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Cats, Diabetes and Stress!

The problem of stress hyperglycaemia has been recognised in both human and veterinary medicine for many years. Among the domestic species we commonly deal with, cats appear particularly predisposed to develop this condition. The major problem this causes is in the diagnosis of diabetes mellitus. The finding of hyperglycaemia, even marked hyperglycaemia with concomitant glucosuria, is not diagnostic of diabetes mellitus in this species, even in the presence of appropriate clinical signs. Other diseases can clearly mimic the clinical picture seen with diabetes mellitus, cats suffering with stress hyperglycaemia can certainly have blood glucose concentrations well above the renal threshold, and in some cats this hyperglycaemia appears to be maintained for a few days. Demonstration of persistent hyperglycaemia is therefore required to make a diagnosis of diabetes, either through continued monitoring of the hyperglycaemic patient and/or through retrospective demonstration of hyperglycaemia (by the measurement of glycated haemoglobin or fructosamine concentrations). One of the curiosities of stress hyperglycaemia is the unpredictability of the phenomenon. Some cats which appear overtly ‘stressed’ have normoglycaemia, whereas others that appear ‘calm’ may develop severe hyperglycaemia. This may reflect the considerable challenge of the clinical and inevitably subjective assessment of ‘stress’, as well as inherent individual variations between cats. Despite the recognition of the feline predisposition to stress hyperglycaemia, until very recently there was very little data to suggest what causes this change. In the past, many clinicians have assumed that the counter-regulatory effect of ‘stress hormones’ such as catecholamines and glucocorticoids may induce peripheral insulin resistance and thereby cause the hyperglycaemia, but this phenomenon has now been the subject of some direct investigations by Drs Feldhahn, Rand and Kinnaird of the University of Sydney in Australia. They report some of their findings in this issue of the Journal of Feline Medicine and Surgery, and in a well conducted study they were able to show that the magnitude of stress hyper-