Using SENVELGO (velagliflozin oral solution) to Treat Feline Diabetes Mellitus

The Product

SENVELGO (velagliflozin oral solution) is a medication to improve glycemic control in naive, otherwise healthy cats with diabetes mellitus. This sodium–glucose cotransporter 2 inhibitor blocks reabsorption of glucose by the kidney, increasing glucose excretion and lowering blood glucose levels. The drug is not intended for cats that are diagnosed with insulin-dependent diabetes mellitus.

SENVELGO oral solution can simplify feline diabetes management. Benefits include:

• Effective glycemic control — SENVELGO oral solution has minimal risk of clinical hypoglycemia and establishes effective glycemic control as soon as one week after treatment starts.
• Oral administration — The liquid is administered directly in the cat’s mouth or applied to a small amount of wet food daily.
• Easy storage — It doesn’t require refrigeration before or after opening and has a six-month shelf life once opened.

Presentation and Relevant History

A hypothetical 6-year-old domestic shorthair cat presented for increased water consumption and a marked increase in urine frequency. The owner reported the cat was in good overall health with a normal appetite. At a routine evaluation eight months previously, the cat’s physical exam and laboratory results revealed no abnormalities.

Diagnostic Picture

The cat had no significant findings on physical examination. However, despite a body condition score of 3/5, it had lost 0.3 kg since the previous visit, which was considered significant because the owner reported it had a normal appetite.

A complete blood count, serum biochemistry and urinalysis revealed hyperglycemia at 423 mg/dL and marked glucosuria (i.e., 4+ on a urine dipstick). The cat’s serum fructosamine concentration was also elevated at 506 μmol/L. The cat was diagnosed with diabetes mellitus, based on clinical signs and laboratory findings.

Treatment

The cat was healthy prior to developing diabetes, and blood work showed no increases in renal or hepatic values and no evidence of anemia, inflammation or other hematologic problems. The cat also showed no evidence of ketosis or diabetic ketoacidosis based on blood beta-hydroxybutyrate and serum bicarbonate values. Based on this, the cat was started on SENVELGO oral solution at 1 mg/kg once daily.

Patient Response

The veterinary team monitored the cat’s response to the treatment by assessing clinical signs, blood ketone concentration and glycemic control. Initial rechecks included:

• Three-day recheck — The owner reported that the cat continued to eat and act normally and had received all the medication doses. The cat’s water consumption and urine frequency were unchanged, physical examination was unremarkable and body weight also was unchanged. The cat’s blood beta-hydroxybutyrate was 1.3 mmol/L and the mean glucose was 298 mg/dL, which indicated that the cat was responding well to treatment.
• One-week recheck — The owner reported that the polydipsia and polyuria were improved, and the cat continued to do well. The physical examination was unremarkable, except for a slight body weight increase. The cat’s urine ketones were negative, mean glucose was 178 mg/dL and blood beta-hydroxybutyrate was 0.8 mmol/L. The overall assessment indicated an excellent clinical response.
• Two-week recheck — The cat continued to thrive after two weeks. The physical examination was normal, blood beta-hydroxybutyrate was stable and mean glucose was 185 mg/dL.
• Four-week recheck — The cat remained stable at the four-week recheck, with markedly improved clinical signs and excellent glucose control. Serum fructosamine was 280 μmol/L, consistent with stable glycemia.

Next Steps

Careful monitoring and follow-up are important for any diabetic cat, whether they are treated with insulin or SENVELGO® (velagliflozin liquid oral solution), but the monitoring strategy for cats receiving SENVELGO oral solution prioritizes ketone monitoring.

SENVELGO oral solution lowers glucose through an insulin-independent mechanism and does not mimic insulin action in any way. This means the drug is effective only when endogenous insulin production is sufficient to prevent ketoacidosis.

The need for close ketone monitoring is underscored by euglycemic diabetic ketoacidosis, a variation of ketoacidosis that develops in an insulin-deficient patient with normal or near-normal blood glucose. Although rare, this can occur in a cat treated with SENVELGO oral solution, because renal glucose excretion is enhanced. Current guidelines recommend stopping this treatment if a diabetic cat develops ketosis or ketoacidosis.

Less intensive monitoring of glucose measurement and glycated protein measurement is needed in stabilized cats treated with SENVELGO oral solution, because following rapidly reduced blood glucose, the drug tends to produce a stable and flat glucose curve, making hypoglycemia an unlikely complication.

Conclusion

SENVELGO oral solution is an excellent option for newly diagnosed diabetic cats who are otherwise healthy, but careful monitoring of ketones and clinical signs of diabetes mellitus are critical. The monitoring plan should be tailored to fit the patient’s goals and targets.

IMPORTANT SAFETY INFORMATION: SENVELGO® (velagliflozin oral solution) is indicated to improve glycemic control in otherwise healthy cats with diabetes mellitus not previously treated with insulin. Before using this product, it is important to read the entire product insert, including the boxed warning.

Cats treated with SENVELGO may be at an increased risk of diabetic ketoacidosis or euglycemic diabetic ketoacidosis, both of which may result in death. Development of these conditions should be treated promptly, including insulin administration and discontinuation of SENVELGO.

Do not use SENVELGO in cats with diabetes mellitus who have previously been treated with insulin, who are receiving insulin, or in cats with insulin-dependent diabetes mellitus. The use of SENVELGO in cats with insulin-dependent diabetes mellitus, or the withdrawal of insulin and initiation of SENVELGO, is associated with an increased risk of diabetic ketoacidosis or euglycemic diabetic ketoacidosis and death.

Sudden onset of hyporexia/anorexia, lethargy, dehydration, or weight loss in cats receiving SENVELGO should prompt immediate discontinuation of SENVELGO and assessment for diabetic ketoacidosis, regardless of blood glucose level. SENVELGO should not be initiated in cats with ketonuria, ketonemia, pancreatitis, anorexia, dehydration, or lethargy at the time of diagnosis of diabetes mellitus, as it may indicate the presence of other concurrent disease and increase the risk of diabetic ketoacidosis.

Keep SENVELGO in a secure location out of reach of children, dogs, cats, and other animals to avoid accidental ingestion or overdose. For more information, please refer to the enclosed package insert or visit SENVELGOClinic.com.

SENVELGO® is a registered trademark of Boehringer Ingelheim Vetmedica GmbH, used under license. ©2024 Boehringer Ingelheim Animal Health USA Inc., Duluth, GA. All rights reserved. US-PET-0607-2024