitary creatures so a cat living alone with their family often appreciate a new cat being introduced. We are more likely to positively interact I they come from the same litter or are introduced at an early age. For cats living in multi-cat households negative interactions can be limited by providing multiple resources to avoid/reduce negative interactions/areas of confrontation this includes multiple feeding and drinking stations, toileting areas, sleeping areas and if possible multiple access routes into the home etc. If we are unhappy/distressed you may notice us not eat as well, toilet in places you don’t want us to, we may become aggressive to you or other animals in the family, we may even decide to leave home. As I mentioned before most of us like to be handled on their own term, some don’t like it at all, so take heed of what we are trying to tell you if we move away or are struggling we are probably not in the mood for cuddles and above all PLEASE do not grab us by the scruff.
We cats like a simple life we will all be happy if you give us what we want when we want it- CAT HOUSE RULES!
Dogs
Freedom from hunger and thirst- I need to have consistent access to a well-balanced diet, I prefer to be fed twice a day but know some of my counterparts prefer to be fed once a day or ad-lib. You do need to be careful with ad lib feeding as some of my greedier friends are more likely overindulge and become overweight. Puppies should be fed 3-4 times a day with smaller meals. We dogs can eat wet and/or dry food whichever we, or our owners, prefer. Some dogs have specific dietary requirements due to dietary intolerance which can affect the gut and/or skin, some dogs are sensitive to fat. When dogs live in a multidog household they should all have separate food bowls, where there is inter-dog conflict they may also need to be fed in separate areas/rooms. We all must have access to fresh water at all times, I personally like to drink fresh rainwater too!
Freedom from pain, injury and disease - I love my vet who always gives me a good fuss and a treat when I go to see them. I realise not all dogs feel the same way but it is important we all have regular check ups so we can get an M.O.T. and vaccinations to help protect us from some potentially fatal diseases such as distemper, hepatitis, parvovirus and leptospirosis. My vet also helps my owner assess my risk of being exposed to pesky parasites and can advise them on the most appropriate worm, flea and tick treatment for me. Urgh ticks I have heard they can carry some pretty unpleasant diseases, especially if a dog travels overseas.
I know my vet will help me if I am injured, feel unwell or am in pain, if my owner notices anything wrong, if I am off food, vomiting, lame, struggling to breath….anything I want them to phone my vet, even if it is just for advice, as I know they will do their best to make me feel better again. Even if it is the middle of the night, if I am very unwell or injured, it is important for me to know my owner can contact my vet and get advice and be seen 24/7.
Freedom from discomfort - I love my warm comfortable bed which I can access whenever I want, it is my safe place and I prefer to be left alone when I go there. Some of my doggy friends feel more secure in a dog crate, their little den. I know some dogs have to sleep on the floor or plastic beds because they have a bad habit of eating soft bedding and making themselves ill, or they have allergies, but overall we like to be warm and cosy just like our owners, sometimes with our owners.
We dogs need access to toileting areas outside regularly to eliminate, even more so as we get older.
Regular grooming, particularly long haired breeds, can help prevent them from being uncomfortable with knots, debris and in some cases a messy back end.
Freedom from fear and distress - I am lucky I am happy dog, I love people and other dogs; I don’t mind cats either and I love to chase pheasants (but don’t tell anyone!). I know some of my cousins are not so confident and outgoing and suffer from fear and anxiety. Environmental factors can heighten their stress response. Some dogs can be more sensitive to high pitched sounds such as fireworks, some dogs are scared of stranger or other dogs, others become distressed when they are away from their owner. It is important that owners recognise their own dog’s behaviour and signs of anxiety and learn how to deal with triggers either avoiding them if realistic, otherwise trying to recondition their response towards being positive rather than negative. I know mental health issue like anxiety are scary and affected dogs may be withdrawn, may toilet themselves or show signs of aggression (growling, barking, lunging, biting) these dogs need time, patience and understanding. Having seen a sibling suffering I urge owners to ask the advice of their vet and be prepared to have their dog see a behavioural specialist, these problems don’t just miraculously go away if anything they get work over time if left untreated. Changes in routine or lifestyle such as moving home or having a new addition to the family can upset any dog but especially those who are already anxious, making changes as slowly and calmly as possible can help your dog adjust more smoothly, your vet will be able to offer you advice and support if needed.
Freedom to exhibit natural behaviours - Dogs, as descendants of wolves, are naturally pack animals so a well-balanced dog likes companionship, this may be with other dogs or their humans, some are happy with other species. Packs will have a hierarchy which in most instances is stable and calm but for some dogs can cause conflict. We dogs need our owners to be mindful that any changes to our pack (animal or human) may upset the balance and we may need time to adjust.
Just like you humans we don’t all like each other. I was born to work which means I like to go for walks with my pack and socialise, whilst I don’t need to hunt my food the activity of walking and running allows me to express at least part of this behaviour. Foraging behaviour can be mimicked by providing me enrichment such as licky mats and kongs to make me work for my meals and/or treats. Whilst different dogs have different exercise requirements a walk is good for us all to help us keep physically and mentally healthy, as well as bond with our pack, even if that pack is just one man and his dog. I love to play ball or chase a frisbee it gives me the sense of hunting as well as helping me feel even closer with my owner/s. I also love to relax and be groomed or stroked, I know not all my counterparts do, but for me chilling out together is an important part of being safe and comfortable with your family is all about.