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Diabetes Mellitus

General Information

Diabetes mellitus is a disease caused by a deficiency of insulin. Insulin is a hormone produced by the pancreas, and is necessary for body tissues to use blood sugar. Without insulin, sugar remains in the blood and eventually passes into the urine. This causes increased urine production and thirst. Hunger increases because the body cannot use the sugar in the blood. As the disease progresses chemicals called ketones accumulate, resulting in vomiting and dehydration. Eventually coma and then death occur in untreated animals.

Diabetes is not a curable disease, but with proper insulin administration, the disease can be controlled.

Important Points in Treatment

1. Blood and urine sugar must be monitored very carefully until your pet's condition is stabilized. Once your pet's insulin requirements are determined and blood-sugar levels are stabilized, only the urine sugar needs to be monitored.

2. Insulin: Give ____________________ units of insulin each day at _________ o'clock.

3. Urine sugar and water consumption: Test for urine sugar each day. You will find variable results. In the end we would hope that about 50% or more of the urine glucose results will be negative. However, don't panic when you have an occasional high urnine glucose result. Keep records of all results and bring them when discussing progress. We are NOT hoping to have all results negative. Also, watch for changes in water consumption. Call the doctor if urine production stays elevated or water consumption stays greater than 1 oz. per pound per day.

With time most owners are able to adjust insulin dosage based on the urine glucose levels. However, it is also useful to evaluate blood glucose "curves" to help interpret urine glucose results. We like to see mostly negative urine glucose results and NO hypoglycemic events. When urine glucose results are all or mostly positive we usually think about working the daily insulin dose up slowly to reduce blood (and thus urine) glucose levels. When urine glucose are all or mostly negative we often consider lowering insulin levels, especially if any low blood sugar events (seizures, weakness) events are seen.

When we lower or raise the insulin levels we try to do so slowly. We will raise or lower the insulin dose by only a unit or two of the daily dose. If we are giving insulin twice daily we will alternate the increase or reduction of the dose between the morning or the evening dose so that both dosages remain similar. We usually stay at any one dosage for about 2 days before we make another change to allow us to fully evaluate the effect of a change before going on to another change.

4. Diet: Feed a diet high in fiber and low in carbohydrates. We usually recommend feeding multiple small meals per day though veterinarians vary on their opinions on this subject. Most veterinarians recommend a relatively high fiber diet though some experts feel that this may NOT be appropriate for cats. Feed as follows:


5. Exercise: Exercise decreases the need for insulin. For proper regulation, the amount of daily exercise should stay as stable as possible.

6. Low blood-sugar reactions: Occasionally insulin treatment may result in blood-sugar levels that are too low. This is most likely to happen 3-7 hours after insulin treatment, especially with strenuous exercise. Your pet may seem weak, tired or uncoordinated, or may have a seizure. Always keep a sugar-containing syrup (for example, Karo) handy to treat low sugar levels. If your pet has a seizure, rub the syrup on the gums and inside the lips. Do not try to force a convulsing animal to swallow the syrup however, if you can get your pet to swallow after some recovery this can help with recovery. After initial recovery from the low sugar event it it better to offer a meal of a more complex food source like normal pet food. Call the doctor if your pet does not improve within a few minutes.

7. Hormones present during "heat" and pregnancy antagonize the effects of insulin. Diabetic females should be spayed as soon as their insulin levels are regulated.

8. Re-examination: During the early weeks of treatment, several re-examinations may be necessary. Call the doctor when questions or problems arise. Make sure you fully understand all aspects of home care.

Notify the Doctor if Any of the Following Occur:

* You cannot give the insulin as directed, or urine-sugar levels increase.
* Your pet's thirst and urination increase.
* Your pet has diarrhea or vomits.
* Your pet acts weak or depressed.
* Your pet has repeated bouts of low blood sugar.
* Your pet has trouble breathing.

There are some useful videos available at this site: http://partnersah.vet.cornell.edu/pet/fhc/diabetes


Article : "BORROWED FROM" Larry Tilley's Recommended Info site (www.VetMedCenter.com)

Nutrition and Diabetes Mellitus in Dogs and Cats

Cheryl Holloway, RVT
Editor Lisa Freeman DVM, PhD, Diplomte, ACVN

Diabetes mellitus (DM) in dogs and cats is a complex disorder; insulin deficiency or dysfunction results in excessive blood sugar levels and abnormal lipid and protein metabolism. Treatment for DM usually includes nutritional management in conjunction with insulin therapy.

The objectives of nutritional management of dogs and cats with DM are to provide adequate nutrients for achieving and maintaining a moderate body weight and condition, to provide optimal conditions for achieving control of blood sugar, and to accommodate concurrent diseases or complications of diabetes. The following areas should be considered when developing a nutritional plan for an animal with DM:

Food intake, body weight, and condition—The animal's food intake, body weight, and condition play an important role in determining the best diet for an animal with DM. After establishing the amount eaten, and whether the animal's body condition is very thin, thin, moderate, stout, or obese (this can be done by using a body condition scoring sheet from your veterinarian), the food intake may be adjusted to attain or maintain a moderate body condition. Excess weight may exacerbate the diabetic state in some cases, and resolution of diabetes after weight loss has been reported in a small number of obese diabetic cats. In managing diabetes, underfeeding and malnutrition also can have negative effects on blood sugar metabolism. Generally, the calorie needs of well-controlled diabetic dogs and cats do not differ from those of normal dogs and cats.
Diet Composition—Your veterinarian may recommend a low fat, high fiber diet, depending on the pet's body condition and test results. A complete history of the animal's current diet should be taken to evaluate the content of water, carbohydrates (sugar, fiber), energy, fat, protein, and vitamins and minerals. If the diet does not provide the veterinarian's recommended intake of nutrients for DM, changing to a more appropriate food may be indicated. When considering the diet, the food type is also an important factor. Of the three types of food (dry, canned, and semi-moist), semi-moist foods are generally avoided because they contain simple sugars. Also, to help control the blood sugar levels, table food should not be given and treats should be kept to a minimum.
Feeding Method—Because insulin usually is administered in conjunction with meals, the feeding method can help to control blood sugar. The goal is for blood sugar to rise slowly when insulin levels are adequate, thereby minimizing rapid rises of the blood sugar level. One method is to feed two equal-sized meals daily as follows: one at the time of the insulin injection and one 8 to 10 hours later. If your veterinarian recommends giving insulin twice daily, half of the daily meal should be given with each insulin injection. If the animal has poor blood sugar control, feeding should be divided into three or more smaller meals to help maintain blood sugar concentrations at the desired level.
Once a nutritional plan is set, keep it constant from day to day. As always, careful follow-up is important to assess if any modifications to the diet need to be made based on changes with the animal's food intake, body weight, body condition, or general overall health.