Symptoms, diagnostic tests and treatments of diabetes in dogs.
I couldn't begin to count the number of times while I was working as an emergency veterinary technician an owner would call and ask about a dog that seemed to be drinking and/or urinating more than usual.
Questioning them would usually reveal the dog had also seemed "off" for a while as well as having lost weight although the appetite had remained unchanged. After hearing about this particular grouping of symptoms, the most common, although complex of canine endocrine disorders would be suspected and tested for. This disorder is diabetes mellitus.
Diabetes mellitus is often called "sugar diabetes" and it comes in two types.
Type 1 diabetes is caused by the insufficient production by the pancreas of the hormone known as insulin.
Type 2 diabetes is a result of an inadequate response by the dog to insulin.
High blood sugar levels (hyperglycemia) develop because the animal's (and humans) body is unable to break down and use glucose properly. This inability causes sugar to appear in the urine (glucosuria) that in turn causes an excessive amount of urination (polyuria). To compensate for the increase in urination the dog must drink an excessive amount (polydipsia). Another common side effect of diabetes mellitus is weight loss in a dog that has maintained a good or even increased appetite.
Although excessive drinking and urination are the most common symptoms, they are in no way the only ones. In addition to the weight loss, dogs can also develop signs of poor skin and hair coat, liver disease, vomiting, weakness in the rear legs (diabetic neuropathy), secondary bacterial infections and dehydration. They can also develop a life threatening condition known as ketoacidosis. A dog whose diabetes is not regulated will often become blind or have kidney problems develop as well. I can remember several dogs that the owners never kept up with the treatments to control the diabetes and the dog would quickly go blind.
The cause isn't known but medical experts feel heredity, obesity and the taking of certain medications increase the chances of a dog developing diabetes. Diabetes mellitus can affect any age, breed or sex of dog.
A veterinarian will first do a physical exam, and then run a number of blood and urine tests to diagnosis diabetes. The urine will be checked for specific gravity, which tells its concentration. Urine will also be checked for glucose (sugar), the presence of blood, ketones, creatinine levels and several other liver/kidney functions. The blood will also be tested for exact glucose and BUN levels as well as several liver, kidney and heart enzymes.
The normal blood glucose level in dogs is between 60 and 120. Most glucometers will results of up to 360 but I have seen some dogs whose glucose levels were so high the meter couldn't register it. If an abnormally high glucose level is found, the dog is usually kept for several days while the levels are monitored every one to three hours. If the glucose levels continue to remain elevated the veterinarian will discuss treatment options with the owner. It will be ultimately up to the owner as to whether the pet is euthanized or placed on a special diet such as Hills w/d while also given injections of insulin. Although there are oral diabetic medications for humans and cats, there is none available for dogs at this time. Deciding to go with the treatments and monitoring of blood glucose levels requires a serious commitment on the part of the owner.
If the owner decides to begin treatment, the dog will still be kept several more days in the animal hospital. If the pet is dehydrated or suffering from ketoacidosis, he or she will have an IV catheter placed through which fluids are given. All dogs will be given insulin injections once or twice a day. Blood glucose levels will usually be checked first thing in the morning before medicating and eating, an hour after the insulin is given and then several times during the day. The time in between blood tests will vary according to the wishes of the individual veterinarian. After working in a practice with nine different veterinarians, I can assure you each one will have his or her own opinions as to when the best times will be.
Another reason for differences in time and medications is that each dog responds differently to insulin. There is more than one type of insulin choice and finding the correct dosage is the tricky part. A dosage that is too low will not control the diabetes whereas a dosage that is too high can cause too low of a blood sugar level (hypoglycemia).
Hypoglycemia can be a life threatening complication to treatment of diabetes mellitus. Signs can include but not restricted to weakness, lack of co-ordination, seizures, coma and even death. If hypoglycemia occurs and the pet is conscious, a mixture of kayro syrup or sugar and water may be given orally. The dog will also be offered its normal diet.
In the case of a dog that is comatose or seizuring, an IV fluid mixture of water and dextrose will often be given. Food or oral liquids should never be given to these animals. For one thing you will not want to get your hands or fingers around the mouth of a seizuring dog because of the risk of bites. For another, an unconscious or seizuring animal can aspirate the fluids and set up a secondary condition known as aspirate pneumonia.
Once the dog has been regulated on its insulin, he or she will be sent home with special feeding instructions. These instructions will often include the reduction in diet to allow the dog to lose weight. Obesity is often a contributing factor in diabetes mellitus and by losing weight; the dog may even be able to come off the medication at some time.
Weight loss in dogs should be carefully monitored and done over a long period of time. Hills/Science Diet, Purina and Iams/Eukanuba each have diets that are beneficial to the control of the diabetes as well as weight loss. These diets are usually high in fiber and carbohydrates. Your veterinarian will give you specific instructions on the type of food, amount be given and what times of the day you should give it. Normally the food will be broken up into at least two feedings. The morning one will be given with the insulin dose and the second one will be given during the peak blood glucose times as determined by the monitoring that would have been done in the hospital or, if two insulin injections are given a day, the second feeding will be given then.
In addition to instructions about feeding, your veterinarian should educate you in the storage (usually refrigerated), use and administration of the insulin. Most will also have handouts about diabetes in general, diet and signs of hypoglycemia as well as advice about the best glucometer to buy, its use and how to acquire blood samples. The glucometers used to measure the blood glucose in dogs will be the same type used for humans and can be bought at any drug or department store. The doctor will also want to set up follow up visits to monitor progress in the control, weight loss and general health of the dog.
Proper care and monitoring of the diabetic dog will require an excellent level of communication between you the owner and the veterinarian treating the pet. If you feel uncomfortable dealing with the veterinarian or have difficulty getting a return call, you would do best to look for a different doctor. You will also want to find out how your doctor handles emergencies. Will he or she take the calls or will they be referred to a local emergency clinic. If referrals are the norm, be sure to know the number and how to get to the clinic if needed.
The initial cost of hospitalization and regulation isn't cheap. In fact, it can run up into hundreds of dollars, but once regulated, most dogs suffering from diabetes mellitus can live long, happy lives as long as the owner is willing to make the effort.