Diabetes in dogs
Encyclopedia
Beta cell
Beta cells are a type of cell in the pancreas located in the so-called islets of Langerhans. They make up 65-80% of the cells in the islets.-Function:...
s of the endocrine pancreas either stop producing insulin or can no longer produce it in enough quantity for the body's needs. The condition is commonly divided into two types, depending on the origin of the condition: Type 1 diabetes, sometimes called "juvenile diabetes", is caused by destruction of the beta cells of the pancreas
Pancreas
The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...
. The condition is also referred to as Insulin-Dependent diabetes, meaning exogenous
Exogenous
Exogenous refers to an action or object coming from outside a system. It is the opposite of endogenous, something generated from within the system....
insulin injections must replace the insulin the pancreas is no longer capable of producing for the body's needs. Dogs have Insulin-Dependent, or Type 1, diabetes; current research finds no Type 2 diabetes in dogs. Because of this, there is no possibility the permanently damaged pancreatic beta cells could re-activate to engender a remission as may be possible with some feline diabetes cases, where the primary type of diabetes is Type 2. There is another less common form of diabetes, Diabetes insipidus
Diabetes insipidus
Diabetes insipidus is a condition characterized by excessive thirst and excretion of large amounts of severely diluted urine, with reduction of fluid intake having no effect on the concentration of the urine. There are several different types of DI, each with a different cause...
, which is a condition of insufficient antidiuretic hormone
Vasopressin
Arginine vasopressin , also known as vasopressin, argipressin or antidiuretic hormone , is a neurohypophysial hormone found in most mammals, including humans. Vasopressin is a peptide hormone that controls the reabsorption of molecules in the tubules of the kidneys by affecting the tissue's...
or resistance to it.
This most common form of diabetes strikes 1 in 500 dog
Dog
The domestic dog is a domesticated form of the gray wolf, a member of the Canidae family of the order Carnivora. The term is used for both feral and pet varieties. The dog may have been the first animal to be domesticated, and has been the most widely kept working, hunting, and companion animal in...
s. The condition is treatable, and need not shorten the animal's life span or interfere with quality of life. If left untreated, the condition can lead to cataracts, increasing weakness in the legs (neuropathy), malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, ketoacidosis
Diabetic ketoacidosis
Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances...
, dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
, and death. Diabetes mainly affects middle-aged and older dogs, but there are also juvenile cases. The typical canine
Dog
The domestic dog is a domesticated form of the gray wolf, a member of the Canidae family of the order Carnivora. The term is used for both feral and pet varieties. The dog may have been the first animal to be domesticated, and has been the most widely kept working, hunting, and companion animal in...
diabetes patient is middle-aged, female, and overweight
Overweight
Overweight is generally defined as having more body fat than is optimally healthy. Being overweight is a common condition, especially where food supplies are plentiful and lifestyles are sedentary...
at diagnosis.
The number of dogs diagnosed with diabetes mellitus has increased three-fold in thirty years. Looking back on survival rates from almost the same time period, only 50% survived the first 60 days after diagnosis and went on to be successfully treated at home. Currently, diabetic dogs receiving treatment have the same expected lifespan as non-diabetic dogs of the same age and gender.
Classification and causes
At present, there is no international standard classification of diabetes in dogs. Commonly used terms are:- Insulin Deficiency Diabetes or Primary Diabetes, which refers to the destruction of the beta cells of the pancreas and their inability to produce insulin.
- Insulin Resistance Diabetes or Secondary Diabetes, which describes the resistance to insulin caused by other medical conditions or by hormonal drugs.
While the occurrence of beta cell destruction is known, all of the processes behind it are not. Canine Primary diabetes mirrors Type 1 human diabetes in the inability to produce insulin and the need for exogenous replacement of it, but the target of canine diabetes autoantibodies has yet to be identified. Various breed and treatment studies have been able provide some evidence of a genetic connection. Studies have also furnished evidence that canine diabetes has a seasonal connection not unlike its human Type 1 diabetes counterpart, and a "lifestyle" factor, with pancreatitis being a clear cause of diabetes in dogs. This evidence suggests that the disease in dogs also has some environmental and dietary factors involved.
Secondary diabetes may be caused by use of steroid medications, the hormones of estrus, acromegaly, (spaying can resolve the diabetes), pregnancy, or other medical conditions such as Cushing's disease
Cushing's syndrome
Cushing's syndrome is a hormone disorder caused by high levels of cortisol in the blood. This can be caused by taking glucocorticoid drugs, or by tumors that produce cortisol or adrenocorticotropic hormone or CRH...
. In such cases, it may be possible to treat the primary medical problem and revert the animal to non-diabetic status. Returning to non-diabetic status would depend on the amount of damage the pancreatic insulin-producing beta cells have sustained.
It happens rarely, but it is possible for a pancreatitis
Canine pancreatitis
Canine Pancreatitis is inflammation of the pancreas that can occur in two very different forms. Acute pancreatitis is sudden while chronic pancreatitis is characterized by recurring or persistent form of pancreatic inflammation...
attack to activate the endocrine portion of the organ back into being capable of producing insulin once again in dogs. It is also possible for acute pancreatitis to cause a temporary, or transient diabetes, most likely due to damage to the endocrine portion's beta cells. Insulin resistance that can follow a pancreatitis attack may last for some time thereafter. Pancreatitis can also damage the endocrine pancreas to the point where the diabetes is permanent.
Genetic susceptibility of certain breeds
This list of risk factors for canine diabetes is taken from the genetic breed study that was published in 2007. Their "neutral risk" category should be interpreted as insufficient evidence that the dog breed genetically shows a high, moderate, or a low risk for the disease. All risk information is based only on discovered genetic factors.High risk
- Cairn TerrierCairn TerrierThe Cairn Terrier is the oldest of the terrier breeds, originating in the Scottish Highlands and recognized as one of Scotland's earliest working dogs...
- SamoyedSamoyed (dog)The Samoyed dog takes its name from the Samoyedic peoples of Siberia. An alternate name for the breed, especially in Europe, is Bjelkier...
Moderate risk
- Bichon FriseBichon FriséA Bichon Frise , is a small breed of dog of the Bichon type. They are popular pets, similar in appearance to, but larger than, the Maltese.-Etymology and History:...
- Border CollieBorder CollieThe Border Collie is a herding dog breed developed in the Anglo-Scottish border region for herding livestock, especially sheep. It is the most widespread of the collie breeds....
- Border TerrierBorder TerrierThe Border Terrier is a small, rough-coated breed of dog of the terrier group. Originally bred as fox and vermin hunters, Border Terriers share ancestry with Dandie Dinmont Terriers and Bedlington Terriers....
- CollieCollieThe collie is a distinctive type of herding dog, including many related landraces and formal breeds. It originates in Scotland and Northern England. It is a medium-sized, fairly lightly built dog with a pointed snout, and many types have a distinctive white pattern over the shoulders. Collies...
- DachshundDachshundThe dachshund is a short-legged, long-bodied dog breed belonging to the hound family. The standard size dachshund was bred to scent, chase, and flush out badgers and other burrow-dwelling animals, while the miniature dachshund was developed to hunt smaller prey such as rabbits...
- English SetterEnglish SetterThe English Setter is a breed of dog. It is part of the Setter family, which includes red Irish Setters, Irish Red and White Setters, and black-and-tan Gordon Setters. It is a gun dog, bred for a mix of endurance and athleticism.- Appearance :...
- PoodlePoodleThe Poodle is a breed of dog. The poodle breed is found officially in toy, miniature, and standard sizes, with many coat colors. Originally bred as a type of water dog, the poodle is highly intelligent and skillful in many dog sports, including agility, obedience, tracking, and even herding...
- SchnauzerSchnauzerA Schnauzer is a German dog type that originated in Germany in the 15th and 16th centuries. The term comes from Schnauze , the German word for "snout", because of the dog's distinctively bearded snout. The word Schnauzer also means moustache in German; some authorities, such as Encyclopædia...
- Yorkshire TerrierYorkshire TerrierThe Yorkshire Terrier is a small dog breed of terrier type, developed in the 19th century in the county of Yorkshire, England to catch rats in clothing mills. The defining features of the breed are its size, to , and its silky blue and tan coat...
Neutral risk
- Cavalier King Charles SpanielCavalier King Charles SpanielThe Cavalier King Charles Spaniel is a small breed of Spaniel-type dog, and is classed as a toy dog by most kennel clubs. It is one of the most popular breeds in the United Kingdom. Since 2000, it has been growing in popularity in the United States. It is a smaller breed of spaniel, and Cavalier...
- Cocker Spaniel
- Doberman
- Jack Russell TerrierJack Russell TerrierThe Jack Russell terrier is a small terrier that has its origins in fox hunting. It is principally white-bodied smooth, rough or broken-coated which is commonly confused with the Parson Russell terrier and the Russell terrier with the term "Jack Russell" commonly misapplied to other small white...
- Labrador RetrieverLabrador RetrieverThe Labrador Retriever is one of several kinds of retriever, a type of gun dog. A breed characteristic is webbed paws for swimming, useful for the breed's original purpose of retrieving fishing nets. The Labrador is the most popular breed of dog by registered ownership in Canada, the United...
- Mixed BreedMixed-breed dogA mixed-breed dog, also known as a mutt or mongrel, is a dog whose ancestry is generally unknown and that has characteristics of two or more types of breeds. A mixed-breed may be a cross-breed dog, a random-bred dog, or a descendant of feral or pariah dog populations...
- RottweilerRottweilerThe Rottweiler is a medium to large size breed of domestic dog that originated in Rottweil, Germany. The dogs were known as "Rottweil butchers' dogs" because they were used to herd livestock and pull carts laden with butchered meat and other products to market...
- West Highland Terrier
Low risk
- BoxerBoxer (dog)Developed in Germany, the Boxer is a breed of stocky, medium-sized, short-haired dog. The coat is smooth and fawn or brindled, with or without white markings. Boxers are brachycephalic , and have a square muzzle, mandibular prognathism , very strong jaws and a powerful bite ideal for hanging on to...
- German Shepherd
- Golden RetrieverGolden RetrieverThe Golden Retriever is a medium-sized breed of dog. They were historically developed as gundogs to retrieve shot waterfowl such as ducks and upland game birds during hunting and shooting parties. As such, they were bred to have a soft mouth to retrieve game undamaged and have an instinctive love...
- Springer SpanielSpringer SpanielSpringer Spaniel refers to two different breeds of dogs, both of which are commonly called simply Springer Spaniel:*English Springer Spaniel*Welsh Springer Spaniel...
- Staffordshire Bull TerrierStaffordshire Bull TerrierThe Staffordshire Bull Terrier is a medium-sized, short-coated, old-time breed of dog. It is an English dog, where it is the 5th most popular breed, and related to the bull terrier...
- WeimaranerWeimaranerThe Weimaraner is a dog that was originally bred for hunting in the early 19th century. Early Weimaraners were used by royalty for hunting large game such as boar, bear, and deer. As the popularity of large game hunting began to decline, Weimaraners were used for hunting smaller animals like...
Pathogenesis
The body uses glucose for energy. Without insulin, glucose is unable to enter the cells where it will be used for this and other anabolicAnabolism
Anabolism is the set of metabolic pathways that construct molecules from smaller units. These reactions require energy. One way of categorizing metabolic processes, whether at the cellular, organ or organism level is as 'anabolic' or as 'catabolic', which is the opposite...
("building up") purposes, such as the synthesis of glycogen, proteins, and fatty acids. Insulin is also an active preventor of the breakdown or catabolism
Catabolism
Catabolism is the set of metabolic pathways that break down molecules into smaller units and release energy. In catabolism, large molecules such as polysaccharides, lipids, nucleic acids and proteins are broken down into smaller units such as monosaccharides, fatty acids, nucleotides, and amino...
of glycogen and fat. The absence of sufficient insulin causes this breaking-down process to be accelerated; it is the mechanism behind metabolizing fat instead of glucose, and the appearance of ketones.
Since the glucose which normally enters the cells is unable to do so without insulin, it begins to build up in the blood where it can be seen as hyperglycemia or high blood glucose levels. The tubules of the kidneys are normally able to re-absorb glucose, but they are unable to handle and process the amount of glucose they are being presented with. At this point, which is called the renal threshold, the excess glucose spills into the urine (glycosuria
Glycosuria
Glycosuria or glucosuria is the excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reclaim all of the filtered glucose back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to...
), where it can be seen in urine glucose testing. It is the polyuria
Polyuria
Polyuria is a condition usually defined as excessive or abnormally large production or passage of urine . Frequent urination is sometimes included by definition, but is nonetheless usually an accompanying symptom...
, or over-frequent urination, which causes polydipsia
Polydipsia
Polydipsia is a medical symptom in which the patient displays excessive thirst. The word derives from the Greek πολυδιψία, which is derived from πολύς + δίψα...
, or excessive water consumption, through an osmotic process
Osmotic diuresis
Osmotic diuresis is increased urination caused by the presence of certain substances in the small tubes of the kidneys. The excretion occurs when substances such as glucose enter the kidney tubules and cannot be reabsorbed...
. Even though there is an overabundance of glucose, the lack of insulin does not allow it to enter the cells. As a result, they are not able to receive nourishment from their normal glucose source. The body begins using fat for this purpose, causing weight loss; the process is similar to that of starvation
Starvation
Starvation is a severe deficiency in caloric energy, nutrient and vitamin intake. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage and eventually, death...
.
Symptoms
Generally there is a gradual onset of the disease over a few weeks, and it may escape unnoticed for a while. The main symptoms are:- excessive water consumption–PolydipsiaPolydipsiaPolydipsia is a medical symptom in which the patient displays excessive thirst. The word derives from the Greek πολυδιψία, which is derived from πολύς + δίψα...
- frequent and/or excessive urination–PolyuriaPolyuriaPolyuria is a condition usually defined as excessive or abnormally large production or passage of urine . Frequent urination is sometimes included by definition, but is nonetheless usually an accompanying symptom...
–possible house "accidents" - greater than average appetite–PolyphagiaPolyphagiaPolyphagia means "eating too much". It derives from the Greek words πολύς which means "very much", and φαγῶ , verb for "I eat"....
–with either weight loss or maintenance of current weight - cloudy eyes–Cataracts
It is also possible that the illness may not be noticed until the dog has symptoms of ketosis
Ketosis
Ketosis is a state of elevated levels of ketone bodies in the body. It is almost always generalized throughout the body, with hyperketonemia, that is, an elevated level of ketone bodies in the blood. Ketone bodies are formed by ketogenesis when the liver glycogen stores are depleted...
or ketoacidosis. When newly-diagnosed, about 40% of dogs have elevated ketone levels; some are in diabetic ketoacidosis when first treated for diabetes.
Management
Early diagnosis and interventive treatment can mean reduced incidence of complications such as cataracts and neuropathy. Since dogs are insulin-dependent, oral drugs are not effective for them. They must instead be placed on insulin replacement therapy. Approved oral diabetes drugsAnti-diabetic drug
Anti-diabetic medications treat diabetes mellitus by lowering glucose levels in the blood. With the exceptions of insulin, exenatide, and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral antihyperglycemic agents...
can be helpful to sufferers of Type 2 diabetes
Diabetes mellitus type 2
Diabetes mellitus type 2formerly non-insulin-dependent diabetes mellitus or adult-onset diabetesis a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Diabetes is often initially managed by increasing exercise and...
because they work in one of three ways: by inducing the pancreas to produce more insulin, by allowing the body to more effectively utilize the insulin it produces, or by slowing the glucose absorption rate from the GI tract. Unapproved so-called "natural" remedies make similar claims for their products. All of this is based on the premise of having an endocrine pancreas with beta cells capable of producing insulin. Those with Type 1
Diabetes mellitus type 1
Diabetes mellitus type 1 is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose...
, or insulin-dependent diabetes, have beta cells which are permanently damaged, thus unable to produce insulin. This is the reason nothing other than a form of insulin replacement therapy
Insulin therapy
Insulin therapy is the treatment of diabetes by administration of exogenous insulin.Insulin is used medically to treat some forms of diabetes mellitus. Patients with Type 1 diabetes mellitus depend on external insulin for their survival because the hormone is no longer produced internally...
can be considered real and effective treatment. Canine diabetes takes the form of insulin-dependency; insulin therapy must be continued for life.
The goal is to regulate the pet's blood glucose using insulin and some probable diet and daily routine changes. The process may take a few weeks or even many months. It is basically the same as in type-1 diabetic humans. The aim is to keep the blood glucose values within an acceptable range during the whole day, or most of it. The commonly recommended method is by "starting low and going slow" as indicated for people with diabetes. Typical starting insulin doses are from 0.25 IU/KG (2.2 lb) to 0.50 IU/KG (2.2 lb) of body weight.
During the initial process of regulation and periodically thereafter, the effectiveness of the insulin dose at controlling blood glucose needs to be evaluated. This is done by a series of blood glucose tests called a curve. Blood samples are taken and tested at intervals of one to two hours over a 12 or 24 hour time period. The results are generally transferred into graph form for easier interpretation. They are then compared against the feeding and insulin injection times for judgment. The curve provides information regarding the action of the insulin in the animal. It is used for determining insulin dose adjustments, determining lowest and highest blood glucose levels, discovering insulin duration problems, and in the case of continued hyperglycemia, whether the cause is insufficient insulin dose or Somogyi rebound
Chronic Somogyi rebound
Chronic Somogyi rebound, also called the Somogyi effect and posthypoglycemic hyperglycemia, is a rebounding high blood sugar that is a response to low blood sugar...
, where blood glucose levels initially reach hypoglycemic levels and are brought to hyperglycemic ones by the body's counterregulatory hormone
Counterregulatory hormone
A counterregulatory hormone is a hormone that opposes the action of another.The action of insulin is counterregulated by glucagon, adrenaline , noradrenaline , cortisol, and growth hormone...
s. Curves also provide evidence of insulin resistance which may be caused by medications other than insulin or by disorders other than diabetes which further testing can help identify.
Other diagnostic tests to determine the level of diabetic control are fructosamine
Fructosamine
Fructosamine is a compound that can be considered the result of a reaction between fructose and ammonia or an amine . A fructosamine is also formed when carbonyl group of glucose reacts with an amino group of a protein, as the double bond to oxygen moves from the end carbon atom to the next carbon...
and glycosylated hemoglobin (GHb) blood tests which can be useful especially if stress may be a factor. While anxiety or stress may influence the results of blood or urine glucose tests, both of these tests measure glycated proteins, which are not affected by them. Fructosamine testing provides information about blood glucose control for an approximate 2 to 4 week period, while GHb tests measure a 2 to 4 month period. Each of these tests has its own limitations and drawbacks and neither are intended to be replacements for blood glucose testing and curves, but are to be used to supplement the information gained from them. While HbA1c tests are a common diagnostic for diabetes in humans, at present there are no standards of measurement for use of the test in animals. This means the information from them may not be reliable.
The diabetic pet is considered regulated when its blood glucose levels remain within an acceptable range on a regular basis. Acceptable levels for dogs are between 5 and 10 mmol/L or 90 to 180 mg/dL. The range is wider for diabetic animals than non-diabetics, because insulin injections cannot replicate the accuracy of a working pancreas.
Insulin therapy
The general form of this treatment is an intermediate-acting basal insulin with a regimen of food and insulin every 12 hours, with the insulin injection following the meal. The most commonly used intermediate-acting insulins are NPHNPH insulin
NPH insulin , is an intermediate-acting insulin given to help control the blood sugar level of those with diabetes...
, also referred to as isophane, or Caninsulin, also known as Vetsulin, a porcine Lente insulin. While the normal diabetes routine is timed feedings with insulin shots following the meals, dogs unwilling to adhere to this pattern can still attain satisfactory regulation. Most dogs do not require basal/bolus
Basal (medicine)
Basal when used in a medical sense refers to a minimal level that is necessary for health or life. As used by diabetics and health care professionals, it describes a low, continuous dosage of insulin intended to "cover" the glucose output of the liver.This works together with a bolus of insulin,...
insulin injections; treatment protocol regarding consistency in the diet's calories and composition along with the established feeding and injection times is generally a suitable match for the chosen intermediate-acting insulin.
With Lantus (insulin glargine)
Insulin glargine
Insulin glargine, marketed by Sanofi-Aventis under the name Lantus, is a long-acting basal insulin analogue, given once daily to help control the blood sugar level of those with diabetes. It consists of microcrystals that slowly release insulin, giving a long duration of action of 18 to 26 hours,...
and Protamine Zinc Insulin (PZI) being unreliable in dogs, they are rarely used to treat canine diabetes. Bovine insulin has been used as treatment for some dogs, particularly in the UK. Pfizer Animal Health discontinued of all three types of its veterinary Insuvet bovine insulins in late 2010 and suggested patients be transitioned to Caninsulin. The original owner of the insulin brand, Schering-Plough Animal Health, contracted Wockhardt
Wockhardt
Wockhardt Ltd. is a pharmaceutical and biotechnology company headquartered in Mumbai, India. The company has manufacturing plants in India, UK, Ireland, France and US, and subsidiaries in US, UK, Ireland and France. It is a global company with a more than half of its revenue coming from Europe. The...
UK to produce them. Wockhardt UK has produced both bovine and porcine insulins for the human pharmaceutical market for some time. Their Hypurin line of bovine insulins is comparable to that of Insuvet.
Diet
Most of the commercially available prescription diabetes foods are high in fiber, in complex carbohydrates, and have proven therapeutic results. Of primary concern is getting or keeping the animal eating, as use of the prescribed amount of insulin is dependent on eating full meals. When no meal at all is eaten, there is still a need for a basalBasal (medicine)
Basal when used in a medical sense refers to a minimal level that is necessary for health or life. As used by diabetics and health care professionals, it describes a low, continuous dosage of insulin intended to "cover" the glucose output of the liver.This works together with a bolus of insulin,...
dosage of insulin, which supplies the body's needs without taking food into consideration. Eating a partial meal would mean a reduction in insulin dose. Basal and reduced insulin dose information should be part of initial doctor–client diabetes discussions in case of need.
It is possible to regulate diabetes without any diet change. If the animal will not eat a prescribed diet, it is not in the dog's best interest to insist on it; the amount of additional insulin required because a non-prescription diet is being fed is generally between 2–4%. Semi moist foods should be avoided as they tend to contain a lot of sugars. Since dogs with diabetes are prone to pancreatitis and hyperlipidemia
Hyperlipidemia
Hyperlipidemia, hyperlipoproteinemia, or hyperlipidaemia is the condition of abnormally elevated levels of any or all lipids and/or lipoproteins in the blood...
, feeding a low-fat food may help limit or avoid these complications. A non-prescription food with a "fixed formula" would be suitable because of the consistency of its preparation. Fixed formula foods contain precise amounts of their ingredients so batches or lots do not vary much if at all. "Open formula" foods contain the ingredients shown on the label but the amount of them can vary, however they must meet the guaranteed analysis on the package. These changes may have an effect on the control of diabetes. Prescription foods are fixed formulas, while most non-prescription ones are open formula unless the manufacturer states otherwise.
Glucometers and urine test strips
The use of an inexpensive glucometer and blood glucose testing at home can help avoid dangerous insulin overdoses and can provide a better picture of how well the condition is managed. Dr. Sara Ford gave a presentation about the need for home blood glucose testing in diabetic pets at the 2010 American Veterinary Medical Association Convention. She believes a diabetic pet needs to be checked at least twice a day, saying, "If you're a human diabetic you monitor your blood sugar between 4-6 times a day. I believe that state-of-the-art care in veterinary medicine in 2010 includes home blood-glucose monitoring."A 2003 study of canine diabetes caregivers who were new to testing blood glucose at home found 85% of them were able to both succeed at testing and to continue it on a long-term basis. Using only one blood glucose reading as the reason for an insulin dose increase is to be avoided; while the results may be higher than desired, further information, such as the lowest blood glucose reading or nadir, should be available to prevent possible hypoglycemia.
Urine strips
Clinistrip
A clinistrip is a urine test strip to measure levels of glucose in urine for diabetics. The small plastic strip has glucose oxidase and an organic dye on one end. The enzyme oxidizes glucose to gluconic acid with the formation of hydrogen peroxide. The hydrogen peroxide reacts with dye to produce a...
are not recommended to be used as the sole factor for insulin adjustments as they are not accurate enough. Urine glucose testing strips have a negative result until the renal threshold of 10 mmol/L or 180 mg/dL is reached or exceeded for a period of time. The range of negative reading values is quite wide-covering normal or close to normal blood glucose values with no danger of hypoglycemia (euglycemia) to low blood glucose values (hypoglycemia
Diabetic hypoglycemia
Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals...
) where treatment would be necessary. Because urine is normally retained in the bladder for a number of hours, the results of urine testing are not an accurate measurement of the levels of glucose in the bloodstream at the time of testing.
Glucometers made for humans are generally accurate using canine and feline blood except when reading lower ranges of blood glucose (<80 mg/dL), (<4.44 mmol/L). It is at this point where the size difference in human vs animal red blood cells can create inaccurate readings. Glucometers for humans were successfully used with pets long before animal-oriented meters were produced. A 2009 study directly compared readings from both types of glucometers to those of a chemistry analyzer. Neither glucometer's readings exactly matched those of the analyzer, but the differences of both were not clinically significant when compared to analyzer results. All glucometer readings need to be compared to same sample laboratory values to determine accuracy.
Blood glucose guidelines
The numbers on the table below are as shown on a typical home glucometer. Seeing ketone values above trace or small is an indication to contact a vet or local emergency treatment center.Diabetic hypoglycemia Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals... when using insulin, even without visible hypoglycemia symptoms. Immediate treatment is needed. |
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Glycosuria Glycosuria or glucosuria is the excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reclaim all of the filtered glucose back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to... for dogs when excess glucose in the blood spills into the urine. The kidneys are unable to reabsorb it all; corresponding diabetic symptoms appear. |
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Dogs can form cataracts at this level and need to be checked for ketones using urine strips Clinistrip A clinistrip is a urine test strip to measure levels of glucose in urine for diabetics. The small plastic strip has glucose oxidase and an organic dye on one end. The enzyme oxidizes glucose to gluconic acid with the formation of hydrogen peroxide. The hydrogen peroxide reacts with dye to produce a... . Higher blood glucose levels indicate a lack of sufficient insulin. The body can switch from using ketones instead of glucose for fuel. |
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High blood glucose values increase the risk of the body switching to using ketones for energy. |
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As blood glucose values increase, so does the possibility for ketone production. Both short and long-term ill effects are possible-see hyperglycemia Hyperglycemia Hyperglycemia or Hyperglycæmia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than 13.5mmol/l , but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l... for details. |
Ketones – ketoacidosis
| Ketone Monitoring Needed: | |
|---|---|
| High Hyperglycemia Hyperglycemia or Hyperglycæmia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than 13.5mmol/l , but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l... blood sugar Blood sugar The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL... |
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| over 14 mmol/L or 250 mg/dL | |
| Dehydration Dehydration In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism... |
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| skin does not snap back into place quickly after being gently pinched; gums are tacky or dry |
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| Not eating for over 12 hours | |
| Vomiting Vomiting Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose... |
Lethargy |
| Infection or illness | High stress levels |
| Breath smells like acetone (nail-polish remover) or fruit. | |
Ketones
Ketone bodies
Ketone bodies are three water-soluble compounds that are produced as by-products when fatty acids are broken down for energy in the liver and kidney. They are used as a source of energy in the heart and brain. In the brain, they are a vital source of energy during fasting...
in the urine or blood, as detected by urine strips
Clinistrip
A clinistrip is a urine test strip to measure levels of glucose in urine for diabetics. The small plastic strip has glucose oxidase and an organic dye on one end. The enzyme oxidizes glucose to gluconic acid with the formation of hydrogen peroxide. The hydrogen peroxide reacts with dye to produce a...
or a blood ketone testing meter, may indicate the beginning of diabetic ketoacidosis
Diabetic ketoacidosis
Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances...
(DKA), a dangerous and often quickly fatal condition caused by high glucose levels (hyperglycemia
Hyperglycemia
Hyperglycemia or Hyperglycæmia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than 13.5mmol/l , but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l...
) and low insulin levels combined with certain other systemic stresses. DKA can be arrested if caught quickly.
Ketones are produced by the liver as part of fat metabolism and are normally not found in sufficient quantity to be measured in the urine or blood of non-diabetics or well-controlled diabetics. The body normally uses glucose as its fuel and is able to do so with sufficient insulin levels. When glucose is not available as an energy source because of untreated or poorly treated diabetes and some other unrelated medical conditions, it begins to use fat for energy instead. The result of the body turning to using fat instead of glucose for energy means ketone production that is measurable when testing either urine or blood for them.
Ketone problems that are more serious than the "trace or slight" range need immediate medical attention; they cannot be treated at home. Veterinary care for ketosis
Ketosis
Ketosis is a state of elevated levels of ketone bodies in the body. It is almost always generalized throughout the body, with hyperketonemia, that is, an elevated level of ketone bodies in the blood. Ketone bodies are formed by ketogenesis when the liver glycogen stores are depleted...
/ketoacidosis can involve intravenous (IV) fluids to counter dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
, when necessary, to replace depleted electrolytes, intravenous or intramuscular short-acting insulin to lower blood glucose levels, and measured amounts of glucose or force feeding, to bring the metabolism back to using glucose instead of fat as its source of energy.
When testing urine for ketones, the sample needs to be as fresh as possible. Ketones evaporate quickly, so there is a chance of getting a false negative test result if testing older urine. The urine testing strip bottle has instructions and color charts to illustrate how the color on the strip will change given the level of ketones or glucose in the urine over 15 (ketones–Ketostix) or 30 (glucose–Ketodiastix) seconds. Reading the colors at those time intervals is important because the colors will continue to darken and a later reading will be an incorrect result. Timing with a clock or watch second hand instead of counting is more accurate.
At present, there is only one glucometer available for home use that tests blood for ketones using special strips for that purpose–Abbott's Precision Xtra. This meter is known as Precision, Optium, or Xceed outside of the US. The blood ketone test strips are very expensive; prices start at about US$50 for ten strips. It is most likely urine test strips–either ones that test only for ketones (brand name example Ketostix) or ones that test for both glucose and ketones in urine (brand name example Ketodiastix) would be used. The table above is a guide to when ketones may be present.
Nonketotic hyperosmolar syndrome
Nonketotic hyperosmolar syndrome (also known as hyperglycemic hyperosmolar syndrome) is a rare but extremely serious complication of untreated canine diabetes that is a medical emergency. It shares the symptoms of extreme hyperglycemia, dehydration, and lethargy with ketoacidosis, but because there is some insulin available in the system, the body does not begin to turn to using fat as its energy source and there is no ketone production. There is not sufficient insulin available to the body for proper uptake of glucose, but there is enough to prevent ketone formation. The problem of dehydration in NHS is more profound than in diabetic ketoacidosis. Seizures and coma are possible. Treatment is similar to that of ketoacidosis, with the exceptions being that NHS requires that the blood glucose levels and rehydration be normalized at a slower rate than for DKA; cerebral edemaCerebral edema
Cerebral edema or cerebral œdema is an excess accumulation of water in the intracellular or extracellular spaces of the brain.-Vasogenic:Due to a breakdown of tight endothelial junctions which make up the blood-brain barrier...
is possible if the treatment progresses too rapidly.
Dehydration
| Clinical Signs of Dehydration | |
|---|---|
| Based on percentage of body weight, not percentage of fluid loss | |
| < 5% (mild) | not detectable |
| 5–6% (moderate) | slight loss of skin elasticity Elasticity (physics) In physics, elasticity is the physical property of a material that returns to its original shape after the stress that made it deform or distort is removed. The relative amount of deformation is called the strain.... |
| 6–8% (moderate) | |
| definite loss of skin elasticity | slight prolongation of capillary refill Capillary refill Capillary refill is the rate at which blood refills empty capillaries. It can be measured by holding a hand higher than heart-level , pressing the soft pad of a finger or toe until it turns white, and taking note of the time needed for the color to return once pressure is released. Normal refill... |
| slight sinking of eyes into orbit Orbit (anatomy) In anatomy, the orbit is the cavity or socket of the skull in which the eye and its appendages are situated. "Orbit" can refer to the bony socket, or it can also be used to imply the contents... |
slight dryness of oral mucous membranes Oral mucosa The oral mucosa is the mucous membrane epithelium of the mouth. It can be divided into three categories.*Masticatory mucosa, para-keratinized stratified squamous epithelium, found on the dorsum of the tongue, hard palate and attached gingiva.... |
| 10–12% (marked)–emergency | |
| tented skin stands in place | |
| prolonged capillary refill | eyes sunken in orbits |
| dry mucous membranes | possible signs of shock |
| 12–15% signs of hypovolemic shock, death–emergency | |
Body fluid loss is measured in two major ways–sensible and insensible. Sensible is defined as being able to be measured in some way; vomiting, urination and defecation are all considered to be sensible losses as they have the ability to be measured. An insensible loss example is breathing because while there are some fluid losses, it is not possible to measure the amount of them. With a condition like fever, it is possible to measure the amount of fluid losses from it with a formula that increases by 7% for each degree of above normal body temperature, so it would be classed as a sensible loss.
A check of the pet's gums and skin can indicate dehydration; gums are tacky and dry and skin does not snap back quickly when pinched if dehydration is present. When the skin at the back is lifted, a dehydrated animal's does not fall back into place quickly. Serious dehydration (loss of 10–12% of body fluids) means the pulled up skin stays there and does not go back into place. At this point, the animal may go into shock; dehydration of 12% or more is an immediate medical emergency. Hypovolemic shock is a life-threatening medical condition in which the heart is unable to pump sufficient blood to the body, due to loss of fluids.
Dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
can change the way subcutaneous
Subcutaneous injection
A subcutaneous injection is administered as a bolus into the subcutis, the layer of skin directly below the dermis and epidermis, collectively referred to as the...
insulin is absorbed, so either hyperglycemia or hypoglycemia are possible; dehydration can also cause false negative or positive urine ketone test results. Hyperglycemia means more of a risk for dehydration.
Hypoglycemia
Hypoglycemia, or low blood glucose, can happen even with care, since insulin requirements can sometimes change without warning. Some common reasons for hypoglycemia include increased or unplanned exercise, illness, or medication interactions, where another medication potentiates the effects of the insulin. VomitingVomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
and diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
episodes can bring on a hypoglycemia reaction, due to dehydration or simply a case of too much insulin and not enough properly digested food. Symptoms of hypoglycemia need to always be taken seriously and addressed promptly. Since serious hypoglycemia can be fatal, it is better to treat a suspected incident than to fail to respond quickly to the signs of actual hypoglycemia. Dr. Audrey Cook addressed the issue in her 2007 article on diabetes mellitus: "Hypoglycemia is deadly; hyperglycemia is not. Owners must clearly understand that too much insulin can kill, and that they should call a veterinarian or halve the dose if they have any concerns about a pet's well-being or appetite. Tell owners to offer food immediately if the pet is weak or is behaving strangely."
Symptoms
Some common symptoms are:- depression or lethargy
- confusion or dizziness
- trembling
- weakness
- ataxia (loss of coordination or balance)
- loss of excretory or bladder control (sudden house accident)
- vomiting, and then loss of consciousness and possible seizures
Successful home treatment of a hypoglycemia event depends on being able to recognize the symptoms early and responding quickly with treatment. Trying to make a seizing or unconsicous animal swallow can cause choking on the food or liquid. There is also a chance that the materials could be aspirated
Aspiration pneumonia
Aspiration pneumonia is bronchopneumonia that develops due to the entrance of foreign materials into the bronchial tree, usually oral or gastric contents...
(enter the lungs instead of being swallowed). Seizures or loss of consciousness because of low blood glucose levels are medical emergencies.
Treatment
Food should be offered at the first signs of possible hypoglycemia. If the animal refuses it, a sugar solution (corn syrupCorn syrup
Corn syrup is a food syrup, which is made from the starch of maize and contains varying amounts of maltose and higher oligosaccharides, depending on the grade. Corn syrup is used in foods to soften texture, add volume, prevent crystallization of sugar, and enhance flavor...
, honey
Honey
Honey is a sweet food made by bees using nectar from flowers. The variety produced by honey bees is the one most commonly referred to and is the type of honey collected by beekeepers and consumed by humans...
, pancake syrup
Maple syrup
Maple syrup is a syrup usually made from the xylem sap of sugar maple, red maple, or black maple trees, although it can also be made from other maple species such as the bigleaf maple. In cold climates, these trees store starch in their trunks and roots before the winter; the starch is then...
, etc.) should be poured on the finger and rubbed on its gums or under the tongue (sublingually). The solution must be applied this way to prevent possible aspiration of it. Intervet suggests one tablespoon of a sugar solution rubbed onto the gums, regardless of the size of the dog. Another hypoglycemia formula is 1 gram of glucose for every kilogram (2.2 lb) of the animal's body weight. Since sugar acts quickly, a response should be seen within a minute or two.
Honey, syrup, or sugar, as simple carbohydrates, act rapidly and will make the blood glucose rise, but the rise will not last very long, as they are broken down quickly by the body. Feeding something containing complex carbohydrates when the pet is able to eat will make sure another hypoglycemia event does not overtake the rapid rise in blood glucose levels from the sugar solution. Complex carbohydrates take longer to be broken down by the body, so they do not raise blood glucose levels until some time after being eaten. A small meal should be fed and the animal taken for medical evaluation to determine if further treatment is needed. Treatment of a serious hypoglycemia episode is similar to that of diabetic humans: using glucose or glucagon infusions, depending on severity.
External links
- Veterinary Emergency & Critical Care Society List of emergency facilities world-wide
- Blood glucose converter: mg/dL to mmol/L, mmol/L to mg/dL Children With Diabetes
- Pounds to Kilograms/Kilograms to Pounds online Converter Open Toronto
- Discontinuation of Critical Need Program Intervet February 7, 2011
- Intervet: Vetsulin Will Return Intervet February 11, 2011
- Dogs and Diabetes - Signs, Treatment, Complexities
- Vet-approved recipes for diabetic dog food