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Diabetes mellitus Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...
is a disease in which the
beta cell Beta cells (β-cells) are a type of cell found in pancreatic islets that synthesize and secrete insulin and amylin. Beta cells make up 50–70% of the cells in human islets. In patients with Type 1 diabetes, beta-cell mass and function are di ...
s of the
endocrine pancreas The pancreatic islets or islets of Langerhans are the regions of the pancreas that contain its endocrine (hormone-producing) cells, discovered in 1869 by German pathological anatomist Paul Langerhans. The pancreatic islets constitute 1–2% of ...
either stop producing insulin or can no longer produce it in enough quantity for the body's needs. The disease can affect humans as well as animals such as dogs. The condition is treatable and need not shorten the animal's life span or interfere with quality of life. If left untreated, the condition can lead to cataracts, increasing weakness in the legs (neuropathy),
malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
,
ketoacidosis Ketoacidosis is a metabolic state caused by uncontrolled production of ketone bodies that cause a metabolic acidosis. While ketosis refers to any elevation of blood ketones, ketoacidosis is a specific pathologic condition that results in changes ...
,
dehydration In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
, and death. Diabetes mainly affects middle-age and older dogs, but there are juvenile cases. (
PDF Portable Document Format (PDF), standardized as ISO 32000, is a file format developed by Adobe in 1992 to present documents, including text formatting and images, in a manner independent of application software, hardware, and operating systems. ...
)
The typical
canine Canine may refer to: Zoology and anatomy * a dog-like Canid animal in the subfamily Caninae ** ''Canis'', a genus including dogs, wolves, coyotes, and jackals ** Dog, the domestic dog * Canine tooth, in mammalian oral anatomy People with the surn ...
diabetes patient is middle-age, female, and
overweight Being overweight or fat is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary. , excess weight reached epidemic proportions globally, with m ...
at diagnosis. The number of dogs diagnosed with diabetes mellitus has increased three-fold in thirty years. In survival rates from almost the same time, only 50% survived the first 60 days after diagnosis and went on to be successfully treated at home. Currently, diabetic dogs receiving treatment have the same expected lifespan as non-diabetic dogs of the same age and gender. The condition is commonly divided into two types, depending on the origin of the condition: type 1 and type 2.
Type 1 diabetes Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when cells that make insulin (beta cells) are destroyed by the immune system. Insulin is a hormone required for the cells to use blood sugar f ...
, sometimes called "juvenile diabetes", is caused by destruction of the beta cells of the
pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an ...
. The condition is also referred to as insulin-dependent diabetes, meaning
exogenous In a variety of contexts, exogeny or exogeneity () is the fact of an action or object originating externally. It contrasts with endogeneity or endogeny, the fact of being influenced within a system. Economics In an economic model, an exogen ...
insulin injections must replace the insulin the pancreas is no longer capable of producing for the body's needs. Type 1 is the most common form of diabetes and affects approximately 0.34% of
dogs The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the wolf. Also called the domestic dog, it is derived from the extinct Pleistocene wolf, and the modern wolf is the dog's nearest living relative. ...
.
Type 2 diabetes Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urinatio ...
can develop in dogs, although it is not as prevalent as type 1. Because of this, there is no possibility the permanently damaged pancreatic beta cells could re-activate to engender a remission as may be possible with some feline diabetes cases, where the primary type of diabetes is type 2. Two additional less common forms of diabetes are
diabetes insipidus Diabetes insipidus (DI), recently renamed to Arginine Vasopressin Deficiency (AVP-D) and Arginine Vasopressin Resistance (AVP-R), is a condition characterized by large amounts of dilute urine and increased thirst. The amount of urine produced ...
, which is a condition of insufficient
antidiuretic hormone Human vasopressin, also called antidiuretic hormone (ADH), arginine vasopressin (AVP) or argipressin, is a hormone synthesized from the AVP gene as a peptide prohormone in neurons in the hypothalamus, and is converted to AVP. It then travel ...
or resistance to it, and gestational diabetes. Gestational diabetes usually occurs during pregnancy. It may be a result of glucose intolerance during the pregnancy period. However, it can be prevented by behavioral and dietary management.


Classification and causes

At present, there is no international standard classification of diabetes in dogs. Commonly used terms are: *Insulin deficiency diabetes or primary diabetes, which refers to the destruction of the beta cells of the pancreas and their inability to produce insulin. *
Insulin resistance Insulin resistance (IR) is a pathological condition in which cells fail to respond normally to the hormone insulin. Insulin is a hormone that facilitates the transport of glucose from blood into cells, thereby reducing blood glucose (blood sugar ...
diabetes or secondary diabetes, which describes the resistance to insulin caused by other medical conditions or by hormonal drugs. While the occurrence of beta cell destruction is known, all of the processes behind it are not. Canine primary diabetes mirrors type 1 human diabetes in the inability to produce insulin and the need for exogenous replacement of it, but the target of canine diabetes autoantibodies has yet to be identified. Breed and treatment studies have been able to provide some evidence of a genetic connection. Studies have furnished evidence that canine diabetes has a seasonal connection not unlike its human Type 1 diabetes counterpart, and a "lifestyle" factor, with pancreatitis being a clear cause. This evidence suggests that the disease in dogs has some environmental and dietary factors involved. Canine obesity causes the corresponding diabetes in dogs also known as canine diabetes (Hoeing 2014). Secondary diabetes may be caused by use of steroid medications, the hormones of
estrus The estrous cycle (, originally ) is the set of recurring physiological changes that are induced by reproductive hormones in most mammalian therian females. Estrous cycles start after sexual maturity in females and are interrupted by anestrous ...
,
acromegaly Acromegaly is a disorder that results from excess growth hormone (GH) after the growth plates have closed. The initial symptom is typically enlargement of the hands and feet. There may also be an enlargement of the forehead, jaw, and nose. Othe ...
, (
spaying Neutering, from the Latin ''neuter'' ('of neither sex'), is the removal of an animal's reproductive organ, either all of it or a considerably large part. The male-specific term is castration, while spaying is usually reserved for female animals. ...
can resolve the diabetes), pregnancy, or other medical conditions such as
Cushing's disease Cushing's disease is one cause of Cushing's syndrome characterised by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary (secondary hypercortisolism). This is most often as a result of a pituitary adenoma (spe ...
. In such cases, it may be possible to treat the primary medical problem and revert the animal to non-diabetic status. Returning to non-diabetic status depends on the amount of damage the pancreatic insulin-producing beta cells have sustained. It happens rarely, but it is possible for a
pancreatitis Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones. There are two main types: acute pancreatitis, and chronic p ...
attack to activate the endocrine portion of the organ back into being capable of producing insulin once again in dogs. It is possible for acute pancreatitis to cause a temporary, or transient diabetes, most likely due to damage to the endocrine portion's beta cells. Insulin resistance that can follow a pancreatitis attack may last for some time thereafter. Pancreatitis can damage the endocrine pancreas to the point where the diabetes is permanent.


Genetic susceptibility of certain breeds

This list of risk factors for canine diabetes is taken from the genetic breed study that was published in 2007. Their "neutral risk" category should be interpreted as insufficient evidence that the dog breed genetically shows a high, moderate, or a low risk for the disease. All risk information is based only on discovered genetic factors. High risk *
Cairn Terrier The Cairn Terrier is a terrier breed originating in the Scottish Highlands and recognized as one of Scotland's earliest working dogs. The breed was given the name Cairn because the breed's function was to hunt and chase quarry between the cai ...
* Samoyed Moderate risk * Bichon Frise *
Border Collie The Border Collie is a Scottish breed of herding dog of medium size. Widely considered to be the most intelligent dog breed, they are descended from landrace sheepdogs once found all over the British Isles, but became standardised in the Ang ...
*
Border Terrier The Border Terrier is a British breed of small, rough-coated terrier. It originates from the area of the Anglo-Scottish border, and shares ancestry with the Dandie Dinmont Terrier and the Bedlington Terrier from the same area. The dogs were t ...
*
Collie Collies form a distinctive type of herding dogs, including many related landraces and standardized breeds. The type originated in Scotland and Northern England. Collies are medium-sized, fairly lightly-built dogs, with pointed snouts. Man ...
*
Dachshund The dachshund ( or ; German: " badger dog"), also known as the wiener dog, badger dog, and sausage dog, is a short-legged, long-bodied, hound-type dog breed. The dog may be smooth-haired, wire-haired, or long-haired, and comes in a variety o ...
*
English Setter The English Setter is a medium-size breed of dog. It is part of the setter group, which includes the red Irish Setters, Irish Red and White Setters, and black-and-tan Gordon Setters. The mainly white body coat is of medium length with long s ...
*
Poodle The Poodle, called the Pudel in German and the Caniche in French, is a breed of water dog. The breed is divided into four varieties based on size, the Standard Poodle, Medium Poodle, Miniature Poodle and Toy Poodle, although the Medium Poodle var ...
*
Schnauzer A Schnauzer (), plural ''Schnauzer'', lit. translation "snouter") is a dog breed type that originated in Germany from the 14th to 16th centuries. The term comes from the German word for "snout" and means colloquially "moustache",Yorkshire Terrier Neutral risk *
Cavalier King Charles Spaniel The Cavalier King Charles Spaniel is a British breed of toy dog of spaniel type. Four colours are recognised: Blenheim (chestnut and white), tricolour (black/white/tan), black and tan, and ruby; the coat is smooth and silky. The lifespan is u ...
*
Cocker Spaniel Cocker Spaniels are dogs belonging to two breeds of the spaniel dog type: the American Cocker Spaniel and the English Cocker Spaniel of which are commonly called simply Cocker Spaniel in their countries of origin. In the early 20th century, Cock ...
* Doberman *
Jack Russell Terrier The Jack Russell Terrier is a small terrier that has its origins in fox hunting in England. It is principally white-bodied and smooth, rough or broken-coated and can be any colour. Small tan and white terriers that technically belong to ot ...
* Labrador Retriever *
Mixed Breed A mixed breed is a domesticated animal descended from multiple breeds of the same species, often breeding without any human intervention, recordkeeping, or selective breeding. Examples include: * Mixed-breed dog, a dog whose ancestry is comple ...
*
Rottweiler The Rottweiler (, ) is a breed of domestic dog, regarded as medium-to-large or large. The dogs were known in German as , meaning Rottweil butchers' dogs, because their main use was to herd livestock and pull carts laden with butchered meat ...
*
West Highland Terrier The West Highland White Terrier, commonly known as the Westie, is a breed of dog from Scotland with a distinctive white harsh coat with a somewhat soft white undercoat. It is a medium-sized terrier, although with longer legs than other Scott ...
Low risk * Boxer *
English Springer Spaniel The English Springer is a breed of gun dog in the Spaniel group traditionally used for flushing and retrieving game. It is an affectionate, excitable breed with a typical lifespan of twelve to fourteen years. They are very similar to the Wels ...
*
German Shepherd The German Shepherd or Alsatian is a German breed of working dog of medium to large size. The breed was developed by Max von Stephanitz using various traditional German herding dogs from 1899. It was originally bred as a herding dog, for ...
*
Golden Retriever The Golden Retriever is a Scottish breed of retriever dog of medium size. It is characterised by a gentle and affectionate nature and a striking golden coat. It is commonly kept as a pet and is among the most frequently registered breeds ...
*
Staffordshire Bull Terrier The Staffordshire Bull Terrier, also called the Staffy or Stafford, is a purebred dog of small to medium size in the terrier group that originated in the northern parts of Birmingham and in the Black Country of Staffordshire, for which it is ...
*
Weimaraner The Weimaraner ( ) is a large dog that was originally bred as a hunting dog in the early 19th century. Early Weimaraners were used by royalty for hunting large game such as boar, bear and deer. As the popularity of large game hunting began t ...
*
Welsh Springer Spaniel The Welsh Springer Spaniel (''Welsh'': ''Llamgi Cymru'') is a breed of dog and a member of the spaniel family. Thought to be comparable to the old Land Spaniel, they are similar to the English Springer Spaniel and historically have been re ...


Gene therapy

In February 2013 scientists successfully cured
type 1 diabetes Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when cells that make insulin (beta cells) are destroyed by the immune system. Insulin is a hormone required for the cells to use blood sugar f ...
in dogs using a pioneering
gene therapy Gene therapy is a Medicine, medical field which focuses on the genetic modification of cells to produce a therapeutic effect or the treatment of disease by repairing or reconstructing defective genetic material. The first attempt at modifying ...
.


Pathogenesis

The body uses
glucose Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, u ...
for energy. Without insulin, glucose is unable to enter the cells where it will be used for this and other
anabolic Anabolism () is the set of metabolic pathways that construct molecules from smaller units. These reactions require energy, known also as an endergonic process. Anabolism is the building-up aspect of metabolism, whereas catabolism is the breakin ...
("building up") purposes, such as the synthesis of glycogen, proteins, and fatty acids. (
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)
Insulin is also an active preventor of the breakdown or
catabolism Catabolism () is the set of metabolic pathways that breaks down molecules into smaller units that are either oxidized to release energy or used in other anabolic reactions. Catabolism breaks down large molecules (such as polysaccharides, li ...
of glycogen and fat. The absence of sufficient insulin causes this breaking-down process to be accelerated; it is the mechanism behind metabolizing fat instead of glucose and the appearance of ketones. Since the glucose that normally enters the cells is unable to do so without insulin, it begins to build up in the blood where it can be seen as hyperglycemia or high blood glucose levels. The
tubules In biology, a tubule is a general term referring to small tube or similar type of structure. Specifically, tubule can refer to: * a small tube or fistular structure * a minute tube lined with glandular epithelium * any hollow cylindrical body stru ...
of the kidneys are normally able to re-absorb glucose, but they are unable to handle and process the amount of glucose they are being presented with. At this point, which is called the renal threshold, the excess glucose spills into the urine (
glycosuria Glycosuria is the excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reabsorb all of the filtered glucose from the tubular fluid back into the bloodstream. Glycosuria is nearly always caused ...
), where it can be seen in urine glucose testing. It is the
polyuria Polyuria () is excessive or an abnormally large production or passage of urine (greater than 2.5 L or 3 L over 24 hours in adults). Increased production and passage of urine may also be termed diuresis. Polyuria often appears in conjunction wi ...
, or over-frequent urination, which causes
polydipsia Polydipsia is excessive thirst or excess drinking.Porth, C. M. (1990). ''Pathophysiology: Concepts of altered health states''. Philadelphia: J.B. Lippincott Company. The word derives from the Greek () "very thirsty", which is derived from (, " ...
, or excessive water consumption, through an osmotic process. Even though there is an overabundance of glucose, the lack of insulin does not allow it to enter the cells. As a result, they are not able to receive nourishment from their normal glucose source. The body begins using fat for this purpose, causing weight loss; the process is similar to that of
starvation Starvation is a severe deficiency in caloric energy intake, below the level needed to maintain an organism's life. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage and eventually, de ...
.


Symptoms

The main symptoms which occur in nearly all dogs with diabetes mellitus are: * excessive water consumption, excessive water consumption due to too much thirst; this condition is often called ''polydipsia.'' * frequent and/or excessive urination, known as
polyuria Polyuria () is excessive or an abnormally large production or passage of urine (greater than 2.5 L or 3 L over 24 hours in adults). Increased production and passage of urine may also be termed diuresis. Polyuria often appears in conjunction wi ...
, often requiring the dog to be let outside to urinate during the night, * greater than average appetite, increased appetite to abnormal levels, which is greater than the average appetite, a condition known as ''polyphagia.'', * weight loss; dogs with diabetes may also suffer from severe weight loss, weakness'', anorexia'' and blindness. Sometimes, the first sign of diabetes noticed by the owner may be that their dog either has become blind (due to the formation of
cataract A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble ...
s in the eyes), or has vomiting, anorexia, lethargy and weakness (due to ketoacidosis). Diabetes mellitus can be a threat to the health of the dog since it may cause urinary tract infections.


Checkups

Although the symptoms of diabetes mellitus such as frequent urination, thirstiness, greater appetites and inactiveness are easily visible, frequent checking of the dog for the disease is required. The dog's body weight should be determined and calculated once every two weeks using weight scale. The daily caloric requirement by the dog's body and BCS should also be determined using a scale as part of dietary management in maintaining average body weight. The protein intake by the dog should also be considered and checked twice a month. Blood pressure of the dog should also be constantly and daily checked in order to predict any future occurrence. The blood sugar level may also be checked using glucometer to check the glucose level in the body of the dog.


Management

Early diagnosis and treatment can reduce the incidence of complications such as
cataracts A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble ...
and
neuropathy Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Damage to peripheral nerves may impair sensation, movement, gland, or o ...
. Since dogs are insulin dependent, oral diabetes drugs, which require a functional
endocrine pancreas The pancreatic islets or islets of Langerhans are the regions of the pancreas that contain its endocrine (hormone-producing) cells, discovered in 1869 by German pathological anatomist Paul Langerhans. The pancreatic islets constitute 1–2% of ...
with beta cells capable of producing insulin, are ineffective. Diabetic dogs require
insulin therapy As a medication, insulin is any pharmaceutical preparation of the protein hormone insulin that is used to treat high blood glucose. Such conditions include type 1 diabetes, type 2 diabetes, gestational diabetes, and complications of diabetes s ...
, which must be continued for life. The goal of treatment is to regulate blood glucose using insulin and some probable diet and daily routine changes. The process may take a few weeks or many months and is similar as in type 1 diabetic humans. The aim is to keep the blood glucose values in an acceptable range. The commonly recommended dosing method is by "starting low and going slow" as indicated for people with diabetes. During the initial process of regulation and periodically thereafter, the effectiveness of the insulin dose at controlling blood glucose is evaluated. This is done by a series of blood glucose tests called a curve. Blood samples are taken and tested at intervals of one to two hours over a 12- or 24-hour period. The results are generally transferred into graph form for easier interpretation. They are compared against the feeding and insulin injection times for judgment. The curve provides information regarding the action of the insulin in the animal. It is used to determine insulin dose adjustments, determine lowest and highest blood glucose levels, discover insulin duration and, in the case of continued hyperglycemia, whether the cause is insufficient insulin dose or Somogyi rebound, where blood glucose levels initially reach hypoglycemic levels and are brought to hyperglycemic ones by the body's
counterregulatory hormone A counterregulatory hormone is a hormone that opposes the action of another. Glucose Counterregulation The action of insulin is counterregulated by glucagon, epinephrine (adrenaline), norepinephrine (noradrenaline), cortisol, and growth hormone. ...
s. Curves also provide evidence of insulin resistance which may be caused by medications other than insulin or by disorders other than diabetes which further testing can help identify. Other diagnostic tests to determine the level of diabetic control are
fructosamine Fructosamines are compounds that result from glycation reactions between a sugar (such as fructose or glucose) and a primary amine, followed by isomerization via the Amadori rearrangement. Biologically, fructosamines are recognized by fructosamine ...
and
glycated hemoglobin Glycated hemoglobin, also known as HbA1c, glycohemoglobin, hemoglobin A1c, A1C, is a form of hemoglobin (Hb) that is chemically linked to a sugar. Most monosaccharides, including glucose, galactose and fructose, spontaneously (i.e. non-enzymat ...
(GHb) blood tests which can be useful especially if stress may be a factor. While anxiety or stress may influence the results of blood or urine glucose tests, both of these tests measure glycated proteins, which are not affected by them. Fructosamine testing provides information about blood glucose control for an approximate 2- to 4-week period, while GHb tests measure a 2- to 4-month period. Each of these tests has its own limitations and drawbacks and neither are intended to be replacements for blood glucose testing and curves, but are to be used to supplement the information gained from them. While HbA1c tests are a common diagnostic for diabetes in humans, only recently has an A1C test become available for cats and dogs. The product is called A1CARE and is available from Baycom Diagnostics. The diabetic pet is considered regulated when its blood glucose levels remain within an acceptable range on a regular basis. Acceptable levels for dogs are between 5 and 10 mmol/L or 90 to 180 mg/dL. The range is wider for diabetic animals than non-diabetics, because insulin injections cannot replicate the accuracy of a working pancreas.


Insulin therapy

The general form of this treatment is an intermediate-acting basal insulin with a regimen of food and insulin every 12 hours, with the insulin injection following the meal. The most commonly used intermediate-acting insulins are NPH, also referred to as isophane, or Caninsulin, also known as Vetsulin, a porcine Lente insulin. While the normal diabetes routine is timed feedings with insulin shots following the meals, dogs unwilling to adhere to this pattern can still attain satisfactory regulation. Most dogs do not require basal/bolus insulin injections; treatment protocol regarding consistency in the diet's calories and composition along with the established feeding and injection times is generally a suitable match for the chosen intermediate-acting insulin. With
Lantus Insulin glargine, sold under the brand name Lantus among others, is a long-acting modified form of medical insulin, used in the management of type I and type II diabetes. It is typically the recommended long acting insulin in the United King ...
and protamine zinc insulin (PZI) being unreliable in dogs, they are rarely used to treat canine diabetes. Bovine insulin has been used as treatment for some dogs, particularly in the UK. Pfizer Animal Health discontinued of all three types of its veterinary Insuvet bovine insulins in late 2010 and suggested patients be transitioned to Caninsulin. The original owner of the insulin brand, Schering-Plough Animal Health, contracted Wockhardt UK to produce them. Wockhardt UK has produced both bovine and porcine insulins for the human pharmaceutical market for some time.


Diet

Most of the commercially available prescription diabetes foods are high in fiber, complex carbohydrates, and have proven therapeutic results. (
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)
Of primary concern is getting or keeping the animal eating, as use of the prescribed amount of insulin is dependent on eating full meals. When no meal is eaten, there is still a need for a basal dosage of insulin, which supplies the body's needs without taking food into consideration. Eating a partial meal means a reduction in insulin dose. Basal and reduced insulin dose information should be part of initial doctor–client diabetes discussions in case of need. It is possible to regulate diabetes without any diet change. If the animal will not eat a prescribed diet, it is not in the dog's best interest to insist on it; the amount of additional insulin required because a non-prescription diet is being fed is generally between 2–4%. Semi moist foods should be avoided as they tend to contain a lot of sugars. Since dogs with diabetes are prone to pancreatitis and
hyperlipidemia Hyperlipidemia is abnormally elevated levels of any or all lipids (fats, cholesterol, or triglycerides) or lipoproteins in the blood. citing: and The term ''hyperlipidemia'' refers to the laboratory finding itself and is also used as an umbre ...
, feeding a low-fat food may help limit or avoid these complications. A non-prescription food with a "fixed formula" would be suitable because of the consistency of its preparation. Fixed formula foods contain precise amounts of their ingredients so batches or lots do not vary much if at all. "Open formula" foods contain the ingredients shown on the label but the amount of them can vary, however they must meet the guaranteed analysis on the package. These changes may have an effect on the control of diabetes. Prescription foods are fixed formulas, while most non-prescription ones are open formula unless the manufacturer states otherwise.


Glucometers and urine test strips

The use of an inexpensive glucometer and blood glucose testing at home can help avoid dangerous insulin overdoses and can provide a better picture of how well the condition is managed. A 2003 study of canine diabetes caregivers who were new to testing blood glucose at home found 85% of them were able to both succeed at testing and to continue it on a long-term basis. (
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)
Using only one blood glucose reading as the reason for an insulin dose increase is to be avoided; while the results may be higher than desired, further information, such as the lowest blood glucose reading or nadir, should be available to prevent possible hypoglycemia. Urine strips are not recommended to be used as the sole factor for insulin adjustments as they are not accurate enough. Urine glucose testing strips have a negative result until the renal threshold of 10 mmol/L or 180 mg/dL is reached or exceeded for a period of time. The range of negative reading values is quite wide-covering normal or close to normal blood glucose values with no danger of hypoglycemia ( euglycemia) to low blood glucose values (
hypoglycemia Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose bel ...
) where treatment would be necessary. Because urine is normally retained in the bladder for a number of hours, the results of urine testing are not an accurate measurement of the levels of glucose in the bloodstream at the time of testing. Glucometers made for humans are generally accurate using canine and feline blood except when reading lower ranges of blood glucose (<80 mg/dL), (<4.44 mmol/L). It is at this point where the size difference in human vs animal red blood cells can create inaccurate readings. Glucometers for humans were successfully used with pets long before animal-oriented meters were produced. A 2009 study directly compared readings from both types of glucometers to those of a chemistry analyzer. Neither glucometer's readings exactly matched those of the analyzer, but the differences of both were not clinically significant when compared to analyzer results. All glucometer readings need to be compared to same sample laboratory values to determine accuracy. Continuous glucose monitoring Some veterinarians are using continuous monitoring as part of the dog's treatment plan (2019). Sensors intended for humans, e.g. Abbot labs Freestyle Libre, can be applied and provide direct measurement of glucose levels eliminating the need for daily urine or blood checks.


Disease complications


Ketones – ketoacidosis

Ketones In organic chemistry, a ketone is a functional group with the structure R–C(=O)–R', where R and R' can be a variety of carbon-containing substituents. Ketones contain a carbonyl group –C(=O)– (which contains a carbon-oxygen double b ...
in the urine or blood, as detected by urine strips or a blood ketone testing meter, may indicate the beginning of
diabetic ketoacidosis Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of ...
(DKA), a dangerous and often quickly fatal condition caused by high glucose levels (
hyperglycemia Hyperglycemia is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1  mmol/L (200  mg/dL), but symptoms may not start to become noticeable until even ...
) and low insulin levels combined with certain other systemic stresses. DKA can be arrested if caught quickly. Ketones are produced by the liver as part of fat metabolism and are normally not found in sufficient quantity to be measured in the urine or blood of non-diabetics or well-controlled diabetics. The body normally uses glucose as its fuel and is able to do so with sufficient insulin levels. When glucose is not available as an energy source because of untreated or poorly treated diabetes and some other unrelated medical conditions, it begins to use fat for energy instead. The result of the body turning to using fat instead of glucose for energy means ketone production that is measurable when testing either urine or blood for them. (
PDF Portable Document Format (PDF), standardized as ISO 32000, is a file format developed by Adobe in 1992 to present documents, including text formatting and images, in a manner independent of application software, hardware, and operating systems. ...
)
Ketone problems that are more serious than the "trace or slight" range need immediate medical attention; they cannot be treated at home. Veterinary care for
ketosis Ketosis is a metabolic state characterized by elevated levels of ketone bodies in the blood or urine. Physiological ketosis is a normal response to low glucose availability, such as low-carbohydrate diets or fasting, that provides an additional ...
/ketoacidosis can involve intravenous (IV) fluids to counter
dehydration In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
, when necessary, to replace depleted
electrolytes An electrolyte is a medium containing ions that is electrically conducting through the movement of those ions, but not conducting electrons. This includes most soluble salts, acids, and bases dissolved in a polar solvent, such as water. Upon di ...
,
intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
or
intramuscular Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle. In medicine, it is one of several methods for parenteral administration of medications. Intramuscular injection may be preferred because muscles ha ...
short-acting insulin to lower blood glucose levels, and measured amounts of glucose or force feeding, to bring the metabolism back to using glucose instead of fat as its source of energy. When testing urine for ketones, the sample needs to be as fresh as possible. Ketones evaporate quickly, so there is a chance of getting a false negative test result if testing older urine. The urine testing strip bottle has instructions and color charts to illustrate how the color on the strip will change given the level of ketones or glucose in the urine over 15 (ketones–Ketostix) or 30 (glucose–Ketodiastix) seconds. Reading the colors at those time intervals is important because the colors will continue to darken and a later reading will be an incorrect result. Timing with a clock or watch second hand instead of counting is more accurate. (
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At present, there is only one glucometer available for home use that tests blood for ketones using special strips for that purpose–Abbott's Precision Xtra. This meter is known as Precision, Optium, or Xceed outside of the US. The blood ketone test strips are very expensive; prices start at about US$50 for ten strips. It is most likely urine test strips–either ones that test only for ketones or ones that test for both glucose and ketones in urine would be used. The table above is a guide to when ketones may be present.


Nonketotic hyperosmolar syndrome

Nonketotic hyperosmolar syndrome (also known as hyperglycemic hyperosmolar syndrome) is a rare but extremely serious complication of untreated canine diabetes, which is a medical emergency. It shares the symptoms of extreme hyperglycemia, dehydration, and lethargy with ketoacidosis; because there is some insulin in the system, the body does not begin to turn to using fat as its energy source and there is no ketone production. There is not sufficient insulin available to the body for proper uptake of glucose, but there is enough to prevent ketone formation. The problem of dehydration in NHS is more profound than in diabetic ketoacidosis. Seizures and coma are possible. Treatment is similar to that of ketoacidosis, with the exceptions being that NHS requires that the blood glucose levels and rehydration be normalized at a slower rate than for DKA;
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is possible if the treatment progresses too rapidly.


Dehydration

Body fluid loss is measured in two major ways–sensible and insensible. Sensible is defined as being able to be measured in some way; vomiting, urination and defecation are all considered to be sensible losses as they have the ability to be measured. An insensible loss example is breathing because while there are some fluid losses, it is not possible to measure the amount of them. With a condition like fever, it is possible to measure the amount of fluid losses from it with a formula that increases by 7% for each degree of above normal body temperature, so it would be classed as a sensible loss. A check of the pet's gums and skin can indicate dehydration; gums become tacky and dry and skin does not snap back quickly when pinched if dehydration is present. When the skin at the back is lifted, a dehydrated animal's does not fall back into place quickly. Serious dehydration (loss of 10–12% of body fluids) means the pulled up skin stays there and does not go back into place. At this point, the animal may go into shock; dehydration of 12% or more is an immediate medical emergency. Hypovolemic shock is a life-threatening medical condition in which the heart is unable to pump sufficient blood to the body, due to loss of fluids.
Dehydration In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
can change the way subcutaneous insulin is absorbed, so either hyperglycemia or hypoglycemia are possible; dehydration can also cause false negative or positive urine ketone test results. Hyperglycemia means more of a risk for dehydration.


Treatment complications


Hypoglycemia

Hypoglycemia, or low blood glucose, can happen even with care, since insulin requirements can change without warning. Some common reasons for hypoglycemia include increased or unplanned exercise, illness, or medication interactions, where another medication potentiates the effects of the insulin.
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diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin w ...
episodes can bring on a hypoglycemia reaction, due to dehydration or simply a case of too much insulin and not enough properly digested food. Symptoms of hypoglycemia need to be taken seriously and addressed promptly. Since serious hypoglycemia can be fatal, it is better to treat a suspected incident than to fail to respond quickly to the signs of actual hypoglycemia. Dr. Audrey Cook addressed the issue in her 2007 article on diabetes mellitus: "Hypoglycemia is deadly; hyperglycemia is not. Owners must clearly understand that too much insulin can kill, and that they should call a veterinarian or halve the dose if they have any concerns about a pet's well-being or appetite. Tell owners to offer food immediately if the pet is weak or is behaving strangely."


Clinical Signs

Some common symptoms are: *depression or lethargy *confusion or dizziness *trembling *weakness *ataxia (loss of coordination or balance) *loss of excretory or bladder control (sudden house accident) *vomiting, and then loss of consciousness and possible seizures Successful home treatment of a hypoglycemia event depends on being able to recognize the symptoms early and responding quickly with treatment. Trying to make a seizing or unconscious animal swallow can cause choking on the food or liquid. There is also a chance that the materials could be aspirated (enter the lungs instead of being swallowed). Seizures or loss of consciousness because of low blood glucose levels are medical emergencies.


Treatment

Food should be offered at the first signs of possible hypoglycemia. If the animal refuses it, a sugar solution (
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, etc.) should be poured on the finger and rubbed on its gums or under the tongue ( sublingually). The solution must be applied this way to prevent possible aspiration of it. Intervet suggests one tablespoon of a sugar solution rubbed onto the gums, regardless of the size of the dog. Another hypoglycemia formula is 1 gram of glucose for every kilogram (2.2 lb) of the animal's body weight. Since sugar acts quickly, a response should be seen within a minute or two. Honey, syrup, or sugar, as simple carbohydrates, act rapidly and will make the blood glucose rise, but the rise will not last very long, as they are broken down quickly by the body. Feeding something containing complex carbohydrates when the pet is able to eat will make sure another hypoglycemia event does not overtake the rapid rise in blood glucose levels from the sugar solution. Complex carbohydrates take longer to be broken down by the body, so they do not raise blood glucose levels until some time after being eaten. A small meal should be fed and the animal taken for medical evaluation to determine if further treatment is needed. Treatment of a serious hypoglycemia episode is similar to that of diabetic humans: using glucose or glucagon infusions, depending on severity. A part from the medicinal way, lifestyle management of the dog can also be considered when preventing a diabetes attack on the dog. Physical exercising activities such as homeopathy2, walking and swimming of the dog are suggested under behavioral management in treating diabetes because it results in tissue preservation. Dietary management in food service is also essential in preventing diabetes attack. A dietary management may include low fat content foods, complex carbohydrates that aid in slowing down glucose absorption, protein and fiber.


References


External links


Dogs and Diabetes - Signs, Treatment, ComplexitiesVet-approved recipes for diabetic dog food
{{DEFAULTSORT:Diabetes in dogs Diabetes Dog diseases