糖尿病貓的餵食

 

Feeding the Cat with Diabetes Mellitus

 

SUNDAY, JANUARY 6, 2013

 

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貓咪的消化代謝系統在演化下形成一種需要高水分,高蛋白質及低碳水化合物的特殊系統.他們依賴這個系統超過千百年,他們沒有有效消化碳水化合物的能力.下面我會就這點來談談為什麼選擇糖尿病貓的食物會這麼重要.
Evolutionary events shaped the cat’s core metabolism such that their systems are uniquely set up to metabolize a diet which is high in moisture, high in protein, and very low in carbohydrates. Because this is the diet they have relied upon for tens of thousands of years, they do not have the ability to process carbohydrates very efficiently (1-4). This becomes extremely important when selecting a diet for cats with diabetes, as I’ll discuss below.

貓咪的正常葡萄醣代謝與飯後血糖
Normal Glucose Metabolism and Postprandial Glycemia in Cats

所以貓咪演化出哪些獨特的適應機制以滿足肉食性動物的飲食?
So what are these specific feline adaptive mechanisms that have developed to meet the requirements of a carnivorous diet?
  • 第一,貓咪的糖異生路徑提供了一個不間斷的葡萄醣或能量產出
  • First, cat’s gluconeogenic pathway provides an almost continuous source of carbon skeletons for glucose or energy production.
  • 第二,葡萄醣激酶的濃度非常明顯的減少或甚至為零,但是己醣激酶活性升高.這跟人類或是狗這樣的雜食性動物的肝有很大的不同,因為雜食性動物的肝含有醣解酵素可以在醣解時催化葡萄糖的磷酸化
  • Secondly, glucokinase concentrations are markedly reduced or absent, whereas hexokinase activity is increased. This is in marked contrast to the liver of omnivores (dogs, man), which contains both glycolytic enzymes that act to catalyze the phosphorylation of glucose during glycolysis.
  • 最後,貓咪小腸的澱粉酶與醣解活性很低,這會降低與延後胰島素的分泌,因此延後胃排空
  • Finally, cats have reduced amylase and disaccarharide activity in the small intestine, reduced and delayed insulin secretion, and delayed gastric emptying (1-4).
這些的不同導致貓咪在被餵食高碳水化合物的食物後血糖降低的速度跟狗或人比起來比較慢,也就是說,就算正常的貓咪在餐後也會有一段長時間的高血糖.
As a result of these differences, plasma glucose clearance rates are longer in cats compared to dogs or humans after feeding a moderate to high carbohydrate meal — in other words, even normal cats have much more prolonged postprandial period of hyperglycemia than might be expected.

健康的人類與狗,餐後的高血糖通常為2到5個小時. 相對來說,最近的一個研究指出健康的貓咪在吃中度碳水化合路飲食(25%ME)後,不但會有高血糖還會有高濃度胰島素滯留約12小時,而且約20%的貓咪會有葡萄糖跟胰島素的濃度會高於基本值24小時的現象.大多數的貓食(尤其是乾飼料)含有甚至更多的碳水化合物,因此不意外這會造成更嚴重的餐後高血糖以及需要更久時間回到基本值.
In healthy humans and dogs, postprandial hyperglycemia normally persists for 2 to 5 hours (5-6). In contrast, a recent study of healthy cats found that both serum glucose and insulin concentrations remained significantly increased for a median time of 12 hours following ingestion of a moderate carbohydrate meal (25% ME), and that both glucose and insulin concentrations remained above baseline values for 24 hours in approximately 20% of the cats (7).  Most feline diets (especially dry foods) contain ever higher amounts of carbohydrate and therefore would be expected to result in more severe postprandial hyperglycemia and a longer time to return to baseline.

糖尿病貓的飲食控制是治療關鍵!
Dietary Management of Cats with Diabetes Mellitus: Key Part of Treatment!

有糖尿病的貓咪,最主要的治療目標是降低餐後高血糖的指數,這是經由餵食而降低beta細胞分泌胰島素,藉由此,我們可以降低"葡萄醣毒性"所造成的的反應,而且希望藉此讓胰島細胞恢復.
In cats with diabetes, a primary goal of therapy is to minimize the degree of hyperglycemia that develops after feeding in order to lessen the subsequent demand on beta-cells to secrete insulin. By doing this, we decrease the effect of “glucose toxicity” and allow the pancreatic islet cell to hopefully recover (8,9).

但是我們要如何做呢?很多專門研究貓醫學的獸醫早就知道一個"教條"就是餵食低碳水化合物的食物是治療糖尿病的中心主義,尤其是把緩解糖尿病嚴重性當作目標的時候.餵食低碳水化合物的飲食會改善胰島素敏感度,降低或是減少外源性的胰島素,以及幫助穩定葡萄醣代謝. 低碳水化合物飲食可以改善糖尿病的等級是因為可以幫助防止嚴重與長時間的餐後高血糖.
But how do we do this? It has long been known and is a well accepted “dogma” by most practicing veterinarians who specialize in feline medicine that feeding a low-carbohydrate diet is the mainstay in the treatment of diabetes mellitus, especially if remission of the diabetic state is the goal. Feeding a low carbohydrate diet will improve insulin sensitivity, reduce or eliminate the need for exogenous insulin, and help stabilize glucose metabolism in these cats (9-12). Again, one major way a low-carb diet improves the diabetic state is by helping to prevent severe and prolonged postprandial hyperglycemia.

越早對糖尿病貓進行低碳水化合物飲食越好. 低碳水化合物是指飲食中只含有少於10%的卡路里是來自碳水化合物.有些貓咪對於稍高的碳水化合物飲食(12-14%)的反應還好,但是有些貓咪最好是低於7%.
The sooner one starts the diabetic cat on a low-carbohydrate diet, the better. By “low-carb,” I mean a diet that provides less than 10% of the calories as carbohydrate. Some cats will do fine on a slightly higher-carb diet (12-14%) whereas others do best on a diet containing less than 7% carbohydrate.

要達到這些低碳水化合物等級,我們必須開始固定餵食自製鮮食或是罐頭.我會建議你去 Dr. Lisa Pierson的網站,你在首頁會看到"蛋白質/脂肪/碳水化合物 表"用以選擇適合的低碳水化合物飲食.
To achieve these low carbohydrate levels, we must formulate a homemade diet or feed a canned food. I'd recommend that one go to Dr. Lisa Pierson's website at www.catinfo.org. Once there, you should review the “Protein/Fat/Carbs Chart” on the sidebar of the homepage to select an appropriate low-carb diet.

沒有一個乾飼料符合低碳水化合物而且大部分的蛋白質都太低.最好限制糖尿病貓吃得乾飼料量,最好是不要吃.
None of the available dry cat foods are very low in carbohydrates and most are too low in protein. It’s best to limit the amount of dry food that is fed to diabetic cats, or even better, not feed dry food at all.

當我們降低貓食裡面的碳水化合物時,必須增加蛋白質或是脂肪或是兩者的含量.我喜歡兩者都曾家, 仿造他們在野外的獵物組成: 40-60%的蛋白質,剩下是脂肪.平均蛋白值越高可以幫助恢復及維持失去的肌肉質量,因為有很多糖尿病貓隨著年老會發展出肌肉萎縮或是肌少症.
When we reduce the content of carb in a cat food, we must raise the content of either protein or fat, or both. I like to do both, feeding my diabetic cats a diet that mimics the composition of their prey in the wild: about 40-60% of protein with the remaining amount in fat. This higher than average protein level also helps restore and maintain lost muscle mass, since many diabetic cats will develop muscle wasting or “sarcopenia” as they age (13-17).

糖尿病貓的飲食控制與緩解
Dietary Management of Diabetic Cats and Remission

餵食早期糖尿病的貓咪低碳水化合物,高蛋白質的另一個好處是這樣的飲食組成(結合胰島素治療)可以明顯改善糖尿病緩解速度.如果糖尿病貓已經達到緩解期(不需要胰島素以維持正常血糖),我們建議終生維持限制碳水化合物的飲食以幫助防止糖尿病復發.
Another plus for feeding low-carb, hi-protein diets in cats with relatively early diabetes is that this diet composition (together with insulin treatment) greatly improves the diabetic remission rate (18-20). If the diabetic cat goes into remission (no more insulin needed to maintain euglycemia), we recommend maintaining a restricted carbohydrate diet for life to help prevent relapse of the diabetic state.
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