New Devices to Treat Feline Diabetes

This is a really cool website-thank you for its creation! I am a former Equine Veterinarian who has been in the human biotech and medical device product development business for nearly twenty years. My endocrinology professor at UC Davis was Dr. Ed Feldman who always said that Feline Diabetes was the closest animal version of the syndrome in humans. Recently, I have found several fascinating technologies in human companies that might be very useful to dedicated cat owners who find the daily routine of injections and monitoring quite daunting.

Does anyone have any idea of the total US population of diabetic cats is today? I need this information to convince these people that cats could benefit from their use. As you can imagine they are leery to provide them outside of typical human channels for fear of FDA reprisal.

If anyone can help me here, or direct me to an informed source, it would be much appreciated.

Michael J. Sterns, DVM
San Francisco Bay Area

 

Hi Michael and welcome to the group.

I have found several fascinating technologies in human companies that might be very useful to dedicated cat owners who find the daily routine of injections and monitoring quite daunting.

What you mind sharing with us what some of these technologies are? We would be very interested to learn about this.

 

Yes, we would be very interested in finding out more about this.

I'm not sure where you would find out how many diabetic cats there are in the US. We have almost 600 members on this new board (we recently moved here from a different site) and all of us have or have had at least one diabetic cat. Many of us have or had more than one. Also we have members from all over the world, so it is not just a US cat disease.

 

Hey Mike! Is that you? UC Davis class of '84?

Did you get tired of getting kicked by horses?

As one former horse vet to another, I am glad to see you posting here. This is a great board and you will not find another group of more dedicated people when it comes to the treatment of feline diabetes.

If you want to email me directly => kitysaver@aol.com.

 

For a rough figure, try this:

http://answers.google.com/answers/threa ... 39417.html says about 90 million owned cats in the US, figure about double that for the english-speaking world in general.

Of that, Dr. Jacquie Rand estimates between 1/50 and 1/400 cats are diabetic.
http://www.uq.edu.au/ccah/index.html?page=43391&pid=0

Say 1/200, that gives 450,000 diabetic cats in the US alone. Probably over a million in households worldwide.


and very very few have vets who have read the very useful article I just linked to.

 

great, looks like lisa knows him. That must mean he is "ok" (ha ha ) :RAHCAT flip_cat

 

It's interesting. Over the last few years, I have seen 1/400 cats and 1/200 cats. Just from the amount of people I meet who mention it when I tell them I have one, and the traffic on the board, I would sure pick the1/200 as the better statistic. I'll be interested to hear what technologies you are thinking of.

 

LOL!!!! Good one!!! :lol:

 

Wow-looks like my old classmate Lisa P has risen to a highly esteemed position : ) I will keep that in mind. BTW-she was a model student and never did anything embarrassing. Hopefully, she only recalls good things about me.

Thank you for the article reference--I had not found that one as this is my initial foray back into the animal world since looking at implantable drug delivery systems for food animals and a bone marrow derived stem cell device for Horses. Most human device companies consider the Veterinary market a distraction, even though they have a lot of good data from their preclinical studies. The feline diabetes market appears to be larger than I expected.

Devices are (currently) of two types.

1. Very clever small delivery devices that stick to skin, are flexible, low profile and only require a light touch to deliver a metered dose. Think of a transdermal patch for humans, but a it's now Star Trek versus the Apollo program. Materials science has come a long way in 20 years. I can easily get a few of them, so perhaps Lisa can find a few test patients for me? Humans don't tend to scratch and fuss with things on their skin, and are less furry-that is the unknown.

2. A new integrated glucose testing meter with all supplies on board. This brings up another issue--your glucose testing regimen. Is it a big problem, or easy to deal with?

Thank you all for your insights. I really appreciate it. There is so much technology here in the Bay Area, and now that computers are on chips, we can basically analyze and chart anything on an iPhone.

My direct email is michaelsterns007@gmail.com. I hope to not wear out my welcome on this site!

 

Hi Dr. Michael. Welcome.

Yes, Dr. Lisa is a favourite on this board. So much so that I'm sure we'd all love to hear some old stories about her! ;-)


With respect to glucose testing, most FD kitty caregivers are using one of the human glucometers. It's a bit of a rough learning curve since the cats are not always compliant... but after a few days, it becomes routine. Most people test before each shot and then do some mid-cycle spot checking and then a curve a couple of times a month to determine if an increase or decrease is appropriate. I think the biggest issue with testing (after the initial learning for the cat and human) is the cost. The strips are quite expensive and a lot of people use 4 - 10 strips or more a day depending on how many times they get an error code or if it's a curve day.

 

Holy cow... I didn't know humans were less furry. :mrgreen:

And yes, the glucose testing regimen is a problem. At least, that's how I feel about it. My cat isn't regulated yet, so a lot of testing is required (I think), but that cannot be done when I'm at work. Any development on remote poking and testing?
Also, my cat hate's the testings. It must be me, guess I'm not good in stabbing someone else.
Other thing. It consumes a lot of time. Not the procedure itself. That I have worked out about now. But it's always on my mind.
So no, I wouldn't say that glucose testing is easy to deal with.

 

My opinion is that this will vary from cat to cat - and from home tester to home tester. There is a learning curve involved in learning how to properly test a cat using a human glucometer (what most of us use). Some cats are easy testers - they are cooperative, they sit still for the test, they bleed easily enough to perform the necessary test, etc. Other kitties are not at all cooperative and for those care givers, testing is harder, less frequent and sometimes, non-existent.

Most people test on ears, some test on paw pads - you have to learn what works best for you and kitty. It is suggested that you test, at minimum, before each and every insulin injection but most people will test more often than that if they are dedicated testers. I'd hazard a guess that would be about 3 to 4 times a day for the dedicated testers.

Even though my sugar baby is currently diet controlled, I still test him bid just to be on the safe side.
I was testing him qid, but have ceased that practice. Whenever I tested myself, I'd test him too as I am hypoglycemic and have to watch my own bgl very closely

Regards,
~M

 

While home testing can turn out to be surprisingly easy (depends on the cat though) once you get the hang of it (for many of us it has become "quality time" and our cats actually seem to enjoy it - go figure!!!) the problems that I see are:

• Vets often want to do a glucose curve at their office. It's expensive compared to home testing, and much less accurate, as well as being stressful all around. If more vets could get on-board with helping clients learn to home test, that would be a great thing.
  
• Home testing is scary at first. I'm amazed at how many people here have succeeded with it - I know it took me a few weeks to feel brave enough to even try it, and then a few more weeks to get it working well. I looked into a continuous monitoring system at one point, but dropped that idea because of cost, availability, and it needing to be calibrated against spot BG tests. Since that was what I was trying to avoid, it seemed to defeat the purpose.

All of that said, the BIGGEST thing I see from my time on the board is that many cats seem to have Type II diabetes that can be managed by diet changes, and often a short course of insulin, but after that they are diet controlled. Probably not anything up your alley in that , but gosh, if someone could put together and market a tidy little "diabetes starter kit" with an inexpensive meter, low-carb food samples & food guide, affordable insulin.... hmmm, I guess that's basically what we are all doing here, though not making any $$$ off it!

The # of Type 1-ers, or lifers for other reasons, who will truly need monitoring and injections for years to come, seems to be a lot smaller, though I have no idea on the #s or %s. I'm not sure that most vets have connected the dots yet on how many cats could go into remission with the right diet and insulin approach, but it's what I've gathered from hanging out here for a while, i.e that many cats can.

 

Michael, you are far too nice...or you have a lousy memory about my nickname of "Lisa Disappierson" because I tended to 'disappear' from labs on more than one occasion. Looking through the microscope made me seasick.

And you must not remember that I spent a lot of time snoring in the back of the room for those 8AM classes. I clicked on my tape recorder....and hoped like heck that the instructor-provided class notes were complete!

And...I remember that you were far smarter than I was and got better grades. That is why you went into research.....the smart ones always went into research.

 

I always thought it would be nice to have a meter implanted into the side of my cat so that, at a glance, I could tell what his BG level is.

Seriously, there is sometimes a high bar to cross with getting someone started with hometesting. In a few instances, the cat is not compliant. But more times, it's the person who is fearful or unconcerned (that is, they lack an understanding of the extreme need for daily BG monitoring). Anything that could be done to make hometesting easier (without significantly increasing the cost) would be very welcome. Keep in mind that money is a big issue for many folks dealing with special needs cats. That is the single biggest reason, IMHO, that the Alpha-Trak meter never caught on with the consumer.

 

I had 2 cats at once and it wasn't that bad. Like Venita says, I was more scared and unsure than my boys.

I had really, really, really good boys though. :RAHCAT

 

This is thought provoking and here, in random order, are a few of mine:

I have never heard of a single cat that went into remission without being on a species appropriate, diabetes friendly diet. Has anyone else heard of such a thing?

The size of the diabetic population is larger than we suspect because of undiagnosed cases. Many diabetics present with inappropriate urination and, for a huge percentage of owners, that is reason enough to euthanize the cat without searching for a cause. We know there are diabetics in the feral population and that they go undiagnosed more often than not. Some diabetes, particularly steroid induced cases, can go into spontaneous remission before the diabetes is treated.

Devices have two drawbacks IMHO. First is cost; the majority of cats diagnosed with diabetes are euthanized because owners don't want the additional cost and time burdens that come with the dx. Tragically, too many vets encourage this practice. Second falls under the rubric of ECID; many cats tolerate transdermal meds perfectly, but my Folly clawed his ears bloody trying to remove the gel. This goes back to cost, there's no way to determine if any given cat will tolerate a particular device until the big cash outlay has been made.

Then there's the FDA. The cost of the clinical trials required for approval is generally too high for manufacturers of devices and drugs for animals to foot the bills. Most of the insulins we use are not FDA approved for animals, the human glucometers we use are not approved for animals either. The cost of testing on a new testing system, for instance, would hike up the final price to the point that most would find it unaffordable. This is true of the "animal" glucometers on the market today.

And finally, we have vets. There is a big gap between the knowledge on this board and the knowledge displayed by a vast number, if not most, of the vets we have encountered. Vets do not want to know about nutrition--they have profit centers provided by the food manufacturers and, no matter how bad these misnamed 'prescription' foods are, the attitude seems to be don't mess with my cash cow. Though people here have been home testing their diabetic cats blood glucose for over ten years the vet community started to wake up to the benefits of this only after they had a device to sell--an expensive device with a high markup. As for insulins, again the vets do not want to inform themselves when they have a sales rep pushing a product they can sell at any markup they choose.

Sorry if I sound cynical, but I've seen too much of these behaviors for too many years with too few improvements. Now if anyone has ideas for changing a lot of hearts and minds it would be good to hear them.

Gia & Quirk (GA)

Guilt trips are a detour from life

 

In case you haven't seen this yet, here are the links we give to newbies to help them read about and learn how to home test.

Home testing links

We also ask people where they live and if there is a member who lives close by we contact that person to see if they would be willing to go to the new person's house and teach them how to test.

We do this as not all vets are onboard with a person home testing their cat. There have actually been vets who forbade their clients from home testing. We have heard everything from you will hurt your cat to you have munchausen by proxy and are going to cause all kinds of problems for your cat.

 

As an example of the sort of thing that happens here, though more dramatic than usual, see
http://www.felinediabetes.com/FDMB/view ... f=9&t=1622

The thread starts off very normally - an owner giving insulin for the first time and also learning to test at the same time - then it gets very edge-of-your-chair. (It comes out OK - the kitty is fine today.)

If any of the devices you are thinking of could help this sort of user, this would be wonderful.

 

I'm baaack! It appears that this audience is very diverse, even someone from my home state of Maine--go Pine Tree State! I've been working to get some of these innovative technology companies to work with me, and have had some success, given the potential market. So let's talk about the delivery device. For some background...my first job out of B-School was working at ALZA, a drug delivery company. My focus was non-traditional delivery of protein drugs, especially iontophoretic delivery (transdermal delivery using low level electric current. We had a lot of materials problems 20 years ago--protein drugs like insulin are very sticky and don't like to leave their surfaces inside the patch. Insulin is very sticky and six molecules stick together and form hexamers, so I even went to Baagsvaerd, Denmark, to the home of Novo Nordisk to see their new monomeric insulin that could be delivered with less molecular stickiness. I also spent time at Eli Lilly looking for new insulin molecules, and that began my fascination with the drug.

The delivery device is s combination of a small, low profile, plastic chamber with a micro catheter tip that goes subcutaneously like you do now with a syringe. The adhesive is designed to last 3 days on humans, and you fill it with your own insulin. The battery is used to pulse a metered dose with a light touch. It is fully disposable. No clinical trials for animals needed, and it is intended to be a consumer device for humans. A couple of issues are the adhesive--can you get good contact after clipping the fur, and how long will it or can it stay in place. I have no data on possible skin irritation in cats versus humans. I once wore an experimental patch at ALZA for seven days to test for irritation-heck $20/day was pretty good back then! For people it will be disposed of after use, but it may be reusable as a Veterinary delivery system and refilled. If it can be refilled, or even attached to a collar??, you can probably see the price being an extra $2/day max, but could be much cheaper depending on the volume savings in manufacturing. However, much of that cost might be in post manufacturing associated with FDA requirements.

The company is interested in trying it in a few feline patients, so stay tuned if you live close to San Jose. Several other similar devices like this are being developed, and I am exploring them as well. The main regulatory issue is to be able to make sure that any unit for animal use never gets into the human distribution channel, since we live in a litigious society. In the mean time they have asked me to characterize the market, and you folks have already helped tremendously.

Michael

 

Devil's advocate here...


Dosing with a light touch? That sounds dangerous...the animal could lean against something or hit the device themselves, no?

Also, what happens if the dose has to be decreased or raised during the time that the device is being worn?

What is the benefit of this device versus shots? The shots are often the easy part of treatment. Home testing and food is often more difficult than giving the shot.

I'm certainly not putting the kibosh on it, but there is no way I would be using that on a cat that was in my charge.

 

That came immediately to my mind too Vic. My elderly diabetic Ennis does little but lay around all day. I can't imagine a location on his body where such a device could be placed that he wouldn't roll onto it.

 

Please, Mike, if tests are done on any cat be sure to get us a description of the effort. I think we will be most amused. Video would be good.

 

Aside from the aforementioned problems I would be nervous because of the inconsistent manner in which cats eat (often picky) and regurgitate a lot (some to many). The pumps I know of still require the human to calculate the bolus. Skin wise cats have really thin skin and many have skin issues already. Now what I can see a great need for are administration and testing devices that can be easily be used by disabled folks. Folks who have manual dexterity and eyesight issues. This is a challenge and these folks often have companion cats. They come on here and though there are a couple of things on the market, they are not really sufficiently well designed IMO for people with more significant problems. That may not fit in here but its something I don't think is sufficiently addressed even for humans who are not pump candidates.

Also dosing for cats even on tight regulation protocols seems to differ quite a bit from humans. Just not sure it would be as helpful of a crossover as things like I mentioned above. Truly testing fear and inability are, for cats' owners' IMO, much more an area where strides could be made so that more people do it and would really be a boon to the population as a whole as well as improving owner stress levels and overall management.

 

All good points, but the light touch is a positive click. Nothing coincidental as far as dosing, otherwise people would have the same issue. There are several other similar devices that may be more appropriate, but having lived through the early days of transdermal and subdermal drug delivery in humans, I try to keep and open mind. ALZA paved the way for many other companies and technologies.

The meter I am looking at is basically like a training computer for jogging or biking. All data stored and downloaded to a computer to analyze metabolic parameters. Keep challenging me as I find out new things. You Tube is a great idea!

Thanks--Michael

 

So it would both test and dose? Would it be able to test without dosing?

 

So in my Magic Kingdom, I'd like to have a device that is somehow attached or implanted in/on the cat in a manner that they wouldn't be inclined to lick/scratch/rub off, nor have one of their feline cohorts do so on their behalf (conspiracies are rampant in my household :smile: ).

I'd like said device to read the blood glucose value as well as let me give a dose of insulin ... but, wait for it ... I'd like to do it remotely via a handheld device. In other words, push a button to get a BG reading, push a different button to administer a dose of insulin (in minute increments, if need be), and be able to programmatically limit the frequency with which you can dose (so as to prevent accidental overdosing -- I'm thinking along the lines of how you get IV morphine in the hospital -- you can push the button as often as you want, but the device only administers if a set amount of time has passed since the previous dose). For those working with a sliding scale, you'd want to be able to change the dosage of each shot.

My logic for this magical hand-held remote device is that it would be a godsend for those with ferals or fractious cats, would help with gathering BG data, and maybe needle-phobes would be more inclined to give it a try. It would also save my back when Chip climbs behind the furniture or under the plantstand just prior to shot time and lays there lazily looking at me as if to say "what, you need something??" (I swear he takes humor in doing this to me, but that's another story).

The device would also need to assess whether it's still properly implanted/installed on the cat and warn if there was a potential problem.

Of course, you've mentioned nothing about remote monitoring or dosing ... so I'm not really answering your questions. But, it would be handy. Just remember to put a "locator" button on it for all of us who tend to misplace things. :mrgreen:

Seriously, though, I'd be concerned about any device that would automatically dose or that is externally attached to the cat. Charlie removed two feeding tubes on his own, despite wearing the vet-provided sweater and careful monitoring on my part. And he was an older, mellow cat at the time. So there'd have to be a creative and safe strategy involved for avoiding infection, minimizing the likelihood of losing/ripping the device off, and safety mechanisms to prevent unintentional dosing.

ETA: I'm probably stating a given...but the insulin reservoir would need to be made of a "neutral" material that doesn't affect the efficacy of the insulin -- i.e., for Lantus (glargine), you're not supposed to pre-load syringes due to the coating on the interior of the syringe.

Just my two cents...

 

Neutral materials are key for sticky, charged molecules like insulin. Wireless sensing is possible with biosensor chips from Proteus, under development for many different drugs. Meters with a wireless chip to download are possible, since chips are cheap. Digital to USB is probably first generation--take a look at the Garmin Cycling Computers like the Forerunner 305 on Amazon.

MJS

 

I've have been working on something myself......Not nearly as high tech! I wanted to develop a simple insulin pen that like the one for humans you dial in the dose and push the button. It would be able to dose in .25U increments, with reasonable accuracy (precision). Could also be useful for small children or diabetic babies. I think Novo Nordisk has a refillable pen (Novo Junior) for thier insulin Aspart that can dose in half-units.

Ideally would be for all diabetics or people with endocrine disorders (thyroid, adrenal disorders...) a implantable device that mimics the biofeedback mechanisms (hypothalmic/pituitary/endocrine gland) of the organism allowing for almost perfect homeostasis. Such an advancement would be seen as as close as it gets to a cure. In cases where a genetic cause could be identified the logical "cure" would likely be something in the growing field of gene replacement therapy.

I certainly would be interested in seeing examples of such new technologies and details of how they work in practice. I'm thinking that the major drawback is going to be the cost. Although when they become more popular it could lower the cost of the current supplies (meters, tests trips, syringes) which would be considered outdated old school materials

Many years ago I worked in Maine........Hope I don't get stoned......Jackson labs :roll: I was also at University of New England School of Medicine.

 

Hi Dr. Mike,

Great to see that someone is thinking about insulin delivery and glucose monitoring in cats. Like you have already heard, many cats are euthanized upon diagnosis.

As a cat rescuer, I now have 4 diabetic cats in my home - 2 adopted and 2 that are fosters. Tomorrow I will take another diabetic foster from Maine!

Two of my cats are easy to test 4 times a day. The other two, well let's say they are not enthused, and sometimes I need help to test them. Because I'm a human diabetic diagnosed in the 70s, I'm not skittish about testing or shots.

Are you basically looking at a miniature Ipod type device? I'm just wondering where I could attach it that my felines wouldn't promptly remove it.

I'm looking forward to hearing about your progress. Can't participate from South Shore in Massachusetts :sad:

 

Dr. Mike,

ohmygod_smile Take a look at the stats on your topic. You've had an amazing number of posts and views in the last couple of hours.

Has to tell you that what your researching is very valuable to our members.

Claudia

 

I don't know the full details, but my specialist vet at one point had told me they had ordered and were expecting soon some kind of device for doing in-house BG curves for fractious cats. She said something is implanted or something like that, and then they "wave a wand in front of it" or something to get the reading. Did not sound priced for home use, but still I liked the idea of the "magic wand". That was VMS in Campbell if anyone is curious to call & ask, but again I don't know the full scoop on it.

 

A year or so ago I posted an vet FD article that included use of a temporary, embedded glucose monitor that transmits to a receiver. I can't find the info now though.

 

Here's something interesting
http://www3.interscience.wiley.com/cgi-bin/fulltext/120715482/PDFSTART

Hopefully the link works

 

Interesting, thanks for posting that link! Here is the info I have seen before:

http://www.kbvetcenter.com/resources/CGMS.pdf

I did a quick Google and am seeing this come up as a topic (continuous glucose monitoring in felines) a lot more than the last time I checked a year or so ago. Good news... progress is coming, slowly but surely!

 

Hi
Some of us with older cats may find that they are less likely to pick at something. Fred is so much less mobile he would totally leave a patch alone.

Any device needs to have fraction doses, not just whole units--that's the problem with the human pens. So ideally something where the dose should be 1.0, 1.2, 1.4, 1.5, 1.6, etc. I have needles with 1/2 unit markings and give fractions of doses between the lines, depending on Fred's numbers.

I've probably been to 7 or 8 vets in the past 4 years since Fred was diagnosed (I usually take him to a different one when we travel since blood tests are cheaper outside of NYC), nearly all do NOT rec. blood testing, although they tend to compliment me on the fact that I do. None of them have known anything about cat nutrition--no grain, lowcarb, wet vs dried etc. A few have been open to my providing them info. I've also always volunteered at my regular vet to help any of his patients who need help--I've never been called. It's pretty pathetic and disheartening. I'm now finding the same thing with CRF and it's hard to know if there is a vet whom you can trust that they actually have expertise, not just general knowledge about these diseases. They also tend to dismiss what they don't want to hear. For example, I'm now using 26 gauge needles to give Fred sub cut. fluids. HE doesn't feel the needle, the water goes in slow and absorbs as it goes in (no huge lumps of water). The vets use 18 and I had to argue to insist, when they were showing me how to do it, to use soemthing smaller. I got them to use a 21 and then once I started doing it experiemented with smaller and smaller needles. I bet many of the kitties who have a problem with the needles would accept it with smaller needles--but the vets just want something fast for them, not what's best for the cat.

The home testing was scary at first. Two wonderful members on this board called me and talked to me about both the testing and the insulin needles, etc. I also hired a vet tech to come over for 3 days in a row to do it while I watched. It's all very easy now, test+ shot takesa bout 5 minutes. The blood test adds 30 seconds to the process--so there is NO excuse for vets to not tell every cat owner to do it.