2018 AAHA Diabetes Management Guidelines for Dogs and Cats.

Diabetes mellitus (DM) is a common disease encountered in canine and feline medicine. The 2018 AAHA Diabetes Management Guidelines for Dogs and Cats revise and update earlier guidelines published in 2010. The 2018 guidelines retain much of the information in the earlier guidelines that continues to be applicable in clinical practice, along with new information that represents current expert opinion on controlling DM. An essential aspect of successful DM management is to ensure that the owner of a diabetic dog or cat is capable of administering insulin, recognizing the clinical signs of inadequately managed DM, and monitoring blood glucose levels at home, although this is ideal but not mandatory; all topics that are reviewed in the guidelines. Insulin therapy is the mainstay of treatment for clinical DM. The guidelines provide recommendations for using each insulin formulation currently available for use in dogs and cats, the choice of which is generally based on efficacy and duration of effect in the respective species. Also discussed are non-insulin therapeutic medications and dietary management. These treatment modalities, along with insulin therapy, give the practitioner an assortment of options for decreasing the clinical signs of DM while avoiding hypoglycemia, the two conditions that represent the definition of a controlled diabetic. The guidelines review identifying and monitoring patients at risk for developing DM, which are important for avoiding unnecessary insulin therapy in patients with transient hyperglycemia or mildly elevated blood glucose.

Feline primary hyperaldosteronism.

Primary hyperaldosteronism (PHA) is being recognized more frequently in cats. Usual hallmarks of the disease include hypokalemia and systemic hypertension. Ultrasound frequently detects an abnormality in the affected adrenal gland. Diagnosis is based on increased plasma or serum aldosterone concentrations, particularly in the face of hypokalemia and low renin activity (when measurement is available). Cats with PHA have good prognoses with surgical excision of tumor-bearing adrenal glands. Medical management can stabilize patients for many months. The reported incidence is likely to increase as practitioners become more aware of the condition and diagnose it earlier in the disease course. If veterinarians choose to use humans as an experimental model, PHA should be considered a differential for cats with hypertension of unknown cause or that is refractory to treatment. Using hypokalemia as a definitive criterion in screening for PHA may result in late-stage diagnosis and underrecognition of incidence of PHA in the hypertensive population.

Evaluation of clinicopathologic features, response to treatment, and risk factors associated with idiopathic neutropenia in dogs: 11 cases (1990-2002).

OBJECTIVE: To evaluate the clinicopathologic features, response to treatment, and risk factors associated with idiopathic neutropenia in dogs. DESIGN: Retrospective case series. ANIMALS: 11 dogs. PROCEDURES: Medical records of dogs with idiopathic neutropenia were reviewed. Signalment, history, clinical signs, and response to treatment were recorded and compared with that in dogs with neutropenia attributable to known causes and to dogs without neutropenia (controls). RESULTS: Compared with dogs with neutropenia attributable to known causes, dogs with idiopathic neutropenia had lower neutrophil counts and were younger. When compared with control dogs, age < 4 years was identified as a risk factor for developing idiopathic neutropenia. In all dogs with idiopathic neutropenia, remission of neutropenia occurred within 18 days after administration of prednisone (2 to 4 mg/kg [0.9 to 1.8 mg/lb], PO, daily) and no serious complications or infections developed. CONCLUSIONS AND CLINICAL RELEVANCE: An immune-mediated pathogenesis should be considered for dogs with idiopathic neutropenia in which the cause is not known. Severe neutropenia and young age were significantly associated with idiopathic neutropenia in dogs. Prognosis appeared to be excellent with prednisone treatment.

Investigation of pulmonary deposition of a nebulized radiopharmaceutical agent in awake cats.

OBJECTIVE: To determine whether conscious, unsedated cats will inhale a nebulized material administered via a facemask and whether this material will reach the lower airways. ANIMALS: 20 healthy adult cats. PROCEDURE: Technetium Tc 99m-diaminetriaminopentaacetic acid (99mTc-DTPA) was nebulized into a spacer and administered to the cats via a closely fitting facemask. By use of a gamma camera, images were then immediately obtained to determine the distribution of 99mTc-DTPA within the lower airways. RESULTS: Images obtained by use of the gamma camera revealed that all 20 cats had inhaled 99mTc-DTPA from the facemask. In each cat, deposition of the radiopharmaceutical agent was evident throughout the lung fields. CONCLUSIONS AND CLINICAL RELEVANCE: Awake cats that were not used to the application of a facemask did inhale substances from such a device. Aerosolization of medications may be a feasible route of administration for cats with lower airway disease.

Leptospirosis in dogs: a serologic survey and case series 1996 to 2001.

All leptospirosis microscopic agglutination test titers for the Leptospira serovars icterohaemorrhagiae, canicola, grippotyphosa, bratislava, hardjo, and pomona conducted on 1,260 blood samples from dogs at the University of Illinois Veterinary Diagnostic Laboratory between March 1996 and March 2001 were evaluated. Low titers (1:100 to 1:400) were predominantly L. icterohaemorrhagiae and L. canicola, which represented the predominant serovars (65.4%) among all positive samples with low titers. L. grippotyphosa was the predominant serovar (72.1%) among samples with clinically significant titers (greater than 1:800). The medical records of 87 dogs with a titer greater than 1:800 that were patients at the Veterinary Teaching Hospital of the University of Illinois were reviewed. A clinical diagnosis of leptospirosis was made in 15 cases (17.2%) based on the elevated titer, appropriate clinical signs, lack of recent vaccination, and lack of concurrent disease that could explain the clinical signs present. Renal disease was present in 10 of the cases, concurrent renal and hepatic disease in two, and hepatic disease in three. In 12 cases, the predominant serovar was L. grippotyphosa; titers to L. grippotyphosa and L. bratislava were equal in magnitude in three cases.

Systolic blood pressure in cats with diabetes mellitus.

OBJECTIVE: To determine the prevalence of systemic hypertension in cats with diabetes mellitus and establish ranges for echocardiographic variables in diabetic cats. DESIGN: Prospective study. ANIMALS: 14 cats with diabetes mellitus and 19 healthy control cats. PROCEDURE: Systolic blood pressure was measured indirectly with a noninvasive Doppler technique. Ophthalmic and echocardiographic examinations were performed, and urine protein concentration was measured. Cats were considered to have hypertension if they had systolic blood pressure > 180 mm Hg and at least 1 other clinical abnormality typically associated with hypertension (eg, hypertensive retinopathy, left ventricular hypertrophy, or proteinuria). RESULTS: None of the diabetic or control cats had systolic blood pressure > 180 mm Hg. One diabetic cat had left ventricular hypertrophy, but systolic blood pressure was 174 mm Hg. None of the cats had evidence of hypertensive retinopathy or proteinuria. Mean values for echocardiographic variables for the diabetic cats were not significantly different from published values for healthy cats. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that hypertension does not occur or occurs in only a small percentage of cats with diabetes mellitus.

Leptospirosis in dogs: a serologic survey and case series 1996 to 2001.

All leptospirosis microscopic agglutination test titers for the Leptospira serovars icterohaemorrhagiae, canicola, grippotyphosa, bratislava, hardjo, and pomona conducted on 1,260 blood samples from dogs at the University of Illinois Veterinary Diagnostic Laboratory between March 1996 and March 2001 were evaluated. Low titers (1:100 to 1:400) were predominantly L. icterohaemorrhagiae and L. canicola, which represented the predominant serovars (65.4%) among all positive samples with low titers. L. grippotyphosa was the predominant serovar (72.1%) among samples with clinically significant titers (greater than 1:800). The medical records of 87 dogs with a titer greater than 1:800 that were patients at the Veterinary Teaching Hospital of the University of Illinois were reviewed. A clinical diagnosis of leptospirosis was made in 15 cases (17.2%) based on the elevated titer, appropriate clinical signs, lack of recent vaccination, and lack of concurrent disease that could explain the clinical signs present. Renal disease was present in 10 of the cases, concurrent renal and hepatic disease in two, and hepatic disease in three. In 12 cases, the predominant serovar was L. grippotyphosa; titers to L. grippotyphosa and L. bratislava were equal in magnitude in three cases.

Detection of occult urinary tract infections in dogs with diabetes mellitus.

Dogs with diabetes mellitus may develop occult urinary tract infections. In this study, diabetic dogs with negative and positive bacterial urine cultures were compared. Records from 51 dogs with diabetes mellitus were reviewed at the University of Illinois. No difference was identified between the groups in urine specific gravity, pH, glucose, ketones, protein, red blood cells, white blood cells, or epithelial cells. Dogs with occult urinary tract infection did have an increased incidence of bacteriuria, but this was not a consistent finding. Therefore, the urine on all diabetic dogs should be cultured to accurately identify the presence or absence of bacterial urinary tract infections.