Diabetes mellitus (sugar diabetes)

Diabetes mellitus (diabetes) is a disease where there is poor regulation of blood sugars due to problems with insulin.

In people diabetes is common in two forms. Type 1 (usually juvenile onset) where not enough insulin is produced, and type two (usually adult onset) where the body responds poorly to the insulin that is there.

Dogs and cats generally get type one diabetes, where not enough insulin is produced, although it is usually an adult onset disease. Cats get some elements of type two diabetes as well. Both dogs and cats with diabetes require insulin therapy. A percentage of cats if treated early in the course of their disease can show a good remission, however current research is they tend to relapse latter in life.. Dogs with diabetes require insulin for life.

How is Diabetes diagnosed?

Often you will notice changes in your pet, including increased water consumption, increased appetite, and weight loss.

We can do blood and urine testing to confirm that diabetes is present in your pet. Both blood and urine will contain high levels of glucose. We can also tell how the other organs, such as the liver, are coping. Diabetes is one of the diseases we commonly screen older patients for as the earlier it is detected the less risk for you pet.

Some pets if undiagnosed and untreated will develop a severe manifestation of diabetes called a keto-acidotic crisis. This is a medical emergency that requires intensive in hospital care.

How is it treated?

Diabetes is treated with a combination of insulin injections, and diet. Occasionally oral medications can be used to decrease the blood glucose but they are much less effective than injections, and no safer, so are rarely used. Insulin injections used in combination with special diets.

For the first few days of treatment your pet may be hospitalised, if they are particularly unwell.

It is very important to get your diabetic pet in to a consistent routine. They should eat the same amount each day, and at the same time. Exercise should also be for about the same length of time each day. Unlike in people it is usually not practical to test our pet’s blood glucose multiple times a day at home.

Periodically your pet will need to come in to the clinic for monitoring. The frequency of monitoring depends on how your pet is progressing medically We aim to keep the blood glucose as well controlled as possible. Two types of problem occur if we don’t. Long term high glucose can cause complications such as:

• Liver disease
• Blindness (cataracts)
• Urine tract infections and possible kidney failure
• Skin disease
• Nerve disease ( loss of sensation)

Low blood glucose, cause by too much insulin, not enough food, extra exercise, or infection, causes acute and life threatening disease. If blood glucose becomes too low your pet may collapse, seizure, and even die. We aim to leave blood glucose a little higher than in a normal animal to minimize the risk of low blood glucose occurring.

Insulin injections

Insulin is usually given twice daily under the skin. We will show you exactly how to give it, and will help you until you are comfortable doing it at home. We find people adapt very quickly to giving insulin, even though most of us don’t initially like the idea.

Always be careful handling insulin, and remember the following points:

• Keep insulin in the fridge.
• Mix the bottle before use by gently inverting the bottle 6-8 times, until the insulin is an even colour, with no residue on the bottom of the bottle. DO NOT SHAKE INSULIN. Vigorous shaking will damage the insulin and may stop it working. If you accidentally shake insulin, or leave it out of the fridge to become warm, you should get a new bottle.

Once you have drawn up your insulin dose, as shown, prepare your pets food. Whilst they are eating give the insulin. This way your pet will hardly notice what you have done, whilst ensuring your pet eats.

If for any reason your pet does not eat their normal meal, do not give insulin. If this occurs please ring the practice, and we will advise you how to proceed.

Diet

The aims of dietary management are three fold.

• To get over weight pets down to their ideal body condition
• To feed the same amount of the same food, and the same time, each day.
• To feed foods that are slowly digested. This avoids big peaks of blood glucose

In general soft foods are not as good as dry foods. Ideally two meals a day are given to coincide with insulin injections. Some cats will need to graze through the day, as they won’t eat set meals.

A number of commercial foods are made specifically for diabetic cats. We will discuss the best regime for your pet.

Monitoring

Whilst we are trying to stabilize your pet, we will usually want to do a glucose curve once a week. This means your pet stays with us for the day, and we measure the blood glucose every 1-2 hours. This allows us to properly adjust your pet’s regime. We need to do this one week after any changes to insulin (dose or type), diet, or exercise.

A glucose curve allows us to evaluate the dose, if the insulin is effective in your pet, and its duration of action.

Occasionally some animals become very stressed in the clinic. This affects the results as it increases the glucose levels. If this occurs we can do another blood test, called a fructosamine assay. This is not as useful as a glucose curve, but is not stress affected. The vast majority of animals cope with glucose curves very well.

At home

Once your pet is stabilized most owners develop a good routine and pet and owner cope very well.

If at any time your pet becomes weak or wobbly, or collapses, you need to administer glucose quickly, even before you ring the practice.

Always keep glucose powder (available in super markets and pharmacies) and/or honey on hand.

Honey can be applied directly on to the gums. Glucose powder can be dissolved in a small amount of water and dribbled under the tongue. These will be rapidly absorbed, and your pet should recover rapidly. As soon as you have administered a glucose source ring the practice.

You may find it useful to print out this chart, and post it to the fridge so that all family members know the regime. We can help you fill out the details

Pets name
Time of treatments/feeding	AM:	PM:
Insulin type
Insulin dose
Food type
Food amount	cups	cups

Gentle agitate insulin until no residue remains in the bottle. DO NOT SHAKE. Draw up your dose of insulin and return the bottle to the fridge immediately. Do not Freeze. Prepare your pets meal and feed them. Whilst they are eating inject their insulin.