Bexagliflozin and Velagliflozin: How to Manage Your Cat's Diabetes Effectively

Feline SGLT-2 inhibitors mark a revolutionary step in treating diabetes mellitus in cats. This new class of FDA-approved oral medications, including drugs like bexagliflozin (Bexacat™) and velagliflozin (Senvelgo®), offers a different approach to managing this common feline condition. Traditionally reliant on insulin therapy, the introduction of SGLT-2 inhibitors changes the landscape of managing diabetes in cats. These drugs work by increasing glucose excretion in the urine, thereby improving blood glucose control without the need for insulin injections. Continue reading to learn more about how bexagliflozin and velagliflozin can help your cat with diabetes.

How do bexagliflozin and velagliflozin work in cats?

Drugs like Bexacat™ (bexagliflozin) and Senvelgo® (velagliflozin) are SGLT-2 inhibitors which stand for Sodium-Glucose Cotransporter-2.

SGLT proteins help move glucose across cell walls, mainly in the small tubes in the kidneys. Among these proteins, the SGLT-2 protein is very important because it helps to reabsorb glucose from the kidneys and back into the blood, therefore increasing blood sugar levels.

SGLT-2 inhibitors work by blocking this glucose reabsorption process in the kidneys.

Instead of glucose being reabsorbed, these drugs such as bexagliflozin and velagliflozin cause it to be excreted in the urine, effectively reducing blood glucose levels.

This mechanism offers a unique advantage in managing diabetes, particularly in cats. Unlike traditional insulin therapy, which requires careful monitoring to avoid hypoglycemia, SGLT-2 inhibitors lower glucose levels in the bloodstream without significantly increasing the risk of hypoglycemia.

This is because another protein, the SGLT1 protein, continues to absorb some glucose, preventing blood sugar levels from dropping too low.

With the FDA's approval of drugs like bexagliflozin and velagliflozin, we now have more tools at our disposal for treating diabetes in cats. These drugs have shown promise in clinical trials, revealing significant improvements in blood glucose levels and overall diabetic symptoms in cats.

What are the benefits of Bexacat™ (bexagliflozin) and Senvelgo® (velagliflozin) for cats?

The introduction of SGLT-2 inhibitors in the treatment of feline diabetes mellitus has brought forth several benefits, making them an amazing option for many cats. Below we will explore the main benefits of choosing one of these drugs when treating your cat with diabetes.

Improved glycemic control

• SGLT-2 inhibitors effectively lower blood glucose levels by increasing the excretion of glucose in urine.
• This action helps in maintaining a more stable and normal range of blood glucose, which is important for the management of diabetic cats.

Reduced risk of hypoglycemia

• Unlike insulin therapy, SGLT-2 inhibitors have a lower risk of causing hypoglycemia (dangerously low blood sugar levels).
• This reduced risk makes them a safer option, especially for cats that may not be closely monitored throughout the day.

Ease of administration

• Being oral medications, SGLT-2 inhibitors are easier to administer compared to insulin injections.
• It's only administered once daily, every 24 hours,
• This ease of administration is particularly beneficial for cat owners who may find it challenging to administer injections.

Weight management and overall health

• These medications can contribute to weight loss and better weight management in obese or overweight diabetic cats, a common issue in feline diabetes.
• Improved weight management can lead to better overall health for diabetic cats.

Positive impact on diabetic symptoms

• SGLT-2 inhibitors have been shown to improve the symptoms of diabetes mellitus in cats, such as excessive thirst (polydipsia), increased urination (polyuria), and increased hunger (polyphagia).
• The plantigrade stance often seen in diabetic cats typically resolves (80% of cases).
• It can take 1-3 months before the maximum effect is noticed, where there is a considerable reduction in symptoms.

What are the potential side effects and risks?

The most common side effects noticed when your cat takes one of these medications include:

• Diarrhea
• Vomiting
• Reduced appetite
• Urinary tract infections

The most common of these side effects is diarrhea which occurs in approximately half of all cats but fortunately, this symptom is usually transient and self-limiting, creating a conducive environment for bacteria to thrive.

What about the hypoglycemia? Isn't that a potential adverse effect?

Interestingly, studies have revealed that for cats taking the recommended dose, none of them experienced hypoglycemia.

One of the greatest risk factors when treating cat diabetes with SGLT-2 inhibitors is the potential to develop Diabetic Ketoacidosis (DKA). While it only occurs in approximately 10% of cats, it can be serious when it does.

Normally DKA will develop when blood glucose is too high and the body starts using ketones as an energy source. The resulting build-up of ketones in the bloodstream can cause DKA.

Cats on Bexacat™ or Senvelgo® often have normal levels of blood glucose so how do they develop DKA? We call this 'euDKA' and it occurs because the cat is not receiving any insulin therapy. You need active insulin to prevent ketone production.

If your cat does develop DKA, it is important to stop the SGLT-2 inhibitor you are using and start insulin therapy as directed by your veterinarian.

If you notice that your cat starts to eat less, feels tired, becomes dehydrated, or loses weight, you should see your veterinarian right away so that they can check for DKA.

How should cats be monitored when on Bexacat™ or Senvelgo®?

Cats that are on SGLT-2 inhibitors require thorough monitoring, especially at the beginning of their treatment.

During treatment, it's very important to regularly monitor clinical signs, blood glucose levels, fructosamine, ketones, and body weight.

On the second or third day after beginning the medication, ketone levels should be evaluated either at home or at your veterinary office. If checking at home, the only meter that is calibrated for cats is the Precision Xtra ketone monitor.

An 8-10 hour glucose curve should ideally be performed once your cat shows signs of improvement on Bexacat® or Senvelgo® to confirm control. Afterward, if your cat's diabetes symptoms are managed and the cat is in good health, a serum fructosamine test may be sufficient.

The fructosamine test is a great option because it is a single blood collection and measures the average blood glucose in the preceding 2-3 weeks.

When should you not use an SGLT-2 inhibitor in your diabetic cat?

While Bexacat™ and Senvelgo® are great options for newly diagnosed diabetic cats, some factors could potentially exclude your cat from using them.

Here are the criteria that we look for when considering an SGLT-2 inhibitor (bexagliflozin or velagliflozin) in diabetic cats:

1. Newly diagnostic diabetic
2. Has not yet received traditional insulin therapy
3. No history of ketosis or diabetic ketoacidosis (DKA)
4. No uncontrolled concurrent diseases (e.g. hyperthyroidism)
5. No signs of dehydration
6. In good body condition

If your cat does not pass these criteria, it may be best to treat your diabetic cat with traditional insulin.

Can cats become hypoglycemic when taking an SGLT-2 inhibitor?

It would be rare for a cat to become hypoglycemic on this medication and at recommended doses.

Blocking SGLT-2 prevents approximately 90% of the glucose from being reabsorbed back into the body but SGLT-1 reabsorbs 10% of the filtered glucose.

As SGLT-1 is not inhibited, there will always be some glucose that is filtered and reabsorbed back into the bloodstream, thereby preventing hypoglycemia.

In conclusion, SGLT-2 inhibitors like Bexacat™ and Senvelgo® offer a promising alternative to insulin for managing feline diabetes, particularly for newly diagnosed cats. These oral medications are less likely to cause hypoglycemia and are easier to administer, supporting better weight management and overall health. They are effective in reducing diabetic symptoms but require careful monitoring for side effects such as diarrhea, vomiting, and the uncommon yet serious risk of diabetic ketoacidosis (DKA). Regular vet checks, blood glucose, and ketone level monitoring are important monitoring. However, these medications are not suitable for cats with certain pre-existing conditions, who have already started insulin therapy, or who have experienced ketoacidosis.

We hope this guide is helpful and we encourage you to reach out to your veterinarian if you have any further questions. If you have a diabetic cat in Kitchener-Waterloo and would like personalized, expert care, please visit us here at Kingsdale Animal Hospital.