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CANINE DIABETES

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Diabetes mellitus (DM) is one of the most common endocrine (hormonal) diseases of dogs.  Like in humans it is a chronic condition in which a deficiency of the hormone insulin impairs the dog's ability to metabolize sugar.  There are two types of diabetes - diabetes mellitus (or sugar diabetes) and diabetes insipidus. Diabetes mellitus is the most common and occurs when the pancreas does not produce enough insulin.  It is the insulin which converts sugar from digested foods into energy that the body tissues can use.  When there is insufficient insulin the sugar cannot be stored and this results in the sugar remaining in the blood and consequently being lost in the urine.  Diagnosing diabetes requires appropriate tests, such as a urinalysis (to detect spilled "sugar") and blood glucose determination.  Additional tests often are needed to assess the overall medical situation.  The disease cannot be cured but most dogs, once stabilised on daily injections and an appropriate diet can lead a full and active life.


Diabetes Mellitus  
The hard to Regulate Diabetic Pet
What is Diabetes Mellitus
Diabetes Mellitus in the Dog
Warning

Diabetes Mellitus

http://www.HealthyPets.com

What is diabetes mellitus?
Diabetes mellitus is a disease involving the pancreas. The pancreas is a small organ that lies along the small intestine near the stomach. It has two basic functions:

1. To produce digestive enzymes
2. To produce insulin. Insulin is the hormone that regulates blood glucose (or blood sugar) levels.

Diabetes mellitus occurs when the pancreas fails to produce enough insulin to control the dog's blood glucose levels. As a result, the blood glucose can become very high. Diabetic dogs require regular injections of insulin to control their blood glucose levels. Without it diabetes mellitus can be fatal.

This disease is relatively common in dogs. It is most often seen in middle-aged or older dogs. A congenital form of diabetes occurs in puppies, but it is very uncommon.

What are the signs of diabetes mellitus?
The signs of diabetes mellitus in dogs are:

Ravenous appetite
Weight loss (despite a good appetite and plenty of food)
Drinking larger than normal amounts of water
Increased urine production

Low insulin and high glucose levels in the bloodstream cause all these signs. Glucose is a key energy source for all types of cells. However, insulin is needed in order for the glucose to be able to enter the cells from the bloodstream. (Insulin has been described as the "gatekeeper," opening the gate so that glucose can enter the cell.) When there is insufficient insulin, the cells are deprived of glucose. The body must therefore use its fat stores and muscle protein as energy sources. This process causes the dog to eat more to replenish its depleted tissues. Despite the ravenous appetite, the dog still loses weight.

Increased water intake and urine production are a direct result of the high blood glucose levels. The body tries to lower the blood glucose by excreting some glucose in the urine. However, the glucose draws water along with it, so the dog produces large amounts of dilute urine. To prevent dehydration from the water loss, the dog must drink more water.

How is diabetes mellitus diagnosed?
Diagnosis is fairly simple. It is based on these criteria:

1. The classic signs
2. High blood sugar level
3. Presence of sugar in the urine

Blood glucose measurements:
In a healthy dog, the normal blood glucose level is 80–120 mg/dl (milligrams per deciliter). Following a meal, it may double. Stress can also increase the blood glucose into this range. In a diabetic dog, the blood glucose may be well over 400 mg/dl. In fact, in some diabetic dogs the blood glucose may be off the scale before treatment.

Blood glucose is measured from a blood sample. It can either be measured as part of a group of blood tests or on its own, using the same measuring kit that diabetic people use on a daily basis.

Urine glucose measurements:
Glucose is not normally present in the urine. If the blood glucose level is normal, there will be no glucose in the urine. When the blood glucose level is persistently increased, glucose is excreted in the urine. This test simply requires a urine sample and a glucose test strip (dipstick).

Can diabetes mellitus be treated?
Diabetes mellitus cannot be cured, but it can be effectively managed. When the diagnosis is first made, it may be necessary for your dog to be hospitalized for a few days to get his/her blood glucose under control. If there are any related health problems, they must also be treated before your dog goes home. Long-term management involves the following:

Dietary changes
Daily insulin injections
Periodic monitoring

Regardless of the details of your dog's diabetes management program, consistency is essential. You must be consistent with diet, feeding times, insulin injections, and your dog's routine. Also, try to keep disruptions and stress to a minimum. You may find that it is easier to regulate your dog's routine if you keep it indoors.

What dietary changes do I need to make?
The dietary changes we recommend are:

Switch to a high-fiber diet:
 Diets that are high in fiber tend to be lower in sugar and are digested more slowly, so there is less of an increase in blood glucose after a meal. We prefer Prescription Diet Canine w/d® or CNM–OM®. If your dog is overweight (despite the weight loss), we recommend Prescription Diet Canine r/d® until the ideal weight is reached

Feed your dog two meals a day, rather than free-choice (where food is available at all times):
Twice-a-day feeding is far better than free-choice feeding for diabetic dogs. It is much easier to regulate your dog's blood glucose level when you feed it twice a day. Also, it is easier for you to monitor the appetite and food intake, especially if you have other dogs.

I don't think I can give my dog an injection. Is it really necessary?
It is essential that your diabetic dog receive an insulin injection once or twice a day to control the blood glucose. On learning this, many dog owners are extremely anxious about this part of diabetes management. That's understandable. As you'll see, it is easy to do and most dogs tolerate their daily injections very well. The needle is tiny, the amount of insulin is very small, the insulin does not sting when injected, and the injection is given in an area where there is no risk of damage to vital organs. You'll quickly become comfortable with giving the injection, and your dog will consider it part of the daily routine.

Your veterinarian will show you how to draw up and give the injection before sending your dog home. Here is the basic technique:

1. Take the insulin bottle from the fridge.

2. Mix the insulin by rolling the bottle between your fingers or palms or by gently turning the bottle upside-down. Some of the insulin may have settled out while the bottle was sitting, so be sure to mix the solution thoroughly before drawing up your dog's next dose. Do not shake the bottle. Shaking causes the solution to foam, which interferes with accurate measurement of the insulin dose. Continue to roll the bottle until there is no white material in the bottom of the bottle.

3. Remove the cap from the needle and pull back on the syringe plunger to fill the syringe with air to the level of the insulin dose. Tip the bottle upside-down, insert the needle through the rubber stopper, and inject the air into the bottle. Then pull back on the syringe plunger to draw up the insulin dose. Withdraw the needle from the bottle.

4. If there is foam or air in the syringe, hold the syringe so that the needle is pointing straight up, and gently flick your middle finger against the syringe a few times. This moves any air bubbles to the highest point in the syringe. Then slowly push the syringe plunger until the air is expelled from the needle. Make sure you have the exact dose of insulin remaining in the syringe. If necessary, draw some more from the bottle.

5. Have someone hold your dog, if necessary. Gently pick up a fold of skin along your dog's back and insert the needle through the skin. Be careful not to go all the way through both sides of the skin fold, but between the two layers of skin. Angle the needle toward your dog's backbone or slightly downward. You will not cause any damage to the backbone because you have raised the skin away from the back and the needle is very short. (Use a different place on your dog's back each day.)

6. Inject the entire dose of insulin by pushing on the syringe plunger until it can go no further.

7. Remove the syringe and needle, and place the cap back on the needle right away.

8. Praise or reward your dog.

9. Put the insulin bottle back in the fridge.

10. Discard the used syringe and needle. *

(*Check with your veterinarian for proper disposal methods.)

Storing the insulin:
The insulin solution should be kept refrigerated (but not frozen). When it is out of the fridge, the insulin should not be left in direct sunlight. It will lose its potency if exposed to heat or direct sunlight for more than a few hours. If the solution is accidentally left on the counter top for a day, it is still usable. Get into the habit of putting it back into the fridge immediately after each injection.

Insulin is safe when used as directed. Just be sure not to inject any into yourself, and keep the bottle (and the syringes and needles) out of the reach of children.

Aren't you supposed to swab the skin before an injection?
For this type of injection, it is neither necessary nor worthwhile to swab the skin with alcohol or antiseptic. Swabbing the hair or skin does not kill very many bacteria (if any). In fact, it may actually increase the number of bacteria carried with the needle through your dog's skin. Another thing to consider is that if you accidentally inject the insulin through both sides of the skin fold and onto your dog's coat, you will not know you've done it. The hair will already be wet from the alcohol or antiseptic.

Some people with diabetes take oral medication. Can't I do that with my dog?
Unfortunately not. There are two different types of diabetes mellitus in humans. One requires daily insulin injections; the other can be managed with an oral medication. Only one type of diabetes mellitus occurs in dogs. It is the type that requires daily insulin injections for control.

What does periodic monitoring involve?
Periodic monitoring is a joint venture between you and your veterinarian. You'll monitor your dog at home and schedule regular visits to your veterinarian for more detailed assessment. Periodic monitoring is important because your dog's condition and needs may change over time.

At home, you'll be monitoring your dog's:

Appetite:
Feed the same amount of food each day and check to see whether it leaves some food or seems hungry after the meal

Body weight:
Weigh your dog at least once a month, and keep a record of it’s weight

Water intake and urine production:
Watch for an increase in water consumption or urine production which would indicate that you dog's blood glucose is not being well regulated

Devise a way of measuring how much water is being consumed, and watch for large variations

The average daily water intake for a healthy dog is a cup of water per 10 LB body weight (or just under 1 quart for a 40-LB dog)

Urine glucose:
Use the glucose test strips available at any pharmacy and check your dog's urine for glucose every 1–2 weeks
These strips are manufactured for use in people, but they also work well for dogs.  
Your veterinarian will advise you on the proper use of these.

Attitude and activity level, hypoglycemia (see below) causes tiredness and weakness:

Call your veterinarian if you notice a significant change in your dog's food intake, body weight, water intake, or urine production.

Fructosamine test:
There is a test of blood glucose regulation that can be performed at any time, regardless of when your dog last ate or received an insulin injection. This test, called the fructosamine test, is an indicator of blood glucose regulation over the past two weeks or so. If the fructosamine level in your dog's blood is increased, it indicates poor regulation of blood glucose in the recent past.

If it is difficult for you to follow the protocol described above, this test can be useful. However, if your dog's fructosamine level is increased, it may be necessary to monitor his/her blood glucose directly.

What are the signs of hypoglycemia and why does it happen?
Hypoglycemia means low blood glucose. When the blood glucose level drops, your dog will become tired and lethargic (has no energy). When it gets below 40 mg/dl, your dog may collapse and loose consciousness; he may even have seizures (convulsions). Persistent severe hypoglycemia can be life threatening, so it is something you should be on the lookout for in your diabetic dog. It is better for the blood glucose to be too high than too low.

Hypoglycemia in a diabetic dog occurs because the insulin dose given is too high for the dog's needs. Here are some situations in which this could occur:


Your dog's insulin requirements have changed, yet the same dose is given
Most dogs do fine for months or years on the same insulin dose, but it is possible for a dog's insulin requirements to change over time.

This is why daily home monitoring and periodic veterinary monitoring are important.

Your dog didn't eat all of his meal, yet the same insulin dose was given
If your dog did not eat his meal, skip that insulin injection; if he ate only half of his meal, give only half of his regular insulin dose

More than the prescribed dose was given
This can happen if you are not careful when drawing up the insulin dose.

It can also happen if your dog is given two doses (e.g. you forgot that you'd already given it and you gave it again, or someone else in your home also gave it) To prevent double dosing or missing a dose, make a chart to record your dog's daily insulin injections. Tick off the chart after each dose is given.

What should I do if I think my dog is hypoglycemic?
No treatment may be necessary if your dog is just a little tired and lethargic. The blood glucose will gradually rise over the next few hours as the effects of the insulin wear off. If your dog is slow to return to normal or if it is very lethargic or depressed, give a tablespoon of corn syrup by mouth. Wait 15 minutes; if there is no response, give him another tablespoon of corn syrup. If there is still no improvement, or if he is unresponsive or having seizures, call our hospital immediately. Dogs with severe hypoglycemia must be treated with intravenous glucose as soon as possible.

If you cannot identify a reason for your dog's hypoglycemic episode, bring him to the hospital for evaluation.

This all seems overwhelming now. Is it really worth it?
Only you can decide that. It is true that long-term care of a diabetic dog requires considerable commitment on your part. Your dog's diet and routine must be kept consistent, and it must receive an insulin injection once or twice a day for life. If you are going away, you'll need to make arrangements for someone reliable to take over your dog's care until you return.

The good news is that the special diet, insulin, and supplies (syringes, needles, urine dipsticks, etc.) are inexpensive. The initial testing and getting your dog's blood glucose under control may be expensive if there are complications of the diabetes or other health problems. After the initial few days of hospitalization, you will need to bring your dog back in for monitoring every 3–7 days until we achieve good regulation of her blood glucose. After that, periodic evaluations are necessary. The cost of long-term maintenance is low.
Copyright © 2001 - 2007 HealthyPets.com - All rights reserved.
Unable to contact author.  Reprinted because of informative information in article
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THE PET HEALTH LIBRARY

By Wendy C. Brooks, DVM, DipABVP
Educational Director, VeterinaryPartner.com
http://www.VeterinaryPartner.com

The Hard to Regulate Diabetic Pet

The goal in long-term management of diabetes mellitus is the alleviation of unpleasant clinical signs (constant thirst, weight loss etc.) and prevention of dangerous secondary conditions (infections, ketoacidosis, etc.). To accomplish this, blood sugar levels should be regulated between 250 mg/dl and 80 mg/dl. This is not as good as the body's natural regulation but it is a fair and achievable goal in most cases.

Some patients just seem completely unaffected by even high doses of insulin and it is important to have a step by step plan to rule out causes of insulin resistance so that regulation can be achieved.
Insulin resistance is defined as:

Persistent high blood sugar levels throughout the day when 3 units of insulin per 4 lbs of patient body weight are used

or

A unit or more of insulin per lb of patient body weight is needed to achieve regulation

Step One: Rule out Owner Related Factors
This may seem very basic, but it's important not to skip the basics. Confirm that the amount of insulin being drawn into the insulin syringe is correct, that the injection technique is correct and that the patient is actually receiving the injection. Rule out any snacking or changes in the patient's feeding schedule. Be sure the bottle of insulin is not expired and that it has been properly stored.

Review insulin storage and handling at our insulin administration guide.

Step Two: Determine for sure that the Patient is Insulin Resistant
A glucose curve is needed to distinguish the following three phenomena:

Somogyi Overswing
 In this case, the insulin dose is too high and drives the blood sugar low for part of the day. When the blood sugar is low, other hormones such as cortisone or adrenalin are released to raise blood sugar. These hormones can have a prolonged effect of many hours, thus creating hyperglycemia (high blood sugar). If the patient's high blood sugar has been caused by a Somogyi overswing, a lower dose should be used and a new curve performed in a week or two.

Rapid Insulin Metabolism
 In this case, the insulin simply isn't lasting long enough to create sustained normal blood sugar levels. If the curve shows that the insulin effect is wearing off too soon, twice a day administration of the insulin may solve this problem or a longer acting insulin may be needed. Longer acting insulins tend to have poorer absorption into the body from an injection site. This may also necessitate change to a different insulin type.

True Insulin Resistance
Here no significant drop in blood sugar level (levels stay greater than 300 mg/dl) is seen in response to the insulin dose used. Usually there is a history of prior increases in insulin dose that were all met with minimal response.

Step Three: Spay
If the patient is a dog, a female and un-spayed, hormone fluctuations will easily account for insulin resistance as progesterone is one of many hormones that raise blood sugar levels by stimulating growth hormone secretion. Canine unspayed female diabetics need to be spayed if regulation is to be achieved. Feline patients do not have a similar relationship with naturally occurring progesterones and do not require spaying; however, progesterone-type medications can produce diabetes in cats. Diabetic patients of either species should not take progesterone-related medications.

Step Four: Rule Out Infection
Diabetic animals are at special risk for developing bladder infections since they have so much sugar in their urine. Stress of any kind will contribute to high blood sugar and infection would lead to stress. A urine culture should be done to rule out bladder infection, plus the teeth and skin should be inspected for infection. If infection per se is not found, the patient should be screened for other chronic illnesses that might constitute a stress. A basic blood panel would be a logical starting point.

If infection, or other stress is allowed to go unchecked, ketoacidosis, an especially life-threatening complication of diabetes mellitus can develop.

Step Five: Control Obesity
Insulin response is typically blunted in obese patients. If obesity is an issue, it should be addressed. A formal weight loss program using measured amounts of a prescription diet and regular weigh-ins is necessary for success. For general information about weight loss for pets visit: www.petfit.com.

If these steps do not reveal a relatively simple explanation for the poor insulin response, then it is time to seek more complicated causes. This generally means an additional hormone imbalance.

Hyperadrenocorticism (Cushing's Disease)
This condition is relatively common in the dog but less so in the cat. In short, this condition involves an excess in cortisone-type hormones either from over-production within the body or over-treatment with medication. Cortisone (more accurately referred to as cortisol) is secreted naturally in response to a fight or flight situation and prepares the body for exercise by mobilizing sugar stores. If sugar is mobilized into the blood stream in the absence of a fight or flight situation, diabetes mellitus can result. If the excess cortisone situation is resolved, it is possible that the diabetes will also resolve.

About 10% of dogs with Cushing's disease are also diabetic. About 80% of cats with Cushing's disease are also diabetic. Testing for Cushing's disease cannot proceed until some degree of diabetic control has been achieved and the patient is not ketoacidotic.

Hyperthyroidism (Cats Only)
Thyroid hormone is another hormone that alters glucose metabolism. While hyperthyroidism is a common condition of older cats, less than 1% of hyperthyroid cats are also diabetic. Still, when a diabetic cat becomes hyperthyroid, control of the thyroid disease generally leads to better regulation of the diabetes.

Excess Circulating Lipids
High levels of circulating triglycerides (fats) interfere with the binding of insulin to the cells it needs to act upon. While most dogs with excess circulating lipids are not diabetic, when a diabetic patient is insulin resistant it may be helpful to attempt to reduce the circulating fats. Excess lipids in the blood usually occurs because of some other hormone imbalance (Cushing's disease, hypothyroidism in dogs etc.) but can simply happen spontaneously in the miniature schnauzer. Circulating fats are reduced by treating the hormone imbalance that caused them, if there is one. If there is no underlying disease, circulating lipids can be reduced with diet and omega 3 fatty acid supplementation.

Acromegaly
Acromegaly results from an over-secretion of the pituitary hormone known as growth hormone. This hormone normally is responsible for one's growth from infancy to adulthood. When adulthood is achieved, its secretion dramatically slows, bone growth plates close, and growth essentially stops. If for some reason this hormone begins secreting again, growth resumes but not generally in normal proportions as the limb bones have closed their growth areas.

One of the effects of growth hormone is causing the body tissues to become resistant to insulin by interfering with tissue insulin receptors. Animals with acromegaly are frequently diabetic.

The prognosis and treatment for acromegaly is very different between dogs and cats. Dogs generally develop acromegaly due to excess progesterone secretion (as would occur from an ovarian cyst). Canine patients are thus usually older unspayed females and spaying may be curative depending on the remaining ability of the pancreas to secrete insulin.

The feline situation more closely approximates the human situation. Cats (and people) develop acromegaly when they develop a growth hormone-secreting pituitary tumor. Over 90% of acromegalic cats are male (though there is no sex predisposition in humans.)

The diagnosis of acromegaly can be very difficult. Growth hormone can make soft tissue organs enlarge and cause characteristic proliferation of gum tissue in the mouth but pituitary tumors require some kind of brain imaging (CT scan or MRI) for detection. Often this diagnosis is reached tentatively based on the clinical picture: intact female dog with insulin resistant diabetes or male cat with heart disease (from the enlargement) and extremely insulin resistant diabetes. There is currently no blood test available to test growth hormone levels but it is possible to measure something called somatomedin C, which is a regulator of growth hormone; patterns of this biochemical may be helpful in diagnosis. Currently the best treatment for a cat with a pituitary tumor is radiation therapy.

Antibodies Against Insulin
When a patient is treated with insulin from another species, the immune system recognizes the introduction of the foreign protein and generates antibodies. It was because of this phenomenon that most commercial insulin available is genetically engineered human insulin so that the world's human diabetics no longer need to worry about making insulin antibodies.

But where does this leave dogs and cats? It leaves them making antibodies against human insulin, that's where.

One would think this would pose a big problem, but in fact insulin antibodies are not always bad. Most of the time the antibodies simply interfere with removal of the insulin. leading to a longer acting insulin than would be achieved with the same type of insulin made from the native species. For example, Humulin L (human insulin) will last longer in the dog than Canine Insulin L. This may be desirable depending on the patient; changing the species of origin of the insulin is one way to get the insulin to last a bit longer.

To become insulin resistant from antibodies, one must lose 70% or more of the insulin injection to antibody binding. This is very unusual but possible and should not be forgotten as a possible cause of insulin resistance. Blood tests to measure insulin antibodies are available in some areas. Insulin can be switched to a species of origin more closely related to the species desired.

If A Cause Cannot Be Found
If a cause cannot be found or if treatment for that cause is not practical or possible, the good news is that multiple high doses of insulin can generally overcome the resistance. Sometimes combinations of short and long-acting insulins are used together to achieve reasonable regulation.
Date Published: 1/3/2004 2:38:00 PM
Copyright 2004 - 2007 by the Veterinary Information Network, Inc. All rights reserved
This work was originally published by Veterinary Information Network, Inc. (VIN) and is republished with VIN's permission.

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What is diabetes mellitus?


http://www.upei.ca/cidd
Diabetes mellitus is a disruption of the body's ability to use carbohydrates/sugars. Normally, certain cells in the pancreas produce the hormone insulin which regulates the uptake of sugars into cells throughout the body. In some forms of diabetes mellitus, the cells are dysfunctional and do not produce insulin, while in other forms insulin is produced but body tissues do not respond appropriately.

Genetics is only one of many factors that may be involved. In some dogs there seems to be a genetic predisposition to to the destruction by the immune system of the insulin-producing cells. In other dogs, less severe genetic-based changes in the cells may make the dog more susceptible to the development of diabetes mellitus - in association with another illness or obesity or exposure to certain drugs.

How is diabetes mellitus inherited?
In keeshonds, diabetes mellitus is inherited as an autosomal recessive trait. The mode of inheritance has not been determined in other breeds.

What breeds are affected by diabetes mellitus?
Breeds at increased risk include the keeshond, Alaskan malamute, chow chow, Doberman pinscher, English springer spaniel, Finnish spitz, golden retriever, Labrador retriever, miniature schnauzer, old English sheepdog, poodle, schipperke, West Highland white terrier.

For many breeds and many disorders, the studies to determine the mode of inheritance or the frequency in the breed have not been carried out, or are inconclusive. We have listed breeds for which there is a general consensus among those investigating in this field and among veterinary practitioners, that the condition is significant in this breed.

What does diabetes mellitus mean to your dog & you?
In dogs with the most severe form of inherited diabetes mellitus, signs are usually apparent by 6 months of age. Pups drink and eat more than normal, and yet grow very slowly. They urinate frequently, and their stools are soft.

In other dogs, diabetes mellitus does not develop until middle age.   The signs of uncomplicated diabetes are typical - increased eating, drinking, and urination, with weight loss - all of which are a result of increased levels of glucose in the blood and urine. Over the long term, this can lead to the development of cataracts, increased susceptibiIity to bacterial infections (especially of the urinary tract), liver disease, and pancreatitis. Eventually, untreated diabetic dogs will develop ketoacidosis, a very serious condition. Signs of ketoacidosis include depression, weakness, vomiting, and irregular breathing patterns.

How is diabetes mellitus diagnosed?
The diagnosis is made based on the typical clinical signs - increased eating, drinking, and urination, with weight loss - together with persistently elevated levels of glucose in both the blood and the urine. Ketones may also be present in the urine. Your veterinarian will do a complete laboratory work-up, to see if there is any other condition that may be causing or contributing to, or occurring as a result of,  the diabetes mellitus. S/he may start your dog on insulin treatment before receiving all the laboratory results.

FOR THE VETERINARIAN:
LABORATORY FINDINGS: fasting hyperglycemia with glucosuria; if the dog has ketoacidosis may see metabolic acidosis, hyponatremia, hyperkalemia, and hypochloremia.
How is diabetes mellitus treated?

In the diabetic dog without any other illness, the goals of therapy are to achieve near-normal blood glucose levels and minimize the daily variation in those levels. This is important to prevent the complications that develop over time in poorly controlled diabetic patients. Treatment includes insulin administration, diet, and exercise, all of which your veterinarian will discuss with you.

Emergency treatment for dogs with ketoacidois includes intravenous fluids and fast-acting insulin. Once the animal is stable, a regular regime of longer-acting insulin, diet, and exercise can be established.

Genetic counselling
In keeshonds, both parents of affected dogs should be considered carriers and should not be used for further breeding. In other breeds, where less is known about the inheritance of this condition, affected dogs should not be bred, and parents and siblings should be considered potential carriers.

FOR MORE INFORMATION ABOUT THIS DISORDER, PLEASE SEE YOUR VETERINARIAN.
Resources Nelson, R.W. 1995. Diabetes Mellitus. In S.J. Ettinger and E.C. Feldman (eds.). Textbook of Veterinary Internal Medicine, p. 1510-1537. W.B. Saunders Co., Toronto.
Copyright © 1998 Canine Inherited Disorders Database. All rights reserved. Revised: October 30, 2001.
reprinted with kind permission from:- Alice Crook, DVM,Coordinator, Sir James Dunn Animal Welfare Centre,
Atlantic Veterinary College,University of Prince Edward Island, 550 University Ave.Charlottetown, PEI C1A 4P3
http://www.upei.ca/cidd
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DIABETES MELLITUS IN DOGS AND CATS

http://www.thepetcentre.com

Diabetes in the dog and cat and the treatment for diabetes mellitus are interesting and challenging topics.  Diabetes mellitus (DM) is a disorder where the body is unable to regulate blood sugar levels.  (There is another dissimilar disease called Diabetes Insipidus that is associated with the pituitary gland.)  Each case seems to be different, and regulating the diabetic dog or cat so that their blood glucose levels are as normal as possible is vitally important.  The real problem with a diabetic dog or cat is that even in the presence of sugar (glucose) in the blood stream, something interferes with the entry of that sugar into the body's cells where it is required for the life sustaining energy of those cells.  With no sugar in the cells, the cell dies in a very short period of time.

A highly complicated disease entity, diabetes has been classified according to what pathway of energy metabolism has been disrupted.  Fortunately with diabetes mellitus in dogs and cats most cases can be managed successfully with insulin injections. There are several brands of insulin available to veterinarians and your veterinarian may suggest or favor one brand rather than another.  Cats often are managed by use of a PZI (protamine zinc) insulin preparation.  Do not be bashful with your dog or cat's veterinarian if you do not understand the how, why, and when of managing diabetes in dogs and cats.
Click on an image to see a full sized version.
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TYPES OF DIABETES MELLITUS (DM) IN DOGS AND CATS
Type I... Occurs when very little or no insulin is produced. In these cases, insulin must be administered bydiabetespc4 injection.  Most diabetic dogs have what is termed "insulin dependent" diabetes. This means that insulin from an external source (injections of insulin) will be required for the dog's survival; dietary modification alone won't stabilize the blood sugar level.

CAUSE
In dogs... The cause is considered in most cases to be due to damage to the cells in the pancreas (called beta cells or islet cells) that produce insulin.  Often the damage is due to an abnormal self-destruction of the cells by the body's own immune system actions.  This is termed "auto-immune destruction" or "immune mediated" damage. 

In cats... The most common causes of diabetes in cats are obesity, pancreatitis, or immune mediated damage of the pancreatic beta cells. 

Type II... Very rarely occurs in dogs and cats. In this type of diabetes the patient may be producing insulin but for various reasons the cells are not able to respond to the presence of insulin-glucose at the cell wall so that glucose carrying molecules are unable to enter the cells... so the energy from glucose is not available to the cell.  This is termed "insulin resistance".  The insulin is present but the cells are resistant to its vital effects in transporting glucose into the cell.

Transient DM... This occurs most often in cats where diabetic signs are variable.  Some diabetic cats may even have periods where they no longer need insulin injections. These periods are unpredictable and blood sugar level tests may need to be done routinely and the cat watched closely for signs of reoccurring diabetes.

SIGNS OF DIABETES MELLITUS
Typical signs of diabetes mellitus in dogs and cats include excess water consumption and excessdiabetespc5small urination, increased appetite but with actual weight loss, and dehydration.  Dogs also commonly develop cataracts whereas cats seldom develop cataracts secondary to diabetes mellitus.
...polyuria (PU) - frequent and more productive urination

...polydipsia (PD) - increased water intake

...polyphagia - excessive appetite

...weight loss

...lethargy

...sugar in the urine

Because there is such a buildup of sugar in the blood stream there is the sensation of thirst in the animal and so it drinks more water to "dilute" the blood.  PD (polydipsia) is the result... the animal drinks excessive amounts of water.  Of course the animal then needs to urinate more often and greater than normal amounts.  This increased urination is called PU (polyuria).  Weight loss occurs even in the presence of an increased appetite because the carbohydrate consumed cannot be used for energy or stored as fat and because the animal metabolizes its own fat and tissue protein for energy instead of utilizing the dietary carbohydrate. If left untreated, Diabetes Mellitus leads to muscle wasting, depression, vomiting, kidney failure and death.  Some dogs develop ocular cataracts quite rapidly and this is another sign that may lead to getting the animal in for an examination by the veterinarian.  In cats, often the owner will notice a wobbly gait or weakness in walking or jumping.  Muscle wasting and weakness are commonly seen in diabetic cats.

diabetespc6 Insulin injections, daily or twice a day, can be a true life saver for dogs and cats with Diabetes Mellitus.  There are now special diets made just for diabetic dogs and cats, too.  These are prescription only diets and can play an important role in maintaining the diabetic patient.  It is important to note that for optimum blood glucose levels to be maintained the dog or cat needs to have three parameters in balance on a day-to-day basis:
1.  The amount and timing of exercise should be the same every day.
2.  The amount of food and time of feeding should be the same every day.
3.  The amount of Insulin administered should be the same and should be given at the same time each day.

If any one of these three parameters are different on any given day, the requirements of the other two parameters will be changed.  For example, if a patient gets the usual amount of exercise today as normal but happens not to eat its usual meal, then the patient may need considerably less Insulin in that day's injection.  If you have already administered the insulin you can't take it back!  If the usual amount of Insulin is given and the pet doesn't eat its routine meal, the pet may become hypoglycemic and develop signs of low blood sugar.  Keeping the diabetic pet regulated in the three areas detailed above will enhance the animal's quality of life.

LOW BLOOD SUGAR... Hypoglycemia (Insulin Shock)
If an animal's blood sugar level becomes so low that the energy needs of the cells are not met, the cells begin to suffer and lose their ability to function.  Especially true with nerve and muscle cells that have high respiratory rates and that need continuous oxygen and glucose for survival, a lack of glucose results in rapid deterioration of function.  The usual signs in a dog that the blood sugar level is too low are trembling, agitation and muscle incoordination.  Ultimately a seizure may occur.  In cats, salivation muscle tremors and weakness are seen.  These animals need a quick source of energy in the form of carbohydrates and will not survive hypoglycemia if oral or intravenous sugars are not administered.  Any diabetic dog or cat should be closely monitored for signs of hypoglycemia, especially if the animal vomits or skips a meal and insulin has been administered.  The insulin will drive much of the circulating glucose into the cells and if there is no recent dietary source of additional glucose, hypoglycemia may result.  As well, if the diabetic animal engages in an unusual session of vigorous physical activity, it may deplete the glucose stores in the body and become hypoglycemic.

TREATMENT FOR DIABETES
NOTE!  Each case is different and requires careful individual assessment by a veterinarian.  The following presentation is one veterinarian's summary of Insulin Therapy.  It is written by a veterinarian who also happens to be a diabetic.  Your veterinarian's suggestions and recommendations may vary significantly from this discussion.

Generally start canine patients with NPH insulin at ¼ unit per pound of body weight twice/day with twice/day feeding.  Ideally, one can generate an insulin response curve with the NPH, but its general action is over the course of twelve hours.  It’s always best to try to regulate a dog on his own home schedule and activity, so frequent blood glucose checking in the early weeks after diagnosis is important.  Usually client education on diet and exercise, and problems with treating anxiety (both the owner’s and the dog’s), feeding and dosing schedule can be discussed and accommodated in these first few weeks after the diagnosis of diabetes is made.

Dogs that are presented with diabetic ketoacidosis (DKA) is a dangerous situation where the patient hasdiabetespc7 been afflicted with diabetes for some time and the body chemistry is way off balance.  Ketoacidosis results from utilization of body protein sources such as muscle for energy because glucose is unable to be utilized.  These patients are often treated with the fast acting insulins.  This does require more frequent blood glucose checking (hourly or every 2 hours) to avoid hypoglycemia until stable normal glucose levels are reached and maintained, the dog feels better and accompanying medical concerns are addressed.  The most commonly available insulins today are the “human insulins” made with recombinant DNA processes to more closely resemble the human insulin molecules.  Dog insulin is more similar to the pork and beef sources of insulin, which still can be available from pharmacies, but require specific a request to obtain them. 

Follow-up glucose checking on dogs that appear to be doing well is recommended about every two to three months.  Some owners have obtained their own glucose meters to more closely follow their dog's blood sugar levels at home.  Generally, the complications from diabetes that humans are concerned about such as nephropathy (kidney disease), retinopathy (damage to the back lining of the inside the eye), and nerve disease occur over many years. Most dogs to not have a natural life span long enough to expect these sorts of complications.  Cataracts (lens pathology) in dogs subsequent to diabetes is quite common, though, and may need  to be surgically removed if vision is impaired.

diabetespc8 Experimentation with dogs was essential in the early 20th century for an understanding of what diabetes was and for the discovery of insulin and its purification from the pancreases of slaughtered meat animals for use in treating diabetes.  Now, people look forward to advances on the medical horizon such as pancreatic islet cell transplantation, potential growth of pancreatic islet cells from stem cell research, or assistance from pigs cloned to have cells missing the rejection markers.  What this will mean for treatment possibilities in dogs is still unknown.

Keep in mind that any animal that is being treated with insulin for Diabetes Mellitus should have a structured lifestyle.  That means the patients should get about the same amount of exercise every day, eat about the same amount of food and at about the same time each day, and then the insulin dose can be regulated consistently every day.  If you change any one of the three variables (exercise, caloric intake, insulin dose) it has an effect on the blood sugar levels.   Normally, a dog's blood sugar varies between 70 and 120 mg/dL.  A cat's normal blood sugar has a wider normal range and can be between 70 and 160 mg/dL.  Learn more about dog and cat normal blood values here.  Consistency in the patient's lifestyle will greatly assist proper dosing of insulin and result in a happier, healthier pet. 
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Diabetes Mellitus in Canines and Felines

Judy Dick

WARNING * Miracle Cures and Alternative Treatments KILL! * WARNING
Beware of anyone telling you that your dog no longer requires insulin shots with statements such as - Canine Diabetes Breakthrough , etc. This could be the most important page that you find on " Miracle Cure Breakthrough " so read it very carefully and think about what you are about to read. Your diabetic dog's life could depend on it!

NOTE: There is no diet or vitamin supplement that can reduce your dog's dependence on insulin injections. This is because vitamins and minerals cannot do what insulin does in the dog's body. If you believe that your dog needs a vitamin or mineral supplement, discuss it with your veterinarian first to make sure that the supplement does not interfere with the action of the dog's other medications. You will still need to give your dog insulin injections twice a day. The professionals from the above website make insulin syringes  and have up to date information on their website and have added the above warning to their website about miracle vitamins or supplements!

More dogs and cats are now being treated for diabetes mellitus and the internet has a vast wealth of information on almost any subject that you can think of.  Unfortunately everything you read on the internet is NOT true.

There are a lot of unprofessional shysters out there who want to profit from the fact that people will do anything to save the life of their pet and that means providing false hope or offering miracle cures and promoting these alternatives to treatment .

These facts are by Edward Murray.
Ed is married to a veterinarian and they own a diabetic dog as well as three diabetic cats.

Important facts:
Dogs:  Dogs with diabetes like humans with Type 1 diabetes have no ability to produce insulin on their own. Their pancreatic beta cells have been destroyed so without external sources of insulin, they will suffer and die. There are no exceptions to this.

Cats: the situation with cats and people with Type 2 diabetes is different. Their beta cells have some degree of functionality such that it is possible to actual restore normal blood sugar in some cases. As you know, we have three diabetic cats. One, Amadeus has half-day honeymoons about once every 10 days. Another, Tiggy, has full day honeymoons about one every 21 days. Unfortunately, Precious has never honeymooned and at the moment is one NPH 4 times a day.

The rest of this article will be about miracle cures for diabetic dogs because dogs DO require insulin injections for the rest of their lives. 

By Edward Murray
People who are promoting these alternatives to treatment should be jailed for animal cruelty. Sadly, the laws don't support doing that. 

The facts is that dogs with diabetes like humans with Type 1 diabetes have no ability to produce insulin on their own. Their pancreatic beta cells have been destroyed so without external sources of insulin, they will suffer and die. There are no exceptions to this.

It is not as simple as "it cannot hurt and may just help."

There are various supplements that can help the body use insulin better such as chromium and vanadium, but this assumes there is insulin to use in the first place. Further, studies of these supplements have produced very mixed findings. It isn't at all clear in what form and quantity they should be given or whether they require other catalysts to be effective. Virtually all the major pet food manufacturers are supporting research in this area in an attempt to find a way to use these chemicals.

We know full well that some medicinal herbs work. In fact, most standard medicines are derived from researching medicinal herbs to find the active ingredients and isolate them. Because they work, they have effects. But those effects are not always benign.

You know that onions and garlic can cause anemia in cats and dogs.

This is a good example of the problem.

First, they are herbs with medicinal properties.

Secondly, they can have strong effects, in this case negative effects.

This illustrates the biggest problem with "it cannot hurt and may just help."

In fact, in dogs and cats these seemingly innocuous herbs can cause life-threatening anemia.
Without specific testing, even things that are scientifically proven to work in humans can have negative effects on cats and dogs.

This belies the conventional wisdom that 'it can't hurt, might help.' Further, it shows why it is recklessly dangerous to have 'an open mind' about alternative treatments. Garlic may well be very helpful for human diabetics, but it can kill a cat or a dog. It is not a case of 'it might help' In fact, it may well kill.

If there is research supporting the benefits of an alternative medicine, it is extremely important to know whether that research has been carried out in pets and even more importantly, diabetic pets.

For him/her to assert without any proof that "I even know of people getting diabetic dogs completely off insulin by feeding them a product/herb, specific diet" is both a lie and irresponsible.  If people are taking diabetic dogs off insulin, those dogs are dying and he needs to note that.  And for him to be making this suggestion is totally irresponsible and unprofessional.

Without in anyway meaning to insult anyone considering using such a product, the notion that keeping an open mind to people like [name removed] is dangerous.  Accepting that people like this have something valid to offer is having a mind so open that the brains have fallen out. He is promoting his books. He is not attempting to help diabetic dogs.

If there were simple solutions such as [name removed] is suggesting, everyone would know about it. No one who is diabetic wants to suffer through the misery of fluctuations in blood glucose, give themselves shots or take medicines that have serious side effects and suffering all the secondary damage that goes with being diabetic.

Again, wish there were an easy way to lock up people like [name removed.]  They are doing real harm with their despicable lies. 

by Judy Dick
If you are searching the internet for a miracle product or cure so that you will not have to give insulin injections to your dog then please think again. 

If you are approached by someone that suggests an alternative treatment instead of insulin shots. Please ask the following questions:

Have you done controlled studies on canines and felines with your product???

At what research facility were these tests conducted?

How many dogs or cats was used in the controlled study?

How many animals have you successfully treated?

How many animals died in the control study?

How many canines have been treated with your program and no longer require insulin???

How much insulin were they taking on initial start of your program?

How much after being on your program one week?  two weeks?  one month?  six months? etc

Do you have blood panels on these animals??

What side effects did your product cause after different lengths of time?

Controlled Clinical trials are research studies in which people help doctors find ways to improve health and diabetes care. Each study tries to answer scientific questions and to find better ways to prevent, diagnose, or treat diabetes and is the treatment safe and effective. 

In a controlled clinical trial, one group of participants serves as a control group. These participants do not receive the intervention being studied.

Having a control group in a clinical trial enables investigators to answer the question "Compared to what?" Do participants receiving the intervention (the investigational group) fare better, worse, or the same as those who get standard therapy or a placebo?

In an uncontrolled study, which has no comparison group, investigators cannot be sure whether the outcomes they observe are caused by the intervention, by chance, or by unknown factors.

These points should be dealt with in a controlled clincal study:

OBJECTIVE: To determine if diabetes mellitus in dogs is reversible if fed this herb or supplement 

DESIGN: Prospective study.

ANIMALS: 100 canines with diabetes mellitus

PROCEDURE: 50 of the dogs in the study used the product and 50 of the dogs did not.

RESULTS: side effects, blood glucose levels

CLINICAL IMPLICATIONS: Did the diabetic dog fed the product fare better,worse or stay the same as the diabetic dog not fed the product.

Through the years many have joined our email group looking for some miraculous herbal remedy so that they would not have to inject insulin. Unfortunately all that has happened is the canine has died because insulin treatment was withheld :((( That makes me very sad. 

My dog Queenie was diabetic for eight years and received two shots of insulin each and every day.
She retained her sight until the last six months of her life. I cannot say that because I fed her homecooking, or gave her certain supplements that she retained her eyesight. That would be absurd! 

Diabetes in Dogs is NOT a Death Sentence.

If you are approached by an individual about a product that will supposedly cure your diabetic dog please contact  Edward Murray so that he can investigate such claims.

There is no food remedy, vitamin or supplement that can REVERSE diabetes in canines! Diabetic Canines require injections of insulin to live.
 
Dr Greco has added a warning to their website as well about supplements and minerals! http://www.bddiabetes.com/

Q:   Are there any vitamin or mineral supplements that will reduce my dog's dependence on insulin? 

R:   No. Dogs generally have type 1 diabetes. Their pancreas produces no insulin at all, so they need insulin injections in order to survive. Vitamins and minerals cannot replace the action of insulin. If you give your dog vitamin supplements, you still need to give it insulin injections. 

They also put up a second warning under Diet and Exercise
NOTE: There is no diet or vitamin supplement that can reduce your dog's dependence on insulin injections. This is because vitamins and minerals cannot do what insulin does in the dog's body. If you believe that your dog needs a vitamin or mineral supplement, discuss it with your veterinarian first to make sure that the supplement does not interfere with the action of the dog's other medications. You will still need to give your dog insulin injections twice a day. http://www.bddiabetes.com/us/pets/dogs/diet_exercise.asp

Think carefully about what you have read because when a person is promoting a product by making outrageous claims  and are unable to produce the specific Control Studies  that were done on diabetic dogs with their product  then do NOT buy their product!

They have nothing to lose but you do "Your Dog's Life"

Studies on type 2 human diabetics do not apply to canine type 1 diabetes? 

Be VERY CAREFUL  or your diabetic dog WILL DIE if you stop giving insulin!
 
reprinted with kind permission from Judy Dick and Edward Murray
Edward Murray grew up nearby in Pinner and worked for a number of years for a British firm based in Chalfont St Giles and is now living in the heart of Red State country in Norman, Oklahoma.
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Pets With Diabetes
 Diabetes
 Exercise for Pets with Diabetes
 Comfortable Injections
What is Diabetes
 How to Withdraw Blood from the tail area for testing
 Information for owners of Canine's with Diabetes Mellitus 
Diabetes and My Dog
Taking Blood from the Lip Area for Testing
 Taking Blood from the Ear for Testing
 Taking Blood from an Elbow Callus for Testing
 How to administer Insulin
Urine Testing Information
 Insulin
 Your Care Kit
 Diabetes
Supplements


Join
Yahoo Groups diabetespets List
 A Yahoo list group for owners of dogs with diabetes mellitus, a great source for information and support.
 
 chloebutton  talabutton  

The above information is simply informational. It's intent is not to replace the advice of a veterinarian nor to assist you in making a diagnosis of your pet. Please consult with your own veterinarian for confirmation of any diagnosis. Your pets life may depend on it.