Glucose concentrations after insulin-induced hypoglycemia and glycemic variability in healthy and diabetic cats.

Abstract

BACKGROUND: Little information is available about posthypoglycemic hyperglycemia (PHH) in diabetic cats, and a causal link between hypoglycemia and subsequent hyperglycemia is not clear. Fluctuations in blood glucose concentrations might only represent high glycemic variability. HYPOTHESIS: Insulin induces PHH in healthy cats, and PHH is associated with poorly regulated diabetes and increased glycemic variability in diabetic cats. ANIMALS: Six healthy cats, 133 diabetic cats. METHODS: Insulin (protamine-zinc and degludec; 0.1-0.3 IU/kg) administered to healthy cats. Blood glucose curves were generated with portable glucose meter to determine the percentage of curves with PHH. Data from insulin-treated diabetic cats with blood glucose curves showing hypoglycemia included data of cats with and without PHH. Post-hypoglycemic hyperglycemia was defined as blood glucose concentrations <4 mmol/L followed by blood glucose concentrations >15 mmol/L within 12 hours. Glycemic variability was calculated as the standard deviation of the blood glucose concentrations. RESULTS: In healthy cats, all insulin doses caused hypoglycemia but PHH was not observed; glycemic variability did not differ between insulin preparations. Among diabetic cats with hypoglycemia, 33 (25%) had PHH. Compared with cats without PHH, their daily insulin dose was higher (1.09&#x2009;&#xb1;&#x2009;0.55 versus 0.65&#x2009;&#xb1;&#x2009;0.56 IU/kg; P&#x2009;<&#x2009;.001), serum fructosamine concentration was higher (565&#x2009;&#xb1;&#x2009;113 versus 430&#x2009;&#xb1;&#x2009;112 &#xb5;mol/L; P&#x2009;<&#x2009;.001), remission was less frequent (10% versus 56%; P&#x2009;<&#x2009;.001), and glycemic variability was larger (8.1&#x2009;&#xb1;&#x2009;2.4 mmol/L versus 2.9&#x2009;&#xb1;&#x2009;2.2 mmol/L; P&#x2009;<&#x2009;.001). CONCLUSIONS AND CLINICAL IMPORTANCE: Insulin-induced hypoglycemia did not cause PHH in healthy cats but it occurred in 25% of diabetic cats with hypoglycemia, particularly when diabetes was poorly controlled. Glycemic variability was increased in cats with PHH.