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Diabetes and Your Pet

By Roxanne Willems Snopek

Diabetes mellitus ("sugar" diabetes) is a complex and common disorder of the endocrine system, affecting many species. The typical warning signs all point to the same process going on in the body: an inability of the pancreas to produce adequate amounts of insulin, a hormone necessary to metabolize carbohydrates to produce energy.

Insulin is required for the transport of food substances - in the form of glucose - into body cells. In other words, insulin allows energy to get from the bloodstream into the tissues where it’s needed. Without enough insulin, glucose accumulates in the bloodstream (hyperglycemia), and “spills over” into the urine (glucosuria). Urine volume increases (polyuria) in an attempt to “flush out” the excess glucose. This causes patients to urinate frequently and become very thirsty (polydipsia). And, in spite of maintaining a good appetite, the tissues become energy-starved because the glucose cannot reach the cells, causing weight loss.

In the earlier stages, animals remain active and alert with few other signs. However, as the disease progresses, poor skin and haircoat, liver disease, and secondary bacterial infections become more common. Further progression without treatment ultimately leads to greater metabolic disturbances and causes vomiting, loss of appetite, weakness, and dehydration.

Although affecting dogs and cats of any breed, sex, or age, diabetes mellitus most often occurs in older, obese animals, males more often than females. While the exact cause is unknown, obesity, genetic predisposition, pancreatic disease, hormonal imbalances, and certain medications have all been incriminated.

The Importance of Early Diagnosis

Like many diseases, diabetes can sneak up, unnoticed, in its early stages. In fact, clinical signs only develop after insulin levels are 75-80% below normal.

Experts agree: early diagnosis is very important, and can prevent potentially life-threatening complications of diabetes.

Many veterinarians recommend annual screening tests – laboratory analysis of blood and urine - for senior pets, and diabetes is one of the diseases they are looking for. Most recommend these screening tests at annual examination visits for pets over seven-eight years of age.

Making the Diagnosis

It’s an easy diagnosis to make. A blood sample is taken to measure glucose levels, and a sample of urine is also taken. Elevated levels of blood glucose, accompanied by the presence of glucose in the urine, confirm the diagnosis.

But cats in particular are also prone to a condition called “stress diabetes” or temporary elevations in blood glucose. Because cats become stressed and frightened by being examined and having blood and urine collected, they often have elevations in their blood sugar and may even have an increase in urine glucose, just from stress.

Though the blood glucose levels in these stressed cats will return to normal once the cat settles down, many of these cats eventually go on to develop full-blown diabetes.

Treatment and Monitoring

Initial treatment requires 24-48 hours of hospitalization for glucose monitoring during the first insulin administration. Frequent blood and urine tests will be taken during that time to measure the response to insulin. Then, for the next four-to-six weeks, weekly 12-24 hour "glucose curves" are required to evaluate the continued response. This provides a “blood glucose profile”, or a graph that indicates the particular pattern of response to insulin and food that an individual has.

Communication between owner and veterinarian is vital to successful management of diabetes.

Topics to be discussed with your veterinarian:

Insulin storage and handling
Insulin administration
Signs and treatment of hypoglycemia
Diet
Home monitoring

Adequate control for most diabetics means long-acting insulin injections, given once or twice daily, and most pets tolerate this amazingly well. The medication is given under the skin through a tiny-gauge needle and most owners give it when their pet is distracted by eating. Though initially many people find the task overwhelming, it quickly becomes routine.

As each animal responds differently to insulin, the proper choice of insulin type, dose, and frequency of administration needs to be determined on an individual basis, according to the glucose profile. The proper dose of insulin may change with time and need adjustments based on repeat blood glucose profiles, intermittent blood and urine sugar measurements, and response to therapy.

Proper treatment of diabetes mellitus is based on severity. Advanced, untreated diabetes often requires intensive care initially, including fluid therapy to correct dehydration and electrolyte abnormalities, as well as short acting insulin.

Diet

A vital piece of the diabetic therapy puzzle is diet. Standard dietary measures include a high fiber, high complex carbohydrate diet to help control blood sugar, with moderate protein, but low fat content. Some diets recommended for diabetics include Hill's Prescription Diet W/D, Science Diet Maintenance Light, or Iams Less Active. Multiple small meals maintain consistent blood glucose levels better than one or two large meals and "nibblers" should have constant access to food.

Of course, weight control is very important, too. Obese diabetics should lose weight gradually (no more than 3 percent of their body weight per week), under veterinary supervision. High fiber, high complex carbohydrate diets are useful, not only by assisting in weight loss, but by helping control blood glucose levels after eating. Underweight diabetics should not be switched to a high fiber diet until they’ve regained their normal weight.

Control - Not Cure

Treated diabetics often look completely normal and healthy, but their lives depend on consistent, reliable medication. However, too much insulin is just as deadly as too little. A serious condition called hypoglycemia (low blood sugar) can result from an overdose of insulin, but strenuous exercise, or insufficient food intake can also cause hypoglycemia. Signs of this potentially dangerous complication include weakness, lack of coordination, convulsions and coma. Left untreated, death may result.

If hypoglycemia develops, the pet should immediately be offered her normal food if she is able to eat. Alternatively, a tablespoon of corn syrup should be rubbed on the gums or, if the cat can swallow, given slowly by syringe into the mouth. Never force fingers, food, or fluids into the mouth of a convulsing or comatose cat. Contact your veterinarian immediately if your pet experiences an episode of hypoglycemia so that further treatment instructions can be given and the insulin administration schedule can be modified.

Pets requiring excessively high insulin doses (greater than one to two units of insulin per pound per day) need further evaluation. Other diseases may be complicating the diabetes and creating a greater need for insulin. Problems with insulin injection, poor absorption or too rapid metabolism of insulin, or even insulin overdose are potential causes of an apparently excessive insulin requirement.

Complications

Even when diabetes is well controlled, it is still a serious disease with potential complications. A dangerous condition called ketoacidosis sometimes develops, in which protein is broken down in the body’s desperate attempt to generate energy. Signs of ketoacidosis include a loss of appetite, vomiting, diarrhea, lethargy, weakness, dehydration, and breathing abnormalities. Without proper and prompt treatment, this condition can prove fatal.

Pancreatic disease is also associated with diabetes. Fortunately, both chronic pancreatitis (inflammation of the pancreas) and exocrine pancreatic insufficiency benefit from the recommended high fiber diet.

However the most common complications are bladder and kidney infections. Frequent, painful or bloody urination are warning signs that a round of antibiotics might be in order. Also, the strain of prolonged high blood glucose levels prior to treatment can damage the kidneys, eventually resulting in renal failure for some diabetics. One more reason why early detection is so important!