Diabetes Mellitus: veterinary information sheet

Diabetes Mellitus: The words are of Latin origin meaning "passing through" and "honey". DM is a metabolic disorder characterized by elevated blood sugar, or glucose. In humans, DM is classified as either Type I (also known as insulin dependent diabetes mellitus (IDDM) or juvenile diabetes) or Type 2 (non insulin dependent diabetes (NIDDM) or adult onset diabetes). Dogs are almost exclusively Type 1; therefore the terms are not usually used. (Note: 30-50% of cats are Type 2).

          Glucose: Simply put, think of glucose as sugar. Specifically it is a type of monosaccharide or "simple sugar". All sugars are types of carbohydrates. Table sugar (sucrose or saccharose) is also a monosaccharide.

          Glycemia: blood sugar.

          Hyperglycemia: elevated blood sugar levels. Usually measured in mg/dl.

          Hypoglycemia: decreased blood sugar levels. This is often a dangerous, and potentially life threatening situation. For more information see below.

Ketones: an energy source produced by the liver in response to unregulated DM. Ketones are acidic and will lead to a severe clinical syndrome

Causes of DM

            The main cause of diabetes in dogs is an immune mediated destruction of the beta cells located in the islets of Langerhans within the pancreas. The beta cells are responsible for creating insulin. (Endocrine Pancreatic Disease)

            Other causes include severe pancreatic inflammation (pancreatitis), pancreatic cancer, obesity, progesterone interference in intact (non-spayed) females and Cushing's Disease (hyperadrenocorticism). Other less common causes also exist.

Signs of DM

            This often depends upon how long the DM has been present and whether or not other more serious complications have arisen. Often early uncomplicated DM goes unnoticed until severe signs occur. Also these signs are common to other diseases and their presence does not create a diagnosis of DM by itself. Signs of uncomplicated DM include: increased thirst and hunger, weight loss, and increased urine volume. Complicated DM (such as DKA(diabetic ketoacidosis) or HHNK syndrome (hyperglycemic hyperosmolar non ketoacidotic syndrome)) include: sudden shock or death, loss of appetite, vomiting, severe dehydration, coma, and weakness, to list a few symptoms. DKA and especially HHNK (or HHS)may  have guarded to poor prognoses.

Cushing's Disease and EPI

            Both of these disorders are associated with DM are often found with a diagnosis of DM. Cushing's disease is a disease of either the pituitary gland or the adrenal glands leading to excess cortisol (natural steroid) production. EPI stands for Exocrine Pancreatic Insufficiency. Simplified, the pancreas may be divided into endocrine (insulin producing) and exocrine (digestive) portions. When the exocrine portion fails, maldigestion occurs and the body stops releasing digestive enzymes into the intestines. Weight loss and chronic diarrhea ensues. Separate blood tests are required for diagnosing each of these disorders.

Natural L-Carnitine

There are many dietary characteristics that are important for dogs and cats with Diabetes. Most of the time a veterinarian will prescribe a specific diet for your pet upon diagnosis of diabetes.

Important characteristics

• Fiber
• Fiber can slow the absorption of glucose and help avoid high spikes of blood sugar
• Controlled carbohydrates
• A moderate restriction is important for dogs.
• For Cats: many times a high protein and low carbohydrate diet has been shown to be beneficial. Many of these diets may be over 50% of protein on a dry matter basis (%DMB)
• L-Carnitine
• Many pets with diabetes are overweight. L-Carnitine has been shown to help maintain lean muscle while losing weight. L-Carnitine also helps muscles convert fat into energy and promote fat metabolism.
• Antioxidants
• Infection, among other problems, are a common concern with diabetics. It is important for diabetics to have antioxidants to help support the immune system.
• Some common antioxidants for dogs and cats include:
• Vitamin C
• Vitamin E
• Beta carotene
• Selenium
• Lipoic Acid
• NOTE: It is not recommended to supplement these to your pet directly. Excess of some nutrients can cause serious disease.
• Total calories
• Maintaining a lean body mass will promote overall health as well as improve insulin response.
• Fat restriction
• Arginine
• Diets that are high in arginine help promote a body's secretion of insulin.
• Taurine
• Taurine helps mainitain normal insulin activity and sensitivity

Treatment Options

            Since dogs are almost exclusively Type 1 diabetes, all dogs must be given insulin injections in order to manage our canine patients.

            Vetsulin is the most common type of insulin used in dogs currently. It is porcine insulin which is identical to canine insulin; therefore it is readily tolerated by our canine patients. Human insulins differ from the canine insulin by one key amino acid.

            There are many types of insulin; so please ask a veterinarian which type it right for your dog.

Food

            Most veterinarians will prescribe special food for your pet. See more below.

Oral Hypoglycemics

            In human medicine, there are many hypoglycemics; these are geared towards Type 2 diabetics in general. As a result they generally do not work in dogs. There have been no oral hypoglycemics proved to remove the need for insulin injection in the average diabetic canine patient. 

Hypoglycemia - IMPORTANT

            Hypoglycemia, or low blood sugar, is potentially life threatening situation. If too much insulin, too concentrated insulin is given or if the pet misses a meal or is otherwise sick; the blood sugar can drop too low leading to depression, seizures, and even death. Familiarize yourself with the signs on the recommended websites. Karo syrup on the gums should be given immediately on any hypoglycemic suspected pet. This should be followed by calingl our hospital or an emergency hospital at once. 

Monitoring

            There are several methods for monitoring the diabetic patient. They include: monitoring of clinical signs at home, urine and blood tests at home, and urine and blood tests in the hospital.

            Why monitor? Continual monitoring is important because it is common for DM patients to require increased amounts of insulin over time. Many factors can lead to a change in insulin  requirement. These may include: infections, weight change, other concurrent diseases, many medications, change in activity level, etc...

At home monitoring

            Any relapse of the signs of diabetes (see left) are indication to contact us at once. Increased water consumption is often the first sign of malregulation. For in house blood and urine testing, please ask one of our veterinarians if this option is right for you and your pet.

Hospital Testing

            Routine glucose curves (all day event), fructosamine levels, glycosylated hemoglobin, basic blood and urine tests may all be necessary to maintain your diabetic pet's health.

The caninsulin website has a wonderful excel spreadsheet designed for European clients to perform glucose curves at home. I have downloaded the spreadsheet and provided it to the right. I have made one modification: I have switched the glucose units to the most common US standard units of mg/dl instead of mmol/l. For the original spreadsheet, just go to the caninsulin website provided below.

WARNING: Before attempting a glucose curve yourself, please make sure that you contact your veterinarian prior and have learned the proper method for obtaining blood glucose tests by a trained professional. Furthermore the spreadsheet provides a starting dose of insulin - DO NOT CHANGE YOUR PET'S INSULIN FROM WHAT YOUR VETERINARIAN HAS PRESCRIBED AND NEVER ALTER INSULIN DOSES WITHOUT CHECKING WITH YOUR VETERINARIAN PRIOR. This sheet is intended for demostrative purposes only and should NOT replace veterinarian advice ever.