Diabetes
mellitus (DM) literally means “sweet urine”. Diabetes occurs in pets due
to a deficiency of, or resistance to, insulin in the body. Insulin,
which enables the body to use utilize glucose, is produced by
specialized cells in the pancreas called beta cells. Without insulin the
body cannot move glucose into cells where it is needed. There are 2
types of diabetes that occur in dogs and cats. Type 1 (insulin
dependent) means the body is not producing any insulin so insulin
needs to be administered. Type 2 (non-insulin dependent) is due to a
relative deficiency of insulin or an inability of the body to use the
insulin that is made (insulin resistance). Type 1 is by far the most
common type and the kind that we see almost exclusively in dogs.
In DM, glucose is
unable to get into the cells so the body feels it is starving. Therefore,
the patient eats more which raises the blood glucose level still higher.
Once that occurs, the glucose level is so high in the blood it is lost in
the urine. This makes the patient urinate more and, consequently, drink
more. Most owners notice their pet drinking, urinating and eating more
while losing weight. There are several factors which may be associated
with the development of DM in dogs and cats such as genetics,
immune-mediated destruction of beta cells, obesity, infection,
pancreatitis and certain drugs. DM may also be seen in conjunction with
other diseases such as heat cycles in an intact female dog, Cushing’s
disease and growth hormone excess (acromegaly).
DM is diagnosed by
bloodwork and analysis of the urine. Most diabetics are otherwise healthy.
Diabetes may be treated with insulin injections given once or twice a day.
There are numerous types of insulin and each is used for a specific
reason. Based on past experience and the medical condition of your pet,
your doctor will select the most appropriate insulin type. Although there
are some cases where a dog or cat may recover from diabetes, most pets
require insulin for life.
The patient is
usually started on a low dose of insulin to minimize the risk of
hypoglycemia (low blood sugar). It takes the new insulin dose about a week
to equilibrate within the body. To ensure that the pet is on the
appropriate dose and frequency of insulin, a glucose curve is then
performed in the hospital. This consists of measuring the blood glucose
every 2-3 hours for a 12 – 24 hour period. Based on these results as well
as how your pet is doing at home, your doctor will adjust the insulin dose
as needed. It often takes 3-4 months to get a new diabetic patient
regulated and may require frequent visits to the vet initially. Once the
patient is regulated, your pet may only need to be seen every 3-6 months.
There are several
potential complications of DM in pets. Dogs are very prone to developing
cataracts which may develop suddenly (i.e. overnight) and will cause
blindness. In most cases however, cataract surgery can be done and vision
restored. Cats may sometimes develop weakness in the rear limbs (diabetic
neuropathy) which may or may not be reversed once the diabetes is
regulated. Diabetic patients are also at a higher risk for developing
infections due to a compromised immune system. Any infection can cause
dysregulation of their diabetes. One of the common areas where we see
infections is in the bladder so your veterinarian may need to culture your
pets urine to ensure there are no bacteria present.
Some diabetic
patients may develop ketoacidotic diabetes mellitus. Some pets may be
diagnosed with DM because they go to see their veterinarian in a
ketoacidotic crisis. These patients may have another disease (i.e.
pancreatitis) which may predispose them to developing this problem.
Ketones are metabolic products that commonly are present in small amounts
in the body but diabetics cannot metabolize them effectively. These
ketones accumulate and the patient becomes dehydrated, which can cause
vomiting or diarrhea. This condition is life threatening if not recognized
and treated aggressively. These patients require intensive care with IV
fluids to correct dehydration and electrolyte imbalances. Any concurrent
conditions may also need to be treated. Very short acting insulin must be
used to correct the problem. Once the ketosis is corrected, the patient is
treated as any other diabetic patient.
TREATING A DIABETIC PET AT HOME
Once your pet has been diagnosed with diabetes mellitus,
you will be shown how to administer insulin injections at home. The
needles used to give insulin are very small and pets typically tolerate
the injections very well.
How the insulin is
stored is very important. We usually recommend keeping it refrigerated,
not frozen.
The type of syringe
used to administer the insulin is also important depending on the type of
insulin you are using (i.e. a U-100 syringe for 100 unit/ml insulin vs. a
U-40 syringe for 40 unit/ml insulin).
The following is the procedure we recommend for insulin
administration:
-
Gently and
completely invert the insulin vial 10 times. You may also gently roll the
insulin vial between your palms. NEVER SHAKE THE INSULIN. This will cause
it to lose its effectiveness.
-
Draw air into your
syringe equal to the amount of insulin that you are administering. Insert
the needle into the vial and inject the air.
-
With the needle in
the vial, turn the insulin vial and syringe upside down and pull the
correct number of units into the syringe.
-
Check the syringe
for bubbles. If bubbles are present, hold the syringe straight up and tap
its side until the bubbles float to the top. Push the bubbles out with the
plunger and then withdraw the correct insulin dose.
-
Once your pet has
eaten, grasp an area of skin on the back or side of your cat or dog
between your index finger and thumb.
-
Insert the needle
into the fold of skin and inject the contents of the syringe.
-
If you think that
you have injected the dose incorrectly, do not repeat the dose.
Giving insulin is
a serious procedure but over time you and your pet will get used to it.
Although care of a diabetic patient is time-consuming and expensive, most
pet owners find that it is a very rewarding experience. Please do not
hesitate to call with your questions or concerns.
COMMONLY ASKED
QUESTIONS:
Q. What if my pet doesn’t eat his/her
meal?
A. If this is the first time this has
occurred, give half of the usual insulin dose. If it happens again at the
next meal, skip the insulin and schedule a recheck appointment with your
veterinarian. Loss of appetite may indicate that there your pet is not
feeling well. Giving insulin on an empty stomach will increase the risk of
hypoglycemia (low blood sugar).
Q. What are the signs of hypoglycemia and
what do I do if my pet is showing these signs.
A. Some of the signs of low blood sugar
are disorientation, staggering, vocalizing or seizures. Cats also may tend
to vomit. If your pet is exhibiting these signs and is alert enough, you
can try offering them some food as this will help increase the blood
sugar. If your pet is having a seizure or is not alert enough to eat, you
can rub some Karo syrup on the gums. If ANY of these signs are noted, skip
the next insulin dose and talk to your veterinarian because a change in
the insulin dose may be required.
Q. What do I do with used insulin
syringes.
A. The safest thing to do is place
them in an empty milk jug or coffee can and bring them in at the time of
your next recheck appointment. We will dispose of them safely.
Q. Is there a special diet that I should
have my diabetic pet on?
A. Recent research in this area indicates
that, in cats, a higher protein, low carbohydrate diet may be helpful in
stabilizing blood sugar throughout the day. In dogs however, we have found
that a high fiber diet can help achieve this goal in many cases, but every
dog is different. Your veterinarian will help you select the best diet for
your particular situation.
Q. Should I modify my pets routine in any
way now that he/she has been diagnosed with diabetes?
A. One thing that may need to be changed
is exercise. While exercise in moderation is fine, strenuous activity
should be avoided. Muscles require glucose to function properly so
increased activity may precipitate a hypoglycemic crisis.
Routine medications
(heartworm preventative and flea control) and vaccinations can still be
given normally.
Q. Where can I purchase insulin?
A. You may buy insulin from your
veterinarian or he/she may call in a prescription to your local pharmacy.
Q. Should I check my pets urine for
glucose?
A. Only under special circumstances will
we ask you to check your pets urine for ketones or glucose. It is not
usually a part of routine diabetes management.
