Diabetes Info

Diabetes Milletus General Information

By Wendy C. Brooks, DVM, DipABVP
Educational Director, VeterinaryPartner.com

WHAT IS DIABETES MELLITUS?

In order to understand the problems involved in diabetes mellitus it is necessary to understand something of the normal body's metabolism.

The cells of the body require the sugar known as glucose as food and they depend on the blood steam to bring glucose to them. They cannot, however, absorb and utilize glucose unless a hormone known as insulin is present. This special hormone, insulin, is produced by the pancreas.

Glucose comes from the diet. When an animal goes without food, the body must break down fat, stored starches, and protein to supply calories for the hungry cells. Proteins and starches may be converted into glucose. Fat, however, requires different processing which can lead to the production of ketones rather than glucose. Ketones may be detected in the urine of starving animals as massive fat mobilization is required for ketone formation.

IN THE DIABETIC ANIMAL THERE ISN'T ENOUGH INSULIN

The cells cannot receive glucose from the blood because there is no insulin to permit it.
The body is unable to detect the glucose present in the blood and is fooled into thinking starvation is occurring.
Protein, starch, and fat breakdown occur as in starvation.
Yet, all along there has been plenty of glucose in the blood; in fact, by now, there is a large excess of glucose in the blood as all resources have been mobilized.
The normal kidney is able to prevent glucose loss in urine. In the diabetic animal, there is so much glucose in the blood that the kidney is overwhelmed and glucose spills into the urine and is lost. In severe cases ketones are also found in the urine, a more complicated diabetic event.
Glucose is able to draw water with it into the urine. This leads to excess urine production and excess thirst to keep up with the fluid loss in excess urine production.

THUS THE MAIN CLINICAL SIGNS OF DIABETES MELLITUS ARE:

Excessive eating
Excessive drinking
Excessive urination
Weight loss

*Note, in the dog, sugars can enter the lens of the eye causing rapid cataract formation. Because the lens of the cat is different, this phenomenon occurs only in dogs.

*Another common symptom of diabetes mellitus is urinary tract infection. All the sugar in the urine makes the bladder an excellent incubator for bacteria. Antibiotics are necessary to clear up such an infection when it occurs and some monitoring may be needed to help detect these infections.

WHAT HAPPENS ONCE A DIAGNOSIS IS REACHED:

It is not possible to know how much insulin your individual pet will require but your veterinarian can make a guess based on what works for other cats and dogs.

The technique of subcutaneous insulin administration should be thoroughly demonstrated by your doctor or an assistant. It is also helpful if you can monitor urine sugar and ketone levels with urine dipsticks called "Ketodiastix." Your pet's insulin may be obtained from your pharmacy as are your pet's insulin syringes and Ketodiastix. If it is possible, keep a diary showing time and amount of insulin administration and Ketodiastix readings. (For more information on home administration of insulin, click here.)

A new bottle of insulin should be obtained every 6-8 weeks regardless of how much is used. Roll the bottle in your hands before drawing up the insulin amount to be injected. Never shake the bottle as this will destroy the insulin molecule.

If your pet escapes in the middle of the injection, do not attempt to approximate the rest of the dose in a second injection. Simply try again tomorrow with that same dose. Your veterinarian may have some helpful hints for restraining your pet during the injection.

Feed your pet 2 equal sized meals approx. 12 hours apart. The high fiber diets offer many benefits in the management of diabetes mellitus in dogs (from reducing obesity to helping the insulin receptors of the body work better). Still, these diets are not always accepted by pets. If your pet will eat such a diet, it is to your pet's benefit to feed such a diet. If your pet refuses to eat a high fiber diet, it is best to work with what your pet will eat rather than trying to starve your pet into eating a healthier diet. In cats, recent work is showing that a high protein diet is more beneficial that high fiber (Feline Growth, for example).

Ketodiastix are urine dipsticks which will tell you how much glucose is escaping in urine and whether Ketones are being produced. If possible, check your pet's urine daily first thing in the morning. If the urine sample you check is not the first of the morning, just write down the time of day the urine was checked in the diary along with the dipstick values. Bring your diary of values with you whenever you return for insulin adjustment.

Never alter the insulin dose recommended by your doctor. It is only through careful monitoring that insulin dose should be adjusted and this type of monitoring cannot be done at home. In about a week after diagnosis your pet should check in to the hospital for a day to create a "glucose curve."

WHAT HAPPENS WHILE YOUR PET IS HOSPITALIZED:

By measuring urine and blood sugar levels in addition to other blood chemistry parameters, the diagnosis of diabetes mellitus is reached.

The next step is to determine the pet's individual dose and type of insulin. Your pet received an initial insulin dose based on weight and returned home for a two to three day adjustment period. After this period, a glucose curve is checked. What this means is that your pet's blood sugar level was measured every one to two hours for a period of at least eight hours. From this curve, we can tell if the insulin dose used is too high, too low, or if a longer lasting type of insulin is required.

The insulin dose is changed based on this information, the pet returns home for another adjustment period, and another follow-up curve is checked every 2-4 weeks until glucose readings appear to stay between 80 gram/dl and 200 gram/dl. Once this goal is achieved, the pet may return home for home monitoring as described above.

WHEN TO RETURN TO THE HOSPITAL/WHAT TO WATCH FOR:

Your pet should have a glucose curve run every 2-4 months even if everything appears to be going fine.
Your pet will probably require re-regulation at some point. During re-regulation periods, expect a curve to be run a week or two after each adjustment in insulin dose.
Bring your pet in for a re-check exam and glucose curve if you note any of the following:

-- persistently high urine glucose levels (2+ or higher)
-- ketones present in urine 3 days in a row
-- the pet seems to feel ill
-- the pet has a ravenous appetite or loses its appetite
-- the pet seems to be drinking or urinating excessively

INSULIN SHOCK

If your pet appears wobbly or drunken, his/her blood sugar level may have dropped too low. This occurs after an insulin overdose. Administer 4 tablespoons of Karo syrup for a 20 lb. pet. If no improvement occurs, immediately see your veterinarian for emergency treatment.

SOME PETS ARE DIFFICULT TO REGULATE

Some pets seem to require re-regulation frequently. There may be an underlying reason to sort out. Here are some possibilities should your pet seem to fit in this category:

Improper administration of insulin. If possible, have your doctor observe you giving the insulin to your pet. Your insulin may be out of date.
Rapid insulin metabolism. Insulin wears off quickly in some animals. Your pet may require a different type of insulin or a second injection during the day.
Insulin overdose may actually lead to elevated glucose levels (and clinical signs of diabetes mellitus) at the end of the day. In these cases, excess drinking, eating, or urinating are seen in the afternoon and evening but not in the morning.
Steroid administration (such as prednisone, prednisolone etc.) will interfere with insulin.
Progesterone also interferes with insulin. Unspayed female diabetics should be spayed once they are sufficiently regulated.

FOR FURTHER INFORMATION YOU MAY WISH TO VISIT: http://www.felinediabetes.com

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