Diabetes Melitus

Diabetes Melitus
Glucose (sugar) is the primary energy source for most cells, and is distributed to them through the bloodstream. To make sure all cells get the sugars they need, transfer of glucose from the blood and into cells is regulated by the hormone insulin. Diabetes Melitus (DM) results when an animal is unable to either make insulin or cells stop responding to it, meaning cells can’t get the sugar they need and large amounts back up in the bloodstream.

Types of Diabetes Melitus
Type 1 diabetes occurs when the body stops making insulin. This can occur for a variety of reasons, is permanent, and requires life-long treatment. Type 1 DM the most common form in dogs (and juvenile humans).

Type 2 diabetes occurs when cells become resistant to insulin – basically, there is plenty of insulin, but it doesn’t have any effect. This is usually associated with obesity, as fat produces hormones that cause insulin resistance. Type 2 DM is the most common form in cats, and sometimes resolves with weight loss.

Clinical Signs
· Increased urination and thirst (excess blood sugar winds up in urine, pulling in more water) · Weight loss and poor body condition
· Appetite is usually increased initially, but decreases over time if untreated
· Lethargy or attitude changes

Diagnosis
Diabetes is usually easily diagnosed by finding high levels of glucose in the blood and urine. Other testing is important though, as diabetes predisposes to many other problems that need to be screened for. At a minimum full bloodwork and a urine culture to check for a UTI is needed. Imaging, such as x rays or abdominal ultrasound, is often recommended if other problems are suspected.

Treatment
Insulin: Pets with diabetes will need daily insulin injections, usually twice daily and for life. Though learning to give injections can be intimidating, most owners find it very manageable. We will start
with a safe low dose and increase that over the first 1-2 months alongside monitoring, as giving too much insulin can cause life-threatening hypoglycemia. While initial regulation is sometimes frustrating, most animals do quite well once the optimal dose is identified.

Initial regulation requires evaluating the body’s response to insulin until we find the right dose. This is done either by checking blood glucose levels every couple hours at a given dose (a blood glucose curve), or by constant monitoring over a week or more with a Freestyle Libre device. Either will need to be done multiple times over the first 1-2 months to safely find the right dose. They will also be repeated in the future if we suspect a problem with diabetic regulation has developed.

Diet and Weight Loss: Diabetic control and long term management can be greatly improved with specific dietary changes, though dogs and cats are different in this regard. For dogs, feeding a high-fiber diet such as EN Fiber Balance only twice daily at the time of insulin administration greatly helps regulate blood sugar. For cats, a low carbohydrate diet such as Purina DM is best. Both diets can aide in weight loss, which also improves regulation.

Monitoring & Follow-Up
Diabetes is usually very treatable, but it is a lifelong disease. It also predisposes pets to many other issues such as urinary tract infections, and can be affected by any other illness a pet experiences – meaning an unrelated minor illness can sometimes cause serious problems with an otherwise stable diabetic. Therefore, ongoing monitoring is essential to good control and health.

After regulation is achieved in the first few months, diabetics should initially be seen every 2-3 months, and very stable pets may be seen every 6 months. While a glucose curve is usually only performed if there are concerns, the following should be checked at least twice yearly in all diabetics.
· A full physical exam and history
· Basic bloodwork
· Blood pressure
· Urine culture

Additionally, while we recommend annual dental care for all pets, this is particularly important for diabetics as inflammation in the mouth (gingivitis) may have a negative effect on diabetic regulation.