Diabetes Mellitus
*For this discussion, anything highlighted in red will be in reference to dogs, anything in blue will be in reference to cats, and anything in green will be in reference to both species.
All cells in the body need glucose, a sugar that we get from food, to function normally. After a meal, glucose is absorbed from the intestinal tract and is transported through the bloodstream. The pancreas secretes a hormone called insulin to take the glucose from the bloodstream into the body's cells, where it can be used for energy. The pancreas secretes insulin in response to how much glucose the body absorbs.
There are two different types of diabetes in animals. One type is similar to type I or juvenile diabetes in people and occurs when the pancreas no longer secretes enough insulin. This type usually occurs in dogs and is why most dogs are insulin-dependent for the rest of their life. The second type is similar to type II or acquired diabetes in people and occurs when the body becomes resistant to insulin over time in response to a diet high in glucose. Cats usually get this second type of diabetes; some remain insulin-dependent for life but some can be weaned off insulin with appropriate treatment.
Symptoms and Diagnosis
The most common clinical signs of diabetes in dogs and cats include:
Treatment
Dogs
When we first make a diagnosis of a stable diabetic dog, we will start insulin therapy. Insulin is given as a twice daily injection at a starting dose, and then we will recheck your dog in 7-10 days to see how we have affected the blood glucose levels. We will run a glucose curve, which is an all-day test where we sample blood glucose levels throughout the day. Based on these readings, we will adjust the dose of insulin as needed. It often times takes several weeks to months to get a diabetic dog regulated, so please be patient and DO NOT adjust insulin levels without consulting a veterinarian.
Another important part of treatment is diet change. We have several prescription diets that are good for diabetic dogs that are higher in fiber than normal diets. This will help regulate the blood sugar levels and keep your dog at a more consistent level than with just insulin therapy alone.
Cats
The mainstay of treatment in newly diagnosed, stable diabetic cats is diet change. Since they usually have insulin resistance, weight loss and decreasing dietary carbohydrates are the primary treatments. We place cats on a low carbohydrate, higher protein food and institute once daily insulin therapy at a starting dose. In 7-10 days, we like to recheck cats (just like with dogs) to make sure the insulin and diet are working, and we adjust the dose of insulin as needed at that time. With cats, we tend to recheck blood glucose curves more frequently during the first few months than we do with dogs, because cats can have remission of their diabetes and no longer need insulin. We need to be monitoring their blood sugar levels so they do not drop too low. In cats, remission (if it occurs) usually happens within the first 6 months. Some cats will need insulin therapy for the rest of their life, even with diet change.
Some cats do not tolerate glucose testing in the hospital. Extreme stress in cats can make the blood glucose skyrocket, and thus make our blood glucose readings in the hospital not indicative of what the cat's blood glucose is at home. For these cats, we can try at home monitoring, urine monitoring or fructosamine testing to facilitate insulin therapy.
If your pet is an intact female, we will also recommend spaying her. Progesterone levels can interfere with insulin regulation, so removing these hormones from your pet by doing a spay will help us be able to better regulate her diabetes.
Complications from diabetes
There are several common complications that occur even in well regulated diabetic dogs and cats. These include cataract formation, chronic urinary tract infections, and dental infections. Please be prepared to test the urine several times a year for bacterial infections, and dental cleanings are an important part of keeping a diabetic patient healthy.
One complication that can result from insulin administration (or in cats that are experiencing diabetic remission) is low blood sugar. Symptoms of low blood sugar include weakness and staggering, staring off into space, excessive drooling, or seizures. Owners with diabetic pets should keep a bottle of Karo syrup at home for these emergency situations. Placing some syrup directly on the lips will help raise blood glucose levels while you are on your way to the veterinarian. If your pet is a diabetic and is not eating well, has been vomiting or has been having diarrhea call the veterinarian before continuing to administer insulin as this can result in dangerously low blood sugar levels.
DKA
In more severe cases, a complication called DKA (diabetic ketoacidosis) can occur. This happens with long-standing unregulated diabetes. Unfortunately, some of our patients are already in this state when a diagnosis is made. When the body cannot utilize glucose as an energy source (either because there is no insulin being produced or the body does not recognize the insulin that is present, thus not being able to bring glucose into the cells for energy), it switches to using fat breakdown for energy. Ketones are byproducts from the breakdown of fat. Over time, as ketones build up in the bloodstream, this can send the pet into DKA, which is a shock type state that is life threatening and characterized by pH and electrolyte imbalances in the body. DKA is an emergency situation. Pets are usually extremely ill, with nausea and vomiting, depression, and inappetance along with the common symptoms for diabetes. The sooner a diagnosis is made and treatment is initiated, the better chance your pet will have. Treatment is extensive and includes intravenous fluids, strict insulin regulation, anti-nausea medication, potassium supplementation, and repeating blood work is often necessary to monitor treatment.
Preventing diabetes in your pet
There are several risk factors in our pets for the development of diabetes. These include:
Breed predispositions in dogs
Acute or chronic pancreatitis or pancreatic cancer - any disease process that affects the pancreas can damage the beta cells in the pancreas, which are responsible for producing insulin.
The main risk factor for cats is obesity. Middle aged, overweight neutered males are the primary cats prone to diabetes. If your cat is overweight, instituting a weight loss program with your veterinarian before any disease process can occur is ideal.
All cells in the body need glucose, a sugar that we get from food, to function normally. After a meal, glucose is absorbed from the intestinal tract and is transported through the bloodstream. The pancreas secretes a hormone called insulin to take the glucose from the bloodstream into the body's cells, where it can be used for energy. The pancreas secretes insulin in response to how much glucose the body absorbs.
There are two different types of diabetes in animals. One type is similar to type I or juvenile diabetes in people and occurs when the pancreas no longer secretes enough insulin. This type usually occurs in dogs and is why most dogs are insulin-dependent for the rest of their life. The second type is similar to type II or acquired diabetes in people and occurs when the body becomes resistant to insulin over time in response to a diet high in glucose. Cats usually get this second type of diabetes; some remain insulin-dependent for life but some can be weaned off insulin with appropriate treatment.
Symptoms and Diagnosis
The most common clinical signs of diabetes in dogs and cats include:
- Excessive drinking
- Excessive urinating and clear, watery looking urine
- Weight loss despite a ravenous appetite
- Signs of a urinary tract infection (blood in urine, straining to urinate, foul odor to urine)
- Dogs - rapid cataract formation
- Cats - weakness in the back legs
Treatment
Dogs
When we first make a diagnosis of a stable diabetic dog, we will start insulin therapy. Insulin is given as a twice daily injection at a starting dose, and then we will recheck your dog in 7-10 days to see how we have affected the blood glucose levels. We will run a glucose curve, which is an all-day test where we sample blood glucose levels throughout the day. Based on these readings, we will adjust the dose of insulin as needed. It often times takes several weeks to months to get a diabetic dog regulated, so please be patient and DO NOT adjust insulin levels without consulting a veterinarian.
Another important part of treatment is diet change. We have several prescription diets that are good for diabetic dogs that are higher in fiber than normal diets. This will help regulate the blood sugar levels and keep your dog at a more consistent level than with just insulin therapy alone.
Cats
The mainstay of treatment in newly diagnosed, stable diabetic cats is diet change. Since they usually have insulin resistance, weight loss and decreasing dietary carbohydrates are the primary treatments. We place cats on a low carbohydrate, higher protein food and institute once daily insulin therapy at a starting dose. In 7-10 days, we like to recheck cats (just like with dogs) to make sure the insulin and diet are working, and we adjust the dose of insulin as needed at that time. With cats, we tend to recheck blood glucose curves more frequently during the first few months than we do with dogs, because cats can have remission of their diabetes and no longer need insulin. We need to be monitoring their blood sugar levels so they do not drop too low. In cats, remission (if it occurs) usually happens within the first 6 months. Some cats will need insulin therapy for the rest of their life, even with diet change.
Some cats do not tolerate glucose testing in the hospital. Extreme stress in cats can make the blood glucose skyrocket, and thus make our blood glucose readings in the hospital not indicative of what the cat's blood glucose is at home. For these cats, we can try at home monitoring, urine monitoring or fructosamine testing to facilitate insulin therapy.
If your pet is an intact female, we will also recommend spaying her. Progesterone levels can interfere with insulin regulation, so removing these hormones from your pet by doing a spay will help us be able to better regulate her diabetes.
Complications from diabetes
There are several common complications that occur even in well regulated diabetic dogs and cats. These include cataract formation, chronic urinary tract infections, and dental infections. Please be prepared to test the urine several times a year for bacterial infections, and dental cleanings are an important part of keeping a diabetic patient healthy.
One complication that can result from insulin administration (or in cats that are experiencing diabetic remission) is low blood sugar. Symptoms of low blood sugar include weakness and staggering, staring off into space, excessive drooling, or seizures. Owners with diabetic pets should keep a bottle of Karo syrup at home for these emergency situations. Placing some syrup directly on the lips will help raise blood glucose levels while you are on your way to the veterinarian. If your pet is a diabetic and is not eating well, has been vomiting or has been having diarrhea call the veterinarian before continuing to administer insulin as this can result in dangerously low blood sugar levels.
DKA
In more severe cases, a complication called DKA (diabetic ketoacidosis) can occur. This happens with long-standing unregulated diabetes. Unfortunately, some of our patients are already in this state when a diagnosis is made. When the body cannot utilize glucose as an energy source (either because there is no insulin being produced or the body does not recognize the insulin that is present, thus not being able to bring glucose into the cells for energy), it switches to using fat breakdown for energy. Ketones are byproducts from the breakdown of fat. Over time, as ketones build up in the bloodstream, this can send the pet into DKA, which is a shock type state that is life threatening and characterized by pH and electrolyte imbalances in the body. DKA is an emergency situation. Pets are usually extremely ill, with nausea and vomiting, depression, and inappetance along with the common symptoms for diabetes. The sooner a diagnosis is made and treatment is initiated, the better chance your pet will have. Treatment is extensive and includes intravenous fluids, strict insulin regulation, anti-nausea medication, potassium supplementation, and repeating blood work is often necessary to monitor treatment.
Preventing diabetes in your pet
There are several risk factors in our pets for the development of diabetes. These include:
Breed predispositions in dogs
- Keeshond
- Miniature schnauzer
- Poodles
- Samoyed
- Dachshund
- Alaskan malamute
- Beagle
- Chow Chow
Acute or chronic pancreatitis or pancreatic cancer - any disease process that affects the pancreas can damage the beta cells in the pancreas, which are responsible for producing insulin.
The main risk factor for cats is obesity. Middle aged, overweight neutered males are the primary cats prone to diabetes. If your cat is overweight, instituting a weight loss program with your veterinarian before any disease process can occur is ideal.