By Sophie McMurrough

A diagnosis of diabetes can be overwhelming to begin with. The management of this disease requires teamwork from the veterinary team and you as an owner. The veterinary team are here to support you, every step of the way and can always be called upon if you have any questions. We are in this together!

What is Diabetes Mellitus?

  Diabetes mellitus is a common hormone disease in dogs and it develops when the pancreas is unable to produce or utilise insulin to meet the needs of the body. This causes your pets blood sugar (known as glucose) to rise. Although we still don’t full understand what causes diabetes in dogs, there are a few factors believed to be involved. These may include your pets genetic background, pancreatitis, immune mediated destruction of the cells in the pancreas or concurrent diseases which interfere with the action of insulin.

What happens in the body and why is insulin important?

• When we eat food, our body breaks the food down and uses the carbohydrates and sugar as energy

• Now that we have plenty of energy in our bloodstream, the pancreas then releases insulin

• Insulin sends the sugar or glucose into the cells, so our body can use the energy to survive

• Think of insulin as the “key to the cell” and without it, the sugar cannot enter the cell and therefore, cannot be used

• This leaves a lot of sugar in the bloodstream, so our blood sugars remain high

• When a pet is diabetic, you need to give your pet insulin by injection

• This will help bring down the blood sugar level and allow the body to use it as energy

Signs and symptoms of Diabetes

• Passing urine more often

• Drinking more

• Wanting to eat more than usual, an increased appetite

• Weight loss in some dogs

 
  The high blood sugar level is filtered by the kidneys. This draws more water out of the blood stream which creates more urine. In return, your pet will become very thirsty and will drink more. Glucose is the body’s main source of energy but without insulin, this cant be used. In order to maintain normal bodily functions, your cat will start to use fat and protein as energy instead. Your pet may eat more but also lose weight for this reason.

Diagnosing diabetes

Diagnosing diabetes is not always straight forward and may involve many tests. Typically, a diagnosis is based upon the signs and symptoms shown by your pet, persistently high blood sugar and the presence of sugar in the urine. In some cases, more tests are required.

  At the time of diagnosis, it is important to screen your pet for other diseases that may be caused by or causing the diabetes. This may include diseases of the kidneys, heart, liver or pancreas to name a few. Additional investigations may include further blood and urine tests, ultrasound, CT, x-rays. These investigations are very important, treating other conditions will help us treat the diabetes successfully.

Possible complications of diabetes

Without treatment, diabetes can lead to some serious complications.

Diabetic ketoacidosis (DKA) – this is a serious complication of diabetes, and it may occur if the diabetes is untreated or unstable. Without adequate insulin, the body uses fat as energy. If large amounts of fat are broken down, they release something called ketones into the bloodstream. This can cause changes in your cat’s electrolytes and may cause severe dehydration. This can become a life-threatening emergency.

Low blood sugar (hypoglycaemia)

  It is very important to monitor your pet for signs of low blood sugar. Low blood sugar is much more dangerous than high blood sugar and can cause serious illness or death very quickly.

How do I know if my pets blood sugar is low?

Normal blood glucose level 3.2-8.5mmol/L

Your pet may show some of the following signs:

• Appearing less energetic than usual

• Very hungry and ravenous for food (more than usual)

• Weak

• Shaking or twitching

• Collapsed or unresponsive

• Coma

If you think your pet may have low blood sugar, is it very important to act quickly.

What do I do if I think my pet has low blood sugar?

• If conscious, offer food (any food)

• If they wont eat or they are unconscious, rub something sugary on their gums (honey, syrup, glucose gel)

• Once you have done this, phone the vet straight away for advice. They may wish to alter the next insulin dose or time.

It is a good idea to keep a blood glucose monitor and some glucose gel at home. Examples of these are:

Blood glucose monitor: AlphaTRAK Blood Glucose Monitoring System (for veterinary use)

Glucose gel: Glucogel or Glucoboost (usually available at your vet clinic)

How do you treat diabetes mellitus in dogs?

  The aim of treatment is to resolve the signs and symptoms, improve the pets (and yours) quality of life and to reduce the risk of diabetic complications.

Insulin injections

  All dogs will need insulin to begin with, some will need it lifelong.

  There are many different types of insulin available. which vary in strength and how long they last. Each pet responds to insulin differently so there is no “one dose fits all”. At the start of treatment, it can take months to find the appropriate insulin and dose that fits your pet. Your vet will typically start off with a lower dose and wean up over weeks or months. This is because it is safer to have a higher blood sugar then starting on higher dose and sending the blood sugar too low.

  Insulin for animals is different to insulin for humans. It is very important that you only use the insulin prescribed by your vet. The human syringes are also different, they must never be used on an animal.

  Your pet will typically need two injections of insulin a day, morning and evening, 12 hours apart. The insulin injections should given at the same time as food. It is a good idea to make sure your pet has eaten at least half of their meal before giving the injection. This should prevent the blood sugar from dropping too low.

The injections can be given into the tented skin between the shoulder blades. This will be demonstrated by your veterinary team.

Diet

  Diet is an important part of diabetic control. A diabetic diet is usually lower in carbohydrates and higher in protein. A good diet will help prevent spikes in blood sugar and will help keep the level consistent throughout the day. Treats should not be given to diabetic animals as this will spike their glucose level and may make treatment ineffective.

  Wet food is often preferred due to the extra moisture content. This will help keep your pet hydrated throughout the day. Not all pets will eat wet food and the most important thing is that your pet is eating a suitable diet they enjoy. Meals should be weighed out to make sure the same amount is given each meal (important when giving insulin).

  Obesity can cause the insulin to be less effective so weight loss in overweight pets is key. This should be a gradual process and any new diets should be gradually introduced over 7-10 days. The old diet should be mixed with the new one, until the old one is weaned out. Please remember that eating is very important for a diabetic pet, so a diet which is not perfect, is more important than not eating at all.

  If your pet has other diseases alongside the diabetes, diet can be an important part of that treatment too. The diet to address the other condition should be chosen over a diabetic diet.

Exercise

  Exercise is important to help maintain good blood sugar levels and to control bodyweight. Exercise should stay consistent, so your pet uses a similar amount of energy during each walk. Please avoid fluctuations such as long walks on a weekend with short walks mid-week. Care should also be taken when going on holiday with your dog, to avoid long period of exercise while away. Longer walks require more energy which may reduce your pets blood sugar level, causing hypoglycaemia (low blood sugar) which may be dangerous.

Treating other conditions that may affect how well the insulin works

Common conditions such as obesity, pancreatitis, infections such as urinary tract infections, heart, liver or kidney disease, hormone diseases such as Cushing’s disease and sex hormones.  If your pet is not responding to insulin as expected, investigations to determine if a source of insulin resistance is present are recommended.

In female dogs, progesterone is an important source of insulin resistance. This is a hormone that is produced in high levels for around 2 months after each season. This hormone can cause stable female diabetic dogs to become unstable, with the risk of developing DKA (see complications). Neutering is strongly recommended if female dogs who are diabetic.

Pancreatitis
Pancreatitis is a common disease in dogs and it can carry a poorer prognosis in dogs with diabetes. In some cases, it has been associated with ingestion of a high fat content, but in most dogs, no clear cause has been identified. Dogs who develop pancreatitis can suffer from several episodes of it during their life which should be monitored closely. There is no treatment that can prevent pancreatitis from recurring, but feeding your dog a low-fat food can decrease the risk of this happening. In diabetic dogs, pancreatitis can interfere with the action of insulin, making it more challenging to achieve a good diabetic control.

Some breeds are more susceptible to pancreatitis such as miniature schnauzers, terrier breeds, cocker spaniels and boxers. Any dog can get pancreatitis, but the above breeds seem to be over-represented.

Water

If is vital that diabetic pets always have access to water. Diabetic pets will become dehydrated much quicker than normal. Severe dehydration can occur if water is not available, which can cause your pet to go into a coma or even die. Large water bowls and fountains a good way of keeping your pet hydrated.

Infections – diabetes can weaken your pet's immune system which means they are more likely to get infections. Urinary tract infections are common in diabetics. Large volumes of sugar in the bladder, makes a perfect breeding ground for bacteria. Infections can occur anywhere in the body, they may cause the insulin to be less effective, so treatment is key.

Long-term monitoring

  A pet whose diabetes is well controlled should have a good appetite, drink and urinate a normal amount, maintain a stable bodyweight and have no signs of low blood sugar.

  Getting to this point can sometimes take months and may not be possible In all pets (typically those with other diseases alongside). Achieving good diabetic control involved teamwork from you, your veterinary surgeon and veterinary nurse.

Glucose monitoring

  Your cat may be admitted to the vet clinic for blood glucose curves. This allows us to see what the blood sugar is doing throughout the day, and how it is responding to the insulin.

Glucose sensors

  Recently, monitors are available which continually measure your pets glucose over several days. They are human sensors and the most common one used in veterinary medicine is the Freestyle Libre. This is a small disc shaped sensor which has a very thin needle. The sensor is placed on your pets skin and measures the glucose continually. This can then be read with an app on your mobile phone. You can also set alarms which will alert you if your pets blood sugar dips too low. The sensors only last a maximum of 2 weeks each time. They are useful during early diagnosis, during insulin dose changes and at periods where your pet may become unstable. The sensors are well tolerated by pets and can be placed by a veterinary nurse in the veterinary clinic.

Glucometer (stick readings)

  Glucometers are easy to use and can be purchased online or from some pharmacies. They are easy to use and most cats tolerate the ear prick very well. They are particularly useful when you think your pet may have low blood sugar. The device allows you to check your pets blood sugar level in real time.

What does this mean for my pets life?

  Diabetic dogs can live a long and happy life. If the blood sugar is controlled and no other diseases are present, your dog can have an excellent quality of life. Life-long management is a team effort and the veterinary team is always there to help you. If in doubt or if you have any queries, a vet or vet nurse is always at the other end of the phone.

For further support, please visit contact your veterinary clinic, who will be happy to advise you further.

Veterinary Nurse – Medicine Geek

Registered Veterinary Nurse and Veterinary Technician Specialist in Small Animal Internal Medicine