Starting & monitoring cats on Senvelgo^®

Before starting Senvelgo^®, the cat should be eating, drinking, interacting normally, hydrated and not showing any signs of DKA (or have any ketones present), with no evidence of clinical pancreatitis, cachexia or chronic diarrhoea. We call these ‘happy diabetic’ patients.

Start Senvelgo^® at 1 mg/kg once daily

Start Senvelgo^® at 1 mg/kg once daily (according to bodyweight syringe markings) either directly by mouth or with a small amount of food so that the entire dose is taken at once.

The priority in the first 2 weeks

The priority in the first 2 weeks is to monitor the cat for ketosis/DKA/eDKA to identify those cats who might not have enough endogenous insulin production:

• The owner should check for ketones at home every 1-3 days
• Check the cat in the clinic 1 week and 2 weeks after starting treatment to check they are healthy and not ketotic (assess history, perform a physical examination and check for ketones)

If ketones are detected

If ketones are detected, or the cat becomes unwell then suspend Senvelgo^®, investigate further and manage accordingly for ketosis/DKA/eDKA and concomitant conditions. Only restart Senvelgo^® if appropriate. We recommend contacting our Technical Services Team for advice with managing these cases and to discuss whether it is appropriate to resume Senvelgo^® treatment.

Four weeks after starting treatment

At 4 weeks after starting treatment, check the cat at the clinic:

• Clinical control (e.g. thirst, appetite, physical examination, hydration status, bodyweight)
• Glycaemic control (e.g. fructosamine)
• Urinalysis (check for ketones and UTI)

Long-term monitoring

Thereafter, check the cat routinely every 3 months in the clinic according to standard diabetes treatment guidelines, including clinical & glycaemic control and urinalysis (to check for ketones and for UTIs).

The owners should develop a habit of routinely monitoring their cat for signs of illness and checking for urine ketones if any concerns.

Diabetes management flowchart

a. Cats previously treated with insulin may be at higher risk for DKA & should be monitored closely when starting treatment. If transitioning from insulin, omit the insulin evening dose the day before starting Senvelgo^® treatment.

b. Soluble insulin & intravenous fluid therapy required to resolve ketoacidosis (supplement with glucose/dextrose if blood glucose <15 mmol/l).

c. A small proportion of cats may not respond adequately to Senvelgo^® treatment due to true insulin deficiency, so long-term treatment with insulin may be required in these cases.

What do I need to know about using Senvelgo^® & ketoacidosis?

Senvelgo^® manages diabetes in a different way to insulin treatment: by causing urinary excretion of excess glucose to reduce hyperglycaemia. This controls clinical signs and reduces glucose toxicity, improving endogenous insulin production whilst also increasing peripheral insulin sensitivity.

It is important to remember, however, that not all diabetic cats are able to produce enough endogenous insulin to prevent catabolic processes and suppress ketogenesis (especially in the early stages of treatment). A small proportion of diabetic cats are therefore at risk of developing ketoacidosis despite treatment with Senvelgo^® since they are not receiving exogenous insulin. If a cat does develop DKA they will usually present with eDKA, and therefore have normal glucose levels.

This is why it is important to monitor for ketones, especially in the first few weeks of treatment before glucose toxicity is controlled and endogenous insulin secretion and sensitivity increases. By monitoring regularly the goal is to identify these cats at the ketotic stage, before they become unwell.

Please refer to the treatment guidelines and flowchart above for a simple guide on how to identify cats at risk of ketoacidosis, and how to monitor for ketones after starting Senvelgo^®.