Diabetes Mellitus - What is it? and How is it diagnosed
& treated?
There are two types of Diabetes; Diabetes Mellitus and
Diabetes Insipidus. This blog is focused
on Diabetes Mellitus and will be referred to simply as diabetes.
Diabetes is a complicated and often challenging disease to
deal with, there are many factors involved in the diagnosis, treatment and
monitoring of it, that it can often be overwhelming for owners - in this blog
our aim is to break down and simplify the key factors involved with diabetes to
allow you to better understand and deal with the disease.
Like us, our pets can suffer from diabetes and it is
diagnosed, treated and monitored in very much the same way.
Diabetes results from the lack of production, or lack of
response to a hormone called insulin, which is produced in the pancreas. This is the key difference between the two
types;
• Insulin
dependent – in humans this is referred to as Type 1 diabetes and results from
the lack of insulin production and is often the type that dogs suffer
from. Life long insulin treatment will
be required to treat this type of diabetes.
• Non-insulin
dependent – in humans referred to as Type 2 diabetes and results from the lack
of response to insulin i.e. insulin resistance and is often the type that cats
suffer from. Often life long insulin
treatment will still be required as in Type 1, but sometimes cats can go into
remission – this is one of many reasons why correct monitoring is required and
this will be discussed later.
The role of insulin is to deliver glucose into the cells of
the body for them to use as energy. If
the cell cannot gain access to this energy source it has no option but to find
other ways such as breaking down fats and proteins - this leads to two of the
common symptoms of diabetes... appetite increases as the body detects the need
for sugar but weight loss occurs due to the breaking down of fats and proteins.
So how do we diagnose diabetes?
Often owners will bring their pets to the vet as they've
noticed some physical or behavioural changes.
Symptoms can include some or all of the following;
• Increased
urination and thirst (polyuria & polydypsia aka PUPD)
• Urinary
accidents in the house
• Dehydration
• Vomiting
• Increased
or decreased appetite
• Lethargy
• Weight
loss - although patients can often be overweight initially.
• One of
the later symptoms you may see in cats is that they can walk really low on their back legs - this is called diabetic neuropathy – when this occurs the
disease has been present for a long time.
Diabetic Neuropathy
Diagnosis
The first thing the vet will do to gain a diagnosis of
diabetes is to take a fasted blood sample and run a full biochemistry &
hematology to check the blood glucose level but also to rule out any other
conditions and or complicating factors.
A urine sample will also be requested so that urine glucose and ketone
levels can be checked, the presence of these are a good indicators of diabetes
as they are rare in other conditions. However, their presence alone is not enough to give a
definitive diagnosis of diabetes.
The vet will need to take into consideration other reasons
that a patient’s blood glucose levels may be increased other than diabetes… for
example when an animal is stressed their blood glucose levels can increase, but
this doesn't mean that they have diabetes.
For this reason a fructosamine blood test may also be
required, fructosamine is a protein that binds to glucose and therefore gives a
good estimation of the blood glucose levels.
Fructosamine levels don’t increase as a response to stress and other
factors that affect blood glucose and so these results can help your vet to
estimate your pets blood glucose levels over the past 2-3 weeks. In general, the higher the fructosamine
levels, the higher the blood glucose.
Treatment & Monitoring
Once a diagnosis of diabetes has being made we then need to
look at how we are going to treat the patient.
The vet may advise that a blood glucose curve is carried out
before any treatment starts, to track how your pet’s blood glucose levels alter
throughout the day. This will highlight
any important low episodes and also help determine the initial insulin dose
that your pet will start on.
After having a consultation with the vet to explain and
demonstrate how, owners will need to administer sub-cuticular insulin
injections after a meal, often twice daily - depending on the type of insulin
used and its duration. This will mean
that every day owners will be giving two injections to their pets at home. This will be a long term commitment that will
affect all sorts of things such as making arrangements for the injections to be
given when owners are on holiday, ensuring that meals and injections are given
at the same time every day. However not
all cases of diabetes require insulin treatment to be started straight away,
for example in some cases of Type 2 diabetes it might be that initial treatment
starts with diet, weight loss or other medications.
Once the suitable treatment has been in place for a couple
of weeks the blood glucose curve will be repeated to check your pet’s response
to the insulin treatment. This will
involve your pet staying at the practice for the day and over a 12 hour period every 2-3 hours a
blood sample is tested to check the blood glucose level, which is recorded on a
chart. These readings allow the vet to
identify if your pets diabetes is being well controlled. It may be that after this blood glucose curve
your pets insulin dose is altered or will remain the same. Owners need to be aware that gaining adequate
control of their pets diabetes can take up to 3-6 months as each patient is
different and can respond differently.
Once control has been gained owners often find that most and if not all,
symptoms are rectified.
In order to keep blood glucose levels as consistent as
possible, to avoid critical highs and lows, feeding has to be set in to meal
times rather than grazing and ideally your pet would be fed a prescription diet
specifically for diabetic patients. The aim of which is to help maintain blood glucose levels within the normal range. We recommend Royal Canin
Diabetic food.
Royal Canin Diabetic food
Exercise has to be consistent each day when caring for a
diabetic patient, i.e. when the weather is nice don't suddenly take your dog
for a 3 hour walk in the countryside when you would normally only do 30 minutes
around the block. This will "use
up" too much of the circulating blood glucose and may lead to a
"hypo".
It is also advised that at least once or twice yearly a
fructosamine test is done, as stated earlier this gives the vet an idea of what
your pets blood glucose levels have been doing over the last couple of
weeks.
It is important that these
monitoring protocols are carried out as problems can be detected early and
before any serious consequences occur.
For example cats are capable of overcoming diabetes, however if the
correct monitoring is not done this may be missed and insulin injections will
continue - this may lead to life threatening hypogylcaemia as the insulin will
lower the blood glucose to dangerous levels.
Consequences of undiagnosed or poorly controlled diabetes
Diabetes that is
poorly controlled affects almost every organ in the body, the side effects of
this are vast but below are some of the more common side effects;
- Eyes – glaucoma, cataracts and diabetic retinopathy
- Nervous system – diabetic neuropathy, digestion problems
- Poor healing times
Can diabetes be prevented?
There are certain medical conditions that can increase the
risk of a patient developing insulin resistance such as being overweight or
obese. We recommend regular health
checks with your vet and weight checks with our nurses. All of this increases the chances of early
detection of not just diabetes but most medical conditions allowing diagnosis
and treatment to commence before serious symptoms occur.
So as you can see there is lots surrounding diabetes in our
pets and your vet will always be happy to discuss any questions or concerns you
may have. We know that it is not always
an easy disease to deal with, however once a patient is stabilised owners often
find it less daunting than they expected.
We hope that you have enjoyed and found this post useful.
Take care guys.
