Feline Diabetes: When and How to Reach for an SGLT-2 Inhibitor

·53 min·5 clips

Dr. Audrey Cook reveals that a cat's blood sugar over 200 poisons its own beta cells every day.

The episode begins with Dr. Cassi introducing the topic of feline diabetes and the new treatment option of SGLT2 inhibitors, sponsored by Boehringer Ingelheim Animal Health. Dr. Audrey Cook, a professor of small animal internal medicine at Texas A&M, joins as the guest. Dr. Cook explains that her default approach for a new diabetic cat is to consider an SGLT2 inhibitor first due to ease of administration and lower hypoglycemia risk, but she outlines key contraindications. The primary criterion is measuring blood ketones, with a threshold of 2.4 mmol/L; levels above this indicate a need for insulin. Comorbid conditions like pancreatitis or significant renal disease may also preclude SGLT2 inhibitor use. Dr. Cook highlights specific scenarios where SGLT2 inhibitors are ideal, such as cats on glucocorticoids, those with acromegaly, or hyperthyroid cats, due to advantages over insulin. The discussion turns to dietary therapy, where Dr. Cook recommends waiting a couple of weeks after starting treatment before switching to a high-protein, low-carb diet to support incretin production and beta cell recovery. She delves into glucose toxicity, citing a study where healthy cats lost 50% of their beta cells after 10 days of hyperglycemia, emphasizing the urgency of achieving euglycemia. Monitoring protocols for cats on SGLT2 inhibitors involve checking ketones at days 2-3, 7, and 14, with blood glucose assessment at day 30. Dr. Cook stresses the importance of using a handheld ketone meter to measure beta-hydroxybutyrate directly, rather than relying on urine dipsticks. She warns about euglycemic DKA, a condition where cats on SGLT2 inhibitors become ketotic and ill but have normal blood sugar, requiring immediate insulin and dextrose. The episode concludes with Dr. Cook encouraging veterinarians to keep a bottle of SGLT2 inhibitor on hand and utilize available resources, including a review paper with treatment recipes for euglycemic DKA.

As heard by us

A practical look at choosing insulin or SGLT-2 inhibitors for newly diagnosed diabetic cats.

A new feline diabetes diagnosis can now lead to a more nuanced treatment choice, and this episode gives that choice a useful clinical frame. Dr.

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Why you'd press play

You want a clearer call on which newly diabetic cats may fit an oral SGLT-2 inhibitor and which are better steered toward insulin.

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