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Diabetic remission

How to recognise and approach diabetic remission

Good glycemic control soon after diagnosis reverses glucose toxicity and many newly-diagnosed diabetic cats can have their insulin dose gradually reduced and many can have their insulin completely withdrawn. It is suggested that insulin not be withdrawn completely for at least two weeks after starting insulin therapy to ensure adequate time for beta cells to recover from glucose toxicity.

Insulin dose can be reduced when indicated by low blood glucose parameters listed above. If pre-insulin glucose is below 10mmol/L and insulin dose has been reduced to 1U, insulin should be withheld and blood glucose measured for 12hrs (if the pre-insulin glucose is below 10mmol/L and insulin dose greater than 1U, insulin dose should be reduced to 1U rather than withheld and pre-insulin glucose measured again in 3-7 days). In most cases, if when insulin is withheld the blood glucose concentration

  • rises rapidly or significantly over 10mmol/L cats should be discharged on 1U twice daily
  • rises slowly towards or just above 10mmol/L, then cats should be discharged on 1U once daily
  • remains below 10mmol/L for 12hrs with no insulin, they can be assumed to be non-insulin dependant and cats should be discharged without insulin with their blood glucose monitored every 2-3 days for several weeks. Confirmed non-insulin dependant diabetic cats should have their blood glucose checked weekly for 3 months and then monthly forever.

Some cats may have a pre-insulin glucose concentration below 10mmol/L within 2 weeks, but insulin therapy should be maintained for at least 2 weeks to give beta cells adequate time to recover from glucose toxicity. Use 1U BID or SID until insulin is withdrawn.

What to do with a diabetic cat in remission
Once remission has occurred, it is vital that blood glucose concentration be measured regularly (initially weekly then monthly) to quickly diagnose a relapse. To facilitate the cat remaining in diabetic remission, it is recommended that a low carbohydrate diet is fed, physical activity is increased, calories are restricted to avoid obesity, and that diabetogenic drugs are contraindicated unless a life threatening situation arises.

How to increase the chance of remission occurring
Our study in diabetic cats (Marshall et al, awaiting publication) found better glycaemic control and higher remission rates when newly diagnosed diabetic cats were treated with glargine compared to lente or PZI insulins. This study also showed that, regardless of insulin type, good glycaemic control soon after diagnosis (within 3 weeks) increases the chance of achieving remission.

For reasons that are presently unknown, glargine treated cats appear to tolerate slight overdosing with insulin very well. For this reason, it is suggested that for the first 4-6 weeks of therapy, insulin be slightly overdosed and cats monitored carefully. Slightly overdosing with glargine increases the risk of hypoglycemia but usually results in achieving early good glycemic control which reverses glucose toxicity and results in a non-insulin dependant state. The benefits of remission far outweighs the risks of hypoglycaemia.

To maximise glycaemic control and hence the chance of remission

  • select glargine as initial insulin
  • administer glargine TWICE daily rather than once daily
  • slightly overdose with insulin for the first 4-6 weeks
  • use a low carbohydrate diet
  • restrict calories if overweight and encourage physical activity

Blood glucose monitoring at home

Measurement of blood glucose concentration (BG) is usually the best method of determining the correct insulin dose for diabetic cats. Stress hyperglycaemia occurs commonly when cats visit a veterinary surgery and can result in the wrong dose of insulin being selected. Thus, the stress-free environment at home is the best place to measure a cats BG.

Most human glucometers are very accurate at measuring cat blood. We prefer the Accu-Chek brand which can be purchased from any chemist for approximately $60.

The easiest and safest place for owners to sample blood from is the ear veins. Cats have small veins that run around the outside of their ears and these veins can be easily accessed from the dorsal surface. Blood can be sampled on both the cranial and caudal border of each ear giving a total of 4 sites to sample. Shaving the hair directly over the vein with a scalpel blade allows much better visualisation and with very slow hair regrow, will last for many weeks.

Procedure
1. Turn the glucometer on or insert test strip so the digital display is requesting blood.
2. Hold the edge of the ear between index-middle finger and thumb-fourth finger and firmly pull taut.
3. Quickly prick the vein with an insulin needle so a small drop of blood is produced on the skin surface. Pre-used insulin syringes are fine to use for this.
4. Bring glucometer down to the skin and place the end of the test strip into the blood until it beeps.
5. Read the number on the display and record it.
6. Wipe any excess blood away with a moist tissue.

Cats rarely react to their ears being pricked but topical anaesthetic creams such as EMLA can be applied prior to sampling if required. The most common complaint from owners is spraying of blood around the house if they shake their heads while blood is pooled on the skin. This can be minimised by not releasing the initial grip on the ear until blood has been transferred (with one hand) to the glucometer and a tissue applied to the ear.  Blood glucose samples are best collected just before an insulin dose is due so dose adjustments can be made immediately if required rather than waiting until the next injection.

Selecting insulin dose
à For newly diagnosed diabetic cats (less than 2 months):
If BG is above 12mmol/L then increase insulin dose 0.5 units (half a unit)
If BG is between 6 and 11mmol/L then keep insulin dose the same
If BG is between 3 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 3mmol/L then don’t give insulin and call the clinic to discuss

à For longer-term diabetic cats (more than 2 months of insulin therapy):
If BG is above 25mmol/L then increase insulin dose 1 units
If BG is between 14 and 25mmol/L then increase insulin dose 0.5 units
If BG is between 6 and 13mmol/L then keep insulin dose the same
If BG is between 4 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 4mmol/L then don’t give insulin and either check for remission or call the clinic to discuss.

How often to sample
Ideally, diabetic cats should have BG sampled several times daily (just like humans do) but for many reasons this is not practical. We recommend that newly diagnosed cats should have their BG checked every 2-3 days for the first few weeks and longer-term diabetic cats be sampled every 1-2 weeks. If insulin dose is changed, then a repeat BG should be done 2-3 days afterwards to check the right decision was made, whereas if the insulin dose is kept the same then a repeat BG is probably not required for 1-2 weeks.

Record keeping
A table should be kept which contains the date, current insulin dose, the BG reading and the new insulin dose selected. Initially, this table should be reviewed by a veterinarian in consultation every few weeks. Your veterinarian will assess the BG readings and the decisions you have made and comment as necessary. Most owners rapidly become competent at sampling blood and selecting the correct insulin dose making it unnecessary to consult us for long periods.

Constipation, Colectomy, and Perineal Hernia

Constipation And How Best To Manage It In Cats

Constipation or difficulty passing faeces is a severely debilitating disease seen commonly in cats of all ages and is life-threatening if left untreated. Effective management requires recognition of the aetiology and choosing the appropriate therapy for both cat and owner.

Clinical examination reveals colonic impaction with varying degrees of dehydration, weight loss, debilitation and abdominal pain. Pelvic fracture malunion may be detected on rectal examination in cats with previous pelvic trauma. Rectal examination is also useful in identifying other unusual causes of constipation, such as foreign bodies, rectal diverticula, strictures, inflammation, or neoplasia. Chronic tenesmus may be associated with perineal herniation in some cases. A complete neurologic examination with special emphasis on caudal spinal cord function should be performed to identify neurologic causes of constipation, e.g., spinal cord injury, pelvic nerve trauma, and Manx sacral spinal cord deformity.

While it is important to consider an extensive list of differential diagnoses in an individual animal, it should be kept in mind that most cases are idiopathic, orthopedic, or neurologic in origin. A recent review suggests that 96% of cases of obstipation are accounted for by idiopathic megacolon (62%), pelvic canal stenosis (23%), nerve injury (6%), or Manx sacral spinal cord deformity (5%).

Table 1. Common Differentials for Feline Constipation

Idiopathic megacolon
Mechanical obstruction
- pelvic deformity
- neoplasia causing intraluminal or extraluminal compression
- strictures
Metabolic
- hypokalaemia
- hypercalcaemia
- dehydration
- hypothyroidism
- renal disease
Neurologic
- spinal cord deformities (Manx)
- lumbosacral disease
- cauda equina
- ileus
Pain
- musculoskeletal
- anorectal
Dietary change

The pathogenesis of idiopathic megacolon has been variably attributed to a primary neurogenic or degenerative neuromuscular disorder. Recent studies suggest that cats affected with idiopathic megacolon have impaired colonic smooth muscle function without significant abnormalities of smooth muscle cells or of myenteric neurons on histologic evaluation. These studies suggest that the disorder of feline idiopathic megacolon is a generalised dysfunction of colonic smooth muscle, and that treatments aimed at stimulating colonic smooth muscle contraction might improve colonic motility.

A complete blood count, serum chemistry, urinalysis and T4 level should be performed in all cats presented for constipation so that metabolic causes of constipation, such as dehydration, hypokalemia, and hypercalcemia may be detected. Serum T4 concentration and other thyroid function tests should also be considered in cats with recurrent constipation and other signs consistent with hypothyroidism.

Abdominal radiography should be performed in all constipated cats to characterise the severity of colonic impaction, and to identify predisposing factors such as intraluminal radio-opaque foreign material (e.g., bone chips), intraluminal or extraluminal mass lesions, pelvic fractures, and spinal cord abnormalities. The radiographic findings of colonic impaction cannot be used to distinguish between constipation, obstipation and megacolon in idiopathic cases.

Further diagnostic tests may be indicated in some cases. Extraluminal mass lesions should be further evaluated by abdominal ultrasonography and guided biopsy, whereas intraluminal mass lesions are best evaluated by colonoscopy. Colonoscopy requires general anesthesia and evacuation of impacted feces. It is used to evaluate the colon and anorectum for suspected inflammatory lesions, strictures, sacculations, and diverticula and. CSF analysis and myelography are indicated for neurogenic causes of constipation.

Successful management of constipation involves safely removing initial impacted faeces and then selecting therapies aimed at allowing effective defaecation on its own. Therapies are classified as either medical or surgical and are selected based on things such as the aetiology, severity, patient compliance and owner compliance.

Medical Therapy
Mild to moderate or recurrent episodes of constipation require medical intervention. Most cats can be managed as outpatients with dietary modification, water enemas, oral or suppository laxatives, and/or colonic prokinetic agents.

Mild constipation can usually be managed using rectal suppositories alone or combined with an oral laxative. A compliant cat and willing owner are required for success. Several types of suppositories are available and include dioctyl sodium sulfosuccinate (emollient laxative), glycerin (lubricant laxative), and bisacodyl (stimulant laxative).
Mild to moderate or recurrent episodes of constipation may require administration of enemas and/or manual extraction of impacted faeces. Several types of enema solutions may be administered, such as warm tap water (5-10 mL/kg), warm isotonic saline (5-10 mL/kg), dioctyl sodium sulfosuccinate (5-10 mL/cat), or lactulose (5-10 mL/cat). Enema solutions should be administered slowly with a well-lubricated 10-12F rubber catheter or feeding tube.

Cases unresponsive to enemas may require manual extraction of impacted faeces. Cats should be adequately rehydrated and then anesthetised and intubated to prevent aspiration should colonic manipulation induce vomiting (many cats vomit watery faeces on recovery from a water pic enema). Warm water is infused into the colon through a water pic enema while the faecal mass is manually broken up by abdominal palpation. Whelping forceps may also be introduced rectally (with caution) to break down the faecal mass. A water pic enema safely and rapidly removes faeces reducing the risks of prolonged anesthesia and colonic perforation. This method has never failed in our clinic and as such I believe surgical removal of faeces via colotomy has no place in feline medicine. Laxative and/or prokinetic therapy may then be instituted once the faecal mass has been removed.

Many constipated cats will respond to bulk-forming laxatives. These are dietary fiber supplements of poorly digestible polysaccharides and celluloses derived principally from cereal grains, wheat bran, and psyllium. Dietary fiber is preferred as it is well tolerated, more effective, and more physiologic than other laxatives. Fiber supplemented diets are available commercially (eg Hills R/D and W/D) or owners may add psyllium (1-4 tsp per meal), wheat bran (1-2 tblsp per meal), or pumpkin (1-4 tblsp per meal) to their normal canned cat food. Cats should be well hydrated before commencing fiber supplementation to maximise the therapeutic effect and to minimise the impaction of fiber in the constipated colon.

A final group of laxative is the poorly absorbed polysaccharides. Lactulose is the most effective agent in this group and probably the only one worth mentioning. The organic acids produced from lactulose fermentation stimulate colonic fluid secretion and propulsive motility. Lactulose administered at a dosage of 0.5 mL/kg every 12hrs fairly consistently produces soft feces in cats. Most cats with recurrent or chronic constipation can be well managed with lactulose. The dosage may have to be tapered in individual cases if flatulence and diarrhea become excessive.

The stimulant laxatives are a diverse group of agents that have been classified according to their ability to stimulate propulsive motility. Bisacodyl, at a dosage of 5 mg q 24 h PO, is the most effective stimulant laxative in the cat. It may be given individually or in combination with fiber supplementation for long-term management of constipation. It is suggested that daily administration of bisacodyl be avoided because injury to myenteric neurons can occur with chronic usage. We do not routinely use stimulant laxatives in our clinic.
Prokinetic Drugs

1.  Cisapride enhances colonic propulsive motility through activation of colonic smooth muscle 5-HT receptors in a number of animal species. In vitro studies have shown that cisapride stimulates feline colonic smooth muscle contraction. The commercial formulation of cisapride (Prepulsid) was withdrawn from human markets several years ago, but the drug is readily available through compounding pharmacies. Laboratory studies have shown that classic histamine H-2 receptor antagonists ranitidine and nizatidine, stimulate feline colonic smooth muscle contraction in vitro but it is not yet clear how effective these drugs are in vivo. While cisapride was unavailable, we used ranitidine 15mg bid with apparent success.

2.  Tegaserod (Zelnorm®-Novartis Corporation) is a potent partial non-benzamide agonist at 5-HT4 receptors and a weak agonist at 5-HT1D receptors. Tegaserod has prokinetic effects in the canine colon although the motor mechanisms responsible are unclear. Its safety and efficacy in cats is unknown and the author has no personal experience using this drug in cats so caution should be exercised.

In vitro studies suggest that tegaserod does not delay cardiac repolarization or prolong the QT interval of the electrocardiogram as had been occasionally reported with cisapride.
Clinical efficacy has been demonstrated in human constipation-predominant irritable bowel syndrome (IBS) and the drug was approved for the treatment of this disorder in the U.S. in 2002.Gastric and intestinal effects of tegaserod have not been reported in the dog, so this drug may not prove as useful as cisapride in stimulating proximal gastrointestinal motility.

3.  Prucalopride (Janssen Pharmaceutical) is a potent partial benzamide agonist at 5-HT4 receptors, but is without effect on other 5-HT receptors or cholinesterase enzyme activity. Unlike tegaserod, prucalopride also appears to stimulate gastric emptying in dogs.
In lidamidine-induced delayed gastric emptying in dogs, prucalopride (0.01-0.16 mg/kg) dose-dependently accelerates gastric emptying of dextrose solutions.

Prucalopride dose-dependently (0.02-1.25 mg/kg) stimulates giant migrating contractions (GMC's) and defecation in the dog. The prucalopride effect is observed most prominently in the first hour after administration, suggesting that the prucalopride effect is a direct effect on the colon rather than on total gut transit time. Prucalopride also enhances defecation frequency in healthy cats. Cats treated with prucalopride at a dose of 0.64 mg/kg experience increased defecation within the first hour of administration. Fecal consistency is not altered by prucalopride at this dosage. Prucalopride has not yet been approved in the U.S.

4.  Misoprostol is a prostaglandin E1 analogue that reduces the incidence of nonsteroidal anti-inflammatory drug-induced gastric injury. The main side effects of misoprostol therapy are abdominal discomfort, cramping, and diarrhea. Dog studies suggest that prostaglandins may initiate a giant migrating complex pattern and increase colonic propulsive activity. Given its limited toxicity, misoprostol may be useful in dogs and cats with severe refractory constipation. Misoprostol was recently shown to stimulate feline colonic smooth muscle contraction in vitro.

Surgical Therapy
Most surgical therapies for constipation in the cat are related to the management of idiopathic megacolon, although causes such as pelvic outlet obstruction, complications of neutering surgery, perineal herniation, and malunion pelvic fractures may also require surgical intervention. Cats with megacolon which are refractory to medical therapy or unable to be medicated, should have their colon surgically removed via a total or sub-total colectomy. A sub-total colectomy involves removal of the majority of the colon except for the ileocolic valve and the proximal colon followed by anastomosing the proximal colon to the distal colon or rectum. A total colectomy involves removal of the entire colon, the ileocolic valve, cecum and distal ileum followed by ileorectal anastomosis.

Sub-total colectomy is an easier and faster surgery to perform than a total colectomy and stools return to normal faster after surgery with sub-total (1-2 weeks) compared with a total (4-10 weeks). A study of 25 cats treated with either total or sub-total colectomy failed to show a difference in long-term recurrence rates so currently, the recommended best surgical therapy for megacolon is sub-total colectomy with the ileocolic junction preserved. In my experience, recurrent constipation is more likely to recur with this technique. Hence I perform a total colectomy in young cats, Burmese cats and cats with idiopathic dilated megacolon to ensure optimal long-term results.

Surgical correction of pelvic canal stenosis may be performed by pelvic osteotomy or pubic symphyseal distraction and may be sufficient alone for some cats suffering from pelvic canal stenosis. Pelvic osteotomy without colectomy has been recommended for cats with pelvic fracture malunion and megacolon of less than 6 months duration. A colectomy can be performed if osteotomy is not curative. Pelvic osteotomies are technically very difficult making some surgeons prefer colectomy.

We often perform a somewhat elective colectomy very early with little or no medical management. Using a 3 year old Burmese cat with faecal impaction from megacolon as an example, if treated medically would need iv fluids, an anaesthetic, water pic enema and hospitalisation which on average may cost $500. Then it is discharged with increased dietary fibre and medicated twice daily with 5mg cisapride bid ($1.30/capsule) and 2mls duphalac. The cost of cisapride alone is $950/year. So if there are no relapses and no revisit consultations, in the first year a constipated cat may cost $1500 and need to be orally medicated twice daily and be forced to eat a high fibre.  If the same 3 year old Burmese cat with faecal impaction and megacolon was taken straight to colectomy, it would have iv fluids, an anaesthetic, colectomy, 2-3 nights in hospital and be discharged on antibiotics for 7 days and likely never need medicating again. The cost for a colectomy at our clinic is about $1500. Thus there are very clear reasons why colectomy is often the best initial therapy.

Procedure for sub-total colectomy

  1. pre-anaesthetic iv fluids at 2 x maintenance
  2. pre-medicate with methadone and midazolam, induce with alfaxan, intubate and maintain on isoflourane/oxygen
  3. start intravenous fentanyl CRI which continues for 6-8hrs post-surgery
  4. prophylactic antibiotics of either cephazalothin or amoxicillin/gentamycin iv
  5. place transdermal fentanyl patch behind neck (Durogesic 25ug)
  6. doppler blood pressure measured every 5-10 minutes
  7. routine caudal laparotomy, colon exteriorised, caudal mesenteric vessels ligated with vascular staples or 2-0 silk, proximal and distal colon manipulated into anastomosis position and arcuate vessels appropriately ligated with 4-0 pds, doyen bowel clamps placed just cranial and caudal to where arcuate vessels were ligated, bowel resected with metzenbaums and disposed of
  8. end-to-end anastomosis of proximal to distal colon using 4-0 pds and a simple continuous suture pattern
  9. clamps are released and anastomosis tested for leakage
  10. abdomen flushed with warm sterile saline 3 times and closed routinely with 3-0 pds
  11. repeat prophylactic antibiotics on recovery and again in 6 hrs, change to clavulox the following morning
  12. cats are offered food and encouraged to eat as soon as recovered from anaesthesia (approx 60 mins)
  13. cats remain in hospital until eating, normothermic and no significant fluid loss in faeces. This is typically 2-3 days.
  14. fentanyl patch removed and discharged on clavulox orally for 7 days and sutures out 10 days post surgery

Cats have a very favorable prognosis for recovery following colectomy, although mild to moderate diarrhea may persist for weeks to months postoperatively in some cases. In the majority of cases, the long-term outcome following subtotal colectomy is considered excellent.

Perineal Hernia

Perineal hernia is a rare disease in cats and is characterised by tenesmus and constipation. It occurs due to a weakness of the muscles and fascia of the pelvic diaphragm allowing deviation or dilation of the rectum into the perineum or less commonly, caudal displacement of abdominal organs. Unlike dogs, abdominal contents are rarely herniated. Instead there is lateral bulging of the rectum containing faecal balls and this bulging is also termed anal sacculation or pre-anal faecolith. This can cause marked and continual discomfort requiring manual extraction and is a common reason for presentation.

A presumptive diagnosis is often made based purely on the owner’s history. The bulk of the faeces is usually in the litter tray but small faecal balls are also found dropped all around the house. Owners may wrongly interpret this as intentional inappropriate toileting. When defaecating, cats with perineal hernias can either have trouble getting started (as the first piece of faeces fails to exit through the anal sphincter and doubles back on itself) or finished (the last piece of faeces fails to exit and forms a pre-anal faecolith). These cause significant pain and cats often run around the house screaming and biting at their back end until it either pops out or is extracted by a veterinarian (usually under sedation or GA). A definitive diagnosis is made by demonstrating marked lateral rectal deviation in the area between anal sphincter and ischium. A diagnosis of perineal hernia can be easily made by digital rectal examination but is often overlooked due to a lack of recognition of the disease entity.
We have found siamese cats to be over represented and male cats more commonly affected. This breed association has not previously been recognised in the literature. Primary or idiopathic perineal herina occurrs in younger cats (mean=2.8yrs, range=1.5-4yrs) while perineal hernia associated with megacolon occurrs in older cats (mean=11.9yrs, range=8.5-15.3yrs). Perineal hernia can be associated with previous tail amputation or perineal urethrostomy although we have never seen a case of the latter. We have seen perineal hernia with caudal displacement of the urinary bladder in two Burmese cats also suffering cutaneous asthenia.

Medical management of perineal hernia is similar to that used for constipation (see below) and unfortunately is usually unsuccessful. Surgical management is regarded as the treatment of choice and may involve colectomy, internal obturator transposition herniorrhaphy, or both. Primary or idiopathic perineal hernia is best corrected using an internal obturator transposition herniorrhaphy.  A colectomy should be performed first in cats with perineal hernia associated with megacolon as this may resolve clinical signs for many years. If a herniorrhapy is performed first in these cases, they are unable to pass faeces at all and require a colectomy for relieve. Careful assessment of cats with perineal hernias associated with megacolon is essential so the correct surgical procedure be performed. It has been a steep learning curve and even when armed with this knowledge, the author admits to performing many surgeries in the wrong order.

Feline Diabetes Mellitus

Diabetes mellitus is a hormonal disease that occurs in about 1 out of every 400 cats. It is characterised by elevated blood glucose (blood sugar) levels.  If untreated, it can lead to life-threatening metabolic disturbances. Diabetes in cats is most similar to type II or adult onset diabetes in humans.

The hormone insulin is produced in the pancreas and is responsible for allowing glucose to be taken into cells to provide energy. If there is resistance to this action or there is a reduction in the total amount of insulin produced, then the cat becomes diabetic.

The cats who are most at risk for developing diabetes are cats over eight years old, male cats, Burmese cats and cats who are overweight.

Signs and Symptoms

Clinical signs of diabetes include:

  • excessive drinking
  • excessive urinating
  • increased appetite
  • problems walking or jumping.  (This is caused by neuropathy which causes poor nervous control to the cat’s hind legs)

Diagnosis

Diagnosis involves blood and urine tests to demonstrate high blood glucose and the presence of glucose in the urine. Sometimes a test for fructosamine is required to distinguish between cats which are stressed and those that are truly diabetic.

Treatment

Diabetes is a very treatable disease, but requires long term commitment. Treatment options include:

  • treating underlying disease (if there is one)
  • insulin therapy (the preferred method, and the one that provides the best control of blood sugar)
  • dietary management  (there have been significant advances in dietary treatment of feline diabetes recently)

After your cat has been diagnosed with diabetes, the next step is to determine the correct type and dose of insulin for her. This varies from cat to cat, and your cat will probably have to spend several days in the hospital.  She will have her blood glucose measured every few hours as the vet determines the correct treatment for her.

Your cat will need to return to the vet:

  • Every week for 3 weeks and then
  • Every month until a stable dose is determined.
  • From then on cats usually return to the clinic every 3 months for a check up.

Insulin Instructions

  • Insulin must be stored in the refrigerator.
  • If your cat is on a crystalline insulin it must be gently mixed by rolling for 30 seconds prior to each use.
  • Glargine (Lantus) insulin does not need to be mixed.
  • A new syringe should ideally be used for each injection.
  • Injections can be given under the skin anywhere on the body but the "scruff" is often easiest and less painful.

Your cat must be monitored closely while he is on insulin therapy.

DO NOT change the dose without consulting your veterinarian. If your cat gets too much insulin it can cause blood glucose levels to become dangerously low.  Your cat could become weak, lethargic or unsteady on her feet.  She could go blind, go into a coma or die.

If your cat accidentally gets too much insulin or if it shows any of these signs, take her to the vet immediately. You might try rubbing honey or glucose syrup on her gums as an emergency treatment.

Remission

Approximately 50% of cats diagnosed with diabetes and treated appropriately will go into remission and no longer require insulin injections. Early diagnosis and aggressive treatment with long-acting insulin and a low carbohydrate diet will increase the chance of your cat going into remission.

How To Contact Us

We love to have you come by our office just make sure to make an appointment first. Our office locations, contact details and trading hours are as below:

Bonney Place,
318 Junction Road,
Clayfield 4011
Phone # : 07-3357 9902
26 Great George Street,
Paddington,
Brisbane 4069
Phone # : 07-3367 0011
189 Creek Road,
Mt Gravatt,
Brisbane 4122
Phone # : 07-3349 0811



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Mt Gravatt (07) 3349 0811
Trading Hours
Consultations available
Monday 7.00am – 7.00pm 7.30am – 7.00pm
Tuesday 7.00am – 7.00pm 7.30am – 7.00pm
Wednesday 7.00am – 7.00pm 7.30am – 7.00pm
Thursday 7.00am – 7.00pm 7.30am – 7.00pm
Friday 7.00am – 7.00pm 7.30am – 7.00pm
Saturday 8.00am – 4.00pm 9.00am – 4.00pm
Sunday 8.00am – 12.00pm 9.00am – 12.00pm
Paddington (07) 3367 0011
Trading Hours
Consultations available
Monday 7.00am – 7.00pm 8am - 11am - 3pm - 7pm
Tuesday 7.00am – 7.00pm 8am - 11am - 3pm - 7pm
Wednesday 7.00am – 7.00pm 8am - 11am - 3pm -7pm
Thursday 7.00am – 7.00pm 8am - 11am - 3pm -7pm
Friday 7.00am – 7.00pm 8am - 11am - 3pm -7pm
Saturday 7.00am – 4.00pm 8.30am - 4.00pm
Sunday 9.00am – 12.00pm No Consultations
Clayfield (07) 3357 9902
Trading Hours
Consultations available
Monday 8.00am – 7.00pm 8am - 11am - 3pm - 7pm
Tuesday 8.00am – 7.00pm 8am - 11am - 3pm - 7pm
Wednesday 8.00am – 7.00pm 8am - 11am - 3pm - 7pm
Thursday 8.00am – 7.00pm 8am - 11am - 3pm - 7pm
Friday 8.00am – 7.00pm 8am - 11am - 3pm - 7pm
Saturday 8.30am – 2.00pm 9.00am – 2.00pm
Sunday CLOSED CLOSED

 

Consultations By Appointment:
7 days a Week
The Cat Clinic Mount Gravatt After Hour Service:

3349 0811
All Hours:

3349 0811