Client Information Sheet Copyright Bilton Veterinary Centre All rights Reserved. Diabetes Mellitus

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1 What is Diabetes Mellitus? Diabetes Mellitus Diabetes mellitus (DM) is often called sugar diabetes in order to distinguish it from a condition called Diabetes insipidus, which is a totally separate condition. The condition is characterized by two key features: 1. Inability of the body to produce or respond to the hormone insulin 2. Persistent high blood glucose not able to be utilized by the body. Insulin allows every living cell in the body to absorb and utilize the major fuel of metabolism, which is glucose. Without insulin, the glucose is present, but cannot be used. DM causes problems because: Cells are deprived of glucose therefore cannot function properly. This is especially the problem with the brain as this relies almost exclusively on glucose for all its functions. The high levels of circulating blood glucose causes damage to other organs, particularly the kidneys, liver, and eyes. There are two different types of DM: Type I is seen in nearly all dogs and most cats. This is the classic diabetes where the pancreas stops producing insulin. Treatment involves supplementing the animal with insulin by injections Type II is rare but seen more frequently in cats compared to dogs. This type of diabetes is where the animal is producing insulin normally, but the cells in the body stop responding to the hormone. This is usually treated by diet, weight loss and an oral medication called Glipizide. What causes Diabetes Mellitus? Sometimes it can occur spontaneously, often for no obvious reason. However there are certain risk factors that can increase the likelihood or incidence. Obesity fat animals are far more likely to develop spontaneous DM Age older animals are more likely to develop DM Pancreatic injury often DM can develop after pancreatitis or due to pancreatic tumours. Drugs certain drugs (corticosteroids, some hormones) can trigger DM Gender female dogs seem to be more predisposed than males. Hormones it is not uncommon for female dogs to become transiently diabetic during a season. Page 1 of 5

2 What are the signs of Diabetes Mellitus? There are a variety of signs and each animal may vary slightly. However usually affected animals show one or more of the following: Excessive thirst (common) Increased frequency and volume of urination (common) Increased appetite (common) Weight loss Swollen abdomen (usually due to liver enlargement) Recurrent urinary tract infections Rapid onset cataract formation How is it diagnosed? DM can be diagnosed in a variety of ways. The presence of glucose in the urine is highly suggestive, but not absolutely diagnostic of DM. More accurately is either to do a blood test to check blood glucose levels or you can measure a substance called fructosamine, which gives you a more accurate impression of what blood glucose levels have been over the past 2 4 weeks. Fructosamine is particularly useful in diagnosing/monitoring diabetic cats. Dipstick Test for glucose in the urine Blood glucose can be measured in seconds at the surgery, whereas Fructosamine needs to be sent away to an external lab to be checked. Results will often come back within hrs. What happens after my pet has been diagnosed with Diabetes? The mainstay of treatment of DM, is giving regular insulin injections. The dose required to control each animal can vary enormously and so the initial stabilisation phase can be quite time consuming and involved while the correct regime is established. Ideally we perform a glucose curve when we start insulin treatment. This involves having the animal at the surgery for a day and we start them on a calculated dose of insulin, then measure their blood glucose every 2 hrs to observe the response. Using this information, we can then either increase or decrease the amount of insulin being given. This is almost always Page 2 of 5

3 done in dogs, but is not so useful in cats, as their blood glucose can be more erratic with stress. With cats, it is sometimes easier to measure their fructosamine levels after a few weeks and then adjust the dose accordingly. A glucose curve plots the blood glucose levels throughout the day, following an insulin injection and eating. Ideally we want the levels to stay within the normal region and neither dipping too low, nor returning too high before the next insulin treatment. On the basis of this curve, we can decide if your pet will need more or less units of insulin per day. Being pregnant or having a season can drastically increase the severity of a pet s existing diabetes problem. Therefore it is recommended not to breed from diabetic pets, and to have neutered as early and as safely as possible once the condition is stabilised. How is the condition treated? When your pet is diagnosed with DM, we will give you a teaching session that explains: How to inject insulin safely and with minimal discomfort to the animal How to measure the dosage correctly When to inject the insulin in relation to feeding How to store the insulin correctly (very important!) How to dispose of the used needles and syringes safely. How often and what to feed your pet. Diet is very important with all diabetic animals. What to do if the animal has a hypo (blood glucose drops too low) Summary Diabetes can be a very frustrating condition to treat. Control is mainly achieved by trial and error and also involves an element of luck. With a good owner and animal compliance many diabetic animals can lead a normal and happy life. Often the thought of giving injections regularly can put a lot of people off but in reality most people find once a routine is established, that it has little impact on everyday life. See the following pages for some common questions about diabetes. Page 3 of 5

4 Common Questions about Diabetes Mellitus Q: Can Diabetes ever be cured? A: In almost all circumstances DM cannot be cured. The only exceptions are if the animal becomes diabetic during pregnancy, if the animal develops DM secondary to a condition called Cushing s disease and a small percentage of cats on low doses of insulin can regain endogenous (natural) insulin again. Q: Is there an alternative to injections? A: No. Oral treatment is not effective in either dogs or cats, and attempted use can actually make the animal more severely ill. The only current method of control is to use insulin injections. Q: I don t think I am going to be able to cope with injecting my pet every day!! A: The needles are absolutely tiny and often your pet will usually tolerate it with minimal reaction. Also they do tend to get used to it very quickly. We will show you very carefully how to use the syringes and needles and make sure that you are completely happy with how to operate them safely and effectively. Q: Do I need to feed my diabetic animal any special food? A: The key to diet is primarily one of routine. For dogs it is ideal to feed two meals a day at the same time every day. With cats, it is better to leave some food available at all times. There are some special diabetic foods, containing high fibre, which are available which aid the control. This food is more expensive when compared to normal pet food prices. Q: If my pet needs an anaesthetic for any reason what are the risks? A: Each case will have to be considered on an individual basis. Anaesthetising a diabetic animal does carry a slightly higher risk of problems compared to healthy animals. Obviously essential operations will still have to take place and with diabetic animals neutering is seen as essential. Non essential procedures may be delayed or other options may be explored. If your diabetic pet requires an anaesthetic, your vet will talk you through the whole process. Q: What if I miss/forget a dose of insulin? A: This is a common occurrence. If you miss a dose of insulin, DO NOT TRY TO CATCH UP OR INCREASE THE NEXT DOSE. Just give the normal dose at the next normal required time. Giving a higher dose of insulin, or giving at the wrong time may make your pet severely ill. Q: I have left my insulin out of the fridge for a while does this matter? A: Insulin is very fragile and if kept out the fridge for more than 30mins or more will become unusable. If you have left the insulin out, you must contact us to obtain a new bottle. Q: What are the signs of a hypo (blood sugar drops too low)? A: Your pet may become weak and wobbly or collapse. You may find odd behaviour such as vacancy, or staring into space. This is more likely to occur during/after a period of sudden exertion, such as going for a walk. Page 4 of 5

5 Q: What do I do if my pet has a hypo (blood sugar drops too low)? A: Stay calm! It is always useful to have some sugar paste or sweet honey to hand if you own a diabetic pet. If your pet is showing the symptoms of a hypo, then quickly rub some sugary substance on the gums and inside the mouth. If your pet is completely conscious you can trickle some sugar water directly into the mouth. This should bring them round quite quickly, but it would be advisable to call the surgery as a precaution. Q: Once diagnosed, how often do I need to come back to the vets for checks? A: The stabilization is the hardest part of control. Once we feel this is suitably achieved we like to check animals over every 3 months to start off with. We may feel a Fructosamine (see earlier) blood test is required. If we are happy with this, we recommend a minimum examination every 6 months. Q: What are the main problems associated with diabetes? A: In reality, even with the best controlled patients, cataract formation is unfortunately a very common problem. This usually does result in complete loss of sight. Although potentially there is an operation that can be performed to remove the cataract, this is a specialist procedure and it is expensive. Other problems can include kidney disease and liver problems. Q: What will happen if I don t treat my diabetic pet? A: Although not a painful condition, untreated diabetics will have a considerably shorter life expectancy and may then suffer from secondary effects such as renal failure or seizures/comas from excessive blood glucose. Ultimately if treatment is not an option, you may have to consider euthanasia. Page 5 of 5