An 11-year-old, 7 kg (15.4 lb) male neutered Domestic Shorthair cat is presented for a recheck of his Diabetes Mellitus, which was diagnosed 8 months prior. The owner is frustrated because the cat’s clinical signs of excessive thirst, urination, and appetite (PU/PD/PP) have not improved despite progressively increasing the insulin dose. The cat is currently receiving 12 units of glargine insulin twice daily. The owner also notes that the cat, despite being an uncontrolled diabetic, has actually gained weight and his head and paws seem larger.
Physical Exam:
T: 101.8°F
P: 190 bpm
R: 32 bpm
MM: pink/moist
CRT < 2 sec
The cat is a large-framed, well-muscled cat with a broad, blocky head and large paws. Mild prognathia inferior (protruding lower jaw) and widened spacing between the incisor teeth are noted. Cardiac auscultation reveals a new Grade III/VI systolic heart murmur. The abdomen is slightly pendulous, and the liver and kidneys feel subjectively large on palpation.
Biochemistry: (from a spot blood glucose check)
Glucose: 550 mg/dL [Ref: 75-125 mg/dL]
Fructosamine: (from 1 week prior)
Result: 610 µmol/L [Ref: < 350 µmol/L]
What will be your tentative and differential diagnosis? What further diagnostic test(s) you will perform to confirm your diagnosis? What will be your treatment plan(s)?
Solution to Case 30 (will be posted on Sept 5)
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