Presented by J. A. Hass DVM, MS
A client seminar presented on 13. October, 2009
Hector and Jimmy’s Restaurant
Milford. MI 48380
Diabetes is a term used to describe diseases that cause polyuria (increased urine production). Diabetes mellitus is a chronic syndrome of impaired metabolism resulting in insufficient secretion of insulin or insulin resistance. In humans there are two major type of diabetes, Type 1 and Type 2. Diabetes mellitus in veterinary patients, although similar in behavior as human diabetes, is more accurately categorized as Insulin dependent (similar to type 1 in people) and Non-insulin-dependent (similar to type 2 diabetes). Dogs more commonly are insulin dependent, or require insulin therapy to remain normoglycemic. Cats can be either, about 30-50 % of feline diabetics are non-insulin dependent. There is no test that distinguishes the insulin-dependent pet from the non-insulin-dependent, the differentiation between the two is made through careful evaluation, observation and management.
There are many factors that may predispose your pet to becoming diabetic. Genetics can play a roll in predisposing a dog or cat to diabetes, just as it does in humans. However, at this time we do not understand the relationship of genetics in the diabetic dog and cat. We do appreciate that diabetes is more common in certain breed groups and as we investigate further the genetic link and how it triggers diabetes, we will develop a better understanding of the familial and genetic influence on diabetes in the dog and cat.
The role of other illnesses and environmental factors in causing diabetes are better understood. Pets that develop pancreatitis, an inflammation of the pancreas, can develop diabetes as a result of damage to the beta cells that produce insulin. Repeated bouts of inflammation can cause permanent damage of beta cells and decrease insulin production.
Amyloid, a polypeptide, deposited within the cells of the pancreas is another mechanism of beta cell damage and decreased insulin production. This occurs more commonly in cats and humans. Amylin is secreted along with insulin and aides in decreasing glucose intake and appetite. However, in obese patients this substance is produced in excessive amounts and results in amyloid deposition within the islets of the pancreas and further damage and altered insulin production.
Obesity is another factor in creation of a diabetic pet. It causes the pet to be resistant to the effects of insulin and eventually leads to diminished insulin production. Cats that become diabetic as a result of obesity, if treated promptly, may be managed through diet, oral glycemic control medications, and weight loss.
Certain medications can also lead to weight gain and poor glucose management. Steroid use can aide in creating a diabetic pet. The use of oral, topical or injectable steroids can mimic an illness called Cushing’s Disease (hyperadrenocorticism). Cushing’s disease is an endocrinopathy, or hormonal imbalance, that leads to excessive cortisol or steroids in the body. This causes insulin resistance and hyperglycemia. Other endocrinopathies like hypothyroidism may predispose a patient to developing diabetes.
As a pet develops diabetes there are common clinical signs (symptoms) that may be noted very early in the disease process. Noting these signs in your pet and seeing your veterinarian as soon as they are noticed may prevent having to manage diabetes for the rest of your pet’s life or it may prevent more serious health issues from developing. There are four signs that are common to the diabetic patient; increased thirst, increased urination, excessive appetite and weight loss.
When a diabetic is not treated or their diabetes is inadequately controlled additional health issues can develop. Cataracts result in an irreversible clouding of the lens of the eye. Cataracts are treated through a surgical procedure that is performed by a veterinary ophthalmologist. Secondary skin and urinary tract infections also can occur when an individual has diabetes. Diabetic neuropathy causes weakness and difficulty ambulating. This disease is most often noted in the feline diabetic, but can be seen in dogs. Pancreatitis, often a contributor to the development of diabetes, and hepatic lipidosis, an abnormal deposition of fat in the liver and subsequent liver dysfunction, are common sequelea of diabetes. Ketoacidosis, a medical emergency, causes a metabolic acidosis, life threatening electrolyte shifts and ultimately, coma and death. Most of these conditions, like ketoacidosis, are treatable, but there is always the risk of complications and deterioration of the patient’s general condition as a result of multiple illnesses. It is always best and more economical, to avoid compounding an already serious health issue, like diabetes.
Diabetes mellitus is an illness that is managed via a variety of techniques. First, the diet is altered. The patient is placed on a regular feeding schedule. Carbohydrate levels in the diet are reduced and the patient is given a diet that is higher in protein and fat with reduced calories when appropriate. There are many diets that are formulated for the canine and feline diabetic. Each one must be chosen based on the needs of the individual animal. Many commercially available canned cat foods, composed mostly of meat proteins, have helped reduce insulin requirements in some of my feline patients. Careful choices regarding the patient’s diet and feeding schedule can prove pivotal in managing a diabetic successfully.
Insulin therapy is another very important key to diabetes management. Most insulin therapies are administered by injection, twice daily, after the pet has eaten their meal. Insulin administration should remain on a very regular schedule. The type of insulin that is chosen by your veterinarian is decided by whether your pet is a dog or cat, the severity with which they are affected and their pattern of hyperglycemia. Each insulin product has a different time of maximal effect and a different degree of glycemic control. NPH insulin is most often prescribed for dogs and PZI insulin is most commonly chosen for cats.
Oral medications that stimulate insulin secretion from the pancreas can be utilized with patients that still have functional beta cells. These medications are only successful in patients that can still produce insulin and therefore are not insulin dependent diabetics. Glipizide, a sulfonylurea, is one of the more commonly used oral hypoglycemic drugs.
Regular exercise and activity is important for both the feline and canine patient. Certainly it is easier to get your dog out for regular walks. But cats can be encouraged to begin new routines and you can make a point of having them with you and interacting with you on a daily schedule. This also allows you to monitor their response to therapies.
Our therapeutic goal for the diabetic patient is to reduce the visible signs of diabetes. The diabetic patient should begin to drink less, urinate less often, eat more regularly and appear more robust with good stamina. As we manage the patient more successfully, long term, we avoid cataracts, neuropathies, liver, kidney and heart disease.
Certainly, the obvious improvements in a diabetics condition are helpful indicators of success, but these occur over time and may not be as accurate techniques of monitoring from week to week or day to day. Other tests can allow us to monitor diabetic management and base our decisions on tests that quantify and qualify the treatments success.
Fructosamine levels can be tested from a single blood sample. Fructosamine is a protein synthesized after the binding of glucose to proteins. Fructosamine concentrations are a marker of blood glucose levels over the past 2-3 weeks. It will not be influenced by stress induced glucose changes and normal levels have been established for the diabetic dog and cat. If glucose levels have been too high over the past 2-3 weeks, the fructosamine will be elevated.
When an animal has high blood glucose, the glucose will leak through the kidneys and can be found in the urine. Urine glucose monitoring allows us to have an indirect indicator of the pet’s blood glucose. Urine glucose monitoring works best with dogs that urinate regularly under circumstances where we can collect samples. Urine glucose can be influenced by a variety of factors that make it a less accurate technique than blood glucose monitoring.
Blood glucose monitoring can be performed both in the hospital and at home. This is the most accurate technique to monitor the patient’s response to therapies and to gauge the quality of glucose control. Blood glucose monitoring gives us numbers that can be held in comparison from day to day. Certain blood testing machines or home glucometers are more accurate that others and careful attention to maintaining a consistent testing technique is necessary.
Blood and urine monitoring allows your veterinarian to aide you in making better decisions regarding insulin dosing as well as deciding which insulin type should be utilized. Visible signs (symptoms) and long term side effects of diabetes can be more consistently avoided through judicious and accurate monitoring.
Additional benefits of monitoring at home include removing the influence of stress of being at the veterinary hospital for glucose testing, called the white-coat phenomena. Stressed animals can have transient hyperglycemic episodes that may interfere with the accuracy of testing. Home testing also allows the pet owner to communicate accurately and in a timely manner regarding changes in the patient’s condition.
Accomplishing the technique of home monitoring, using properly calibrated equipment, accurate record keeping and prompt and complete communication to your veterinarian are the keys to successful long term management of your diabetic pet.
Abbott Laboratories has developed one of the most user friendly and accurate home glucose monitoring divices for the canine and feline diabetic. AlphaTRAK®Blood Glucose Monitoring System Features; fast results (within 15 seconds), less costly home testing that may help prevent expensive and lengthy hospital stays, small sample amounts and tests that are calibrated and validated for the dog and cat. Read more about the AlphaTRAK system and see examples of techniques in collecting samples for testing at
http://www.abbottanimalhealth.com/ad_ah_com/url/content/en_US/20.30.30:20/general_content/General_Content_0000009.htm
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