3/27/26 Academic journal article: Use of an Automated Delivery System in a Cat with Diabetes Mellitus

Mary & Jude

Mary & Jude

Member Since 2024
Link: https://academic.oup.com/jvim/article/40/1/aalaf001/8432917?login=false


Abstract​

Diabetes mellitus (DM) in cats is commonly managed with insulin injections and glycemic control is assessed with glucose monitoring systems. Automated insulin delivery (AID) systems, which integrate a continuous glucose monitoring system with an insulin pump controlled by a set algorithm, are successful in managing type 1 DM in humans but have not been reported in cats until now. Here, the use of an AID system is described in an 11-year-old cat with DM. After an initial 6 days of treatment with twice daily administration of protamine zinc insulin and insulin glargine, the AID was applied and managed by the cat owner. The system rapidly improved glycemic control and remission of DM was achieved. Throughout the application period, the AID system was well tolerated by the cat. This case suggests that AID systems can be used in diabetic cats and that they might improve glycemic control.
 
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Thanks for sharing Mary! My wheels are turning, the tech nerd that I am. I’ll write out some thoughts.
  • Adhesive used to hold the pump on, I know there are issues with adhesives and the Libres damaging skin. Would be worried about that.
  • It does seem like some cats that show up here go into remission more easily than others. Could the cat in the study have been one of the quick cases and their success not be necessarily related to this treatment technique? We’d probably want to see a remission rate from a bigger sample size. Certainly can’t conclude yet that remission rate is greater using the AID, which I don’t think they are.
  • $1,050 for the month long experiment. So can we assume that’s roughly what it would cost per month after that? If so, that’s quite a bit more expensive than Lantus and a ReliOn meter.
  • How long does a pump last?
Not taking away from the caregiver who contributed. That took some work. I think there are certainly benefits to a system like this and if it saves cats from being euthanized too, that’s awesome. As long as it has good safety protocols in place and is feasible for people cost-wise.
 
I think that the adhesive issue is easily resolved, as we've seen people here resolve it. We've learned here that the adhesive of the CGM is all that is needed + a t-shirt or bandage to cover the monitors.

Yes, the small sample size of one is certainly problematic in terms of drawing broad conclusions. I think the point of this research/study is to introduce a new alternative to modulating blood glucose in FD patients. I hope this is a new procedure that is introduced to other kitties. The end-goal seems to be holding kitties steady in good bg numbers, and we know that tends to lead to remission.

I don't think the cost would extend too much beyond remission. This cat spent about two months with monitoring, etc. After that, it was in remission with only the costs of monthly testing, I assume.

How long a pump will last is likely something that is an unknown, since this is an apparatus made for humans now being used on a non-human mammal. We've seen issues with CGMs, made for humans--they tend to fail frequently on kitties. I'm not sure how the failure rate compares to humans.

Besides the possible failures of the CGM and AID, to me, the more difficult aspect would be setting the algorithms in the AID. I suspect since humans do this with AIDs, though, maybe it's not as difficult as I'm imagining. It's just not something I'm familiar with.

AIDS/CGMs work very well for humans. Even if a kitty doesn't go into remission, I think about the freedom the devices offer for hands off monitoring. If I were at work, Jude would be monitored by the CGM, and administered insulin by the AID. That would be a huge relief to me.
 
Tim & Pookey said:
Thanks for sharing Mary! My wheels are turning, the tech nerd that I am. I’ll write out some thoughts.
  • Adhesive used to hold the pump on, I know there are issues with adhesives and the Libres damaging skin. Would be worried about that.
  • It does seem like some cats that show up here go into remission more easily than others. Could the cat in the study have been one of the quick cases and their success not be necessarily related to this treatment technique? We’d probably want to see a remission rate from a bigger sample size. Certainly can’t conclude yet that remission rate is greater using the AID, which I don’t think they are.
  • $1,050 for the month long experiment. So can we assume that’s roughly what it would cost per month after that? If so, that’s quite a bit more expensive than Lantus and a ReliOn meter.
  • How long does a pump last?
Not taking away from the caregiver who contributed. That took some work. I think there are certainly benefits to a system like this and if it saves cats from being euthanized too, that’s awesome. As long as it has good safety protocols in place and is feasible for people cost-wise.
Click to expand...
I have personal experience with this. The device used in the study is a “Pod” and in humans it must be changed every 3 days. It holds 200 units of insulin. Not sure what they did in the study case, I don’t think it was mentioned. It also has to be used in conjunction with a CGM (dexcom) which means you would have 2 devices on a cat constantly which could become cumbersome for some kitties.

The other thing that would be of concern to me is that it works with regular (fast acting) insulin and I don’t know that too much in the way of studies have been done of how cats do on it long term.

As Mary mentions, calculating the correct dose according to a cats insulin sensitivity rate to set the algorithm would be difficult since their metabolism is so different from a human. I think the technology is amazing and if it could be used to help FD cats that would be awesome.
 
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Mary & Jude said:
I don't think the cost would extend too much beyond remission.
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Yea, that’s what I mean like what if it never went into remission, that would be a lot of money…

Mary & Jude said:
Besides the possible failures of the CGM and AID, to me, the more difficult aspect would be setting the algorithms in the AID. I suspect since humans do this with AIDs, though, maybe it's not as difficult as I'm imagining. It's just not something I'm familiar with.
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Good point. Would there be a need for adjustments to the algorithm since ECID I wonder.
 
Tim & Pookey said:
Yea, that’s what I mean like what if it never went into remission, that would be a lot of money…
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For me, the benefit of having something monitor bg and administer insulin would be quite appealing. I could actually go somewhere and not have to be home every 12 hours to test/shoot. As it stands right now, that's not a possibility for me and hasn't been since Jude came out of remission.
 
Kat & Trixie said:
I have personal experience with this. The device used in the study is a “Pod” and in humans it must be changed every 3 days. It holds 200 units of insulin. Not sure what they did in the study case, I don’t think it was mentioned. It also has to be used in conjunction with a CGM (dexcom) which means you would have 2 devices on a cat constantly which could become cumbersome for some kitties.

The other thing that would be of concern to me is that it works with regular (fast acting) insulin and I don’t know that too much in the way of studies have been done of how cats do on it long term.

As Mary mentions, calculating the correct dose according to a cats insulin sensitivity rate to set the algorithm would be difficult since their metabolism is so different from a human. I think the technology is amazing and if it could be used to help for FD cats that would be awesome.
Click to expand...
Another thing to consider is that they have just released a new CGM that is implanted under the skin. It's changed out yearly. If that is something a cat could use, it would be much less cumbersome and require only the on-skin AID.
 
Very interesting. Thanks Mary for sharing this information.
My 2 cents on the adhesive that comes on the back of a with a Libre is it’s no big deal.
The caveat is that when vets apply surgical glue (a huge no no) is when we see all kinds of problems with shutting down a Libre and harming kitty’s skin.

Also, a more fragile skin situation, such as in a Cushing’s cat, would be of concern.

But for our “regular” FD kitties who use a CGM, if the skin is cared for with normal procedures and the Libre site is altered each and every time it’s installed, there “should be no issues”.

Of course ECID, and the cat parent must monitor skin condition and observe carefully to avoid any issues.

Great discussion everyone here 🥰
 
Mary & Jude said:
For me, the benefit of having something monitor bg and administer insulin would be quite appealing. I could actually go somewhere and not have to be home every 12 hours to test/shoot. As it stands right now, that's not a possibility for me and hasn't been since Jude came out of remission.
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For me is financially unavailable, but if it was is too new of a product ,I would be terrified that it malfunctions and administer too little or too much insulin which it would be worse, it could kill , I'm Old School, and is true what Mary says it is appealing, knowing that you don't have to be home to shoot or give insulin, I know it works great for humans because I know several people that uses it, but for a small little thing like our cats? has it been tested with enough felines? long enough to know is safe?
 
Something to note:
https://www.facebook.com/permalink.php?story_fbid=pfbid02jHWPQ4XKArnaLZ46PKwtkTCqBEXX4GMtMCpnDhN4gZhgJVq9jAzsp7Wj7HhAdikDl&id=100090112201784
This article is posted on the Facebook page VetEd. In the comments, the owner (Katja Jacob) of the cat (his name is Buddy) that was the subject of the study weighs in and says that one of the challenges and concerns of the AID is rotation of location site. Apparently, the AID has to be rotated every three days, and it's difficult to find new places while the other places are healing (unlike the CGM which is rotated less frequently and is much smaller). She said that this didn't become a problem for them, though, because Buddy was only on the AID for a couple of months.

Buddy is out of remission now after being in remission for two years. It's interesting to read her overall comments as well as the other comments on the post.
 
Mary & Jude said:
Something to note:
https://www.facebook.com/permalink.php?story_fbid=pfbid02jHWPQ4XKArnaLZ46PKwtkTCqBEXX4GMtMCpnDhN4gZhgJVq9jAzsp7Wj7HhAdikDl&id=100090112201784
This article is posted on the Facebook page VetEd. In the comments, the owner (Katja Jacob) of the cat (his name is Buddy) that was the subject of the study weighs in and says that one of the challenges and concerns of the AID is rotation of location site. Apparently, the AID has to be rotated every three days, and it's difficult to find new places while the other places are healing (unlike the CGM which is rotated less frequently and is much smaller). She said that this didn't become a problem for them, though, because Buddy was only on the AID for a couple of months.

Buddy is out of remission now after being in remission for two years. It's interesting to read her overall comments as well as the other comments on the post.
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Very interesting!
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