Diabetes Mellitus – Principles of Treatment in Dogs
What is diabetes mellitus?
Diabetes mellitus is caused by the failure of the pancreas to regulate blood sugar. In the dog, diabetes mellitus is usually Insulin Dependent Diabetes Mellitus (also called Type 2 Diabetes). This type of diabetes usually results from destruction of most or all of the beta-cells that produce insulin in the pancreas. As the name implies, dogs with this type of diabetes require insulin injections to stabilize blood sugar levels.
Some people with diabetes take insulin shots, and others take oral medication. Is this true for dogs?
In humans, there are two types of diabetes mellitus. Both types are similar in that there is a failure to regulate blood sugar, but the basic mechanisms of disease differ somewhat between the two.
"Type I Diabetes Mellitus is the most common type of diabetes in dogs."
Diabetes Mellitus (sometimes also caused Insulin Dependent Diabetes Mellitus), results from total or near-complete destruction of the beta-cells. This is the most common type of diabetes in dogs. As the name implies, dogs with this type of diabetes require insulin injections to stabilize blood sugar.
Diabetes Mellitus (sometimes called Non-insulin Dependent Diabetes Mellitus), is different because some insulin-producing cells remain. However, the amount of insulin produced is insufficient, there is a delayed response in secreting it, or the tissues of the dog's body are relatively resistant to it (also referred to as insulin resistance). Type II diabetes may occur in older obese dogs. People with this form may be treated with an oral drug that stimulates the remaining functional cells to produce or release insulin in an adequate amount to normalize blood sugar. Unfortunately, dogs tend not to respond well to these oral medications and usually need some insulin to control the disease.
How is diabetes mellitus treated in dogs? Is treatment expensive?
Dogs with diabetes mellitus require one or more daily insulin injections, and almost all require some sort of dietary change. In general, they must be fed the same food in the same amount on the same schedule every day. Although the dog can go a day or so without insulin and not have a crisis, this should not be a regular occurrence; treatment should be looked upon as part of the dog's daily routine. This means that you, as the dog's owner, must make both a financial commitment and a personal commitment to treat your dog. If are out of town or go on vacation, your dog must receive proper treatment in your absence. Once your dog is well regulated, the treatment and maintenance costs are minimal. The special diet, insulin, and syringes are not expensive. However, the financial commitment may be significant during the initial regulation process, or if complications arise.
Initially, your dog may be hospitalized for a few days to deal with any immediate crisis and to begin the insulin regulation process. The "immediate crisis" is only great if your dog is so sick that it has quit eating and drinking for several days. Dogs in this state, called diabetic ketoacidosis, may require a several days of intensive care. Otherwise, the initial hospitalization may be only for a day or two while the dog's initial response to insulin injections is evaluated. . At that point, your dog returns home for you to administer medication. At first, return visits are required every three to seven days to monitor progress. It may take a month or more to achieve good insulin regulation.
"It is important that you pay close attention to all instructions related to administration of medication, diet, and home monitoring."
The financial commitment may again be significant if complications arise. Your veterinarian will work with you to try to achieve consistent regulation, but some dogs are difficult to keep regulated. It is important that you pay close attention to all instructions related to administration of medication, diet, and home monitoring. One serious complication that can arise is hypoglycemia, or low blood sugar, which can be fatal. This may occur due to inconsistencies in treatment.
What specifically is the treatment of diabetes?
Consistent treatment is a vital component of the proper management of the diabetic dog. Your dog needs consistent administration of insulin, consistent feeding, and a stable, stress-free lifestyle. Although it is not essential, your dog should live indoors, to minimize uncontrollable variables that can disrupt regulation.
"What your dog eats is important in the treatment of diabetes mellitus."
What your dog eats is important in the treatment of diabetes mellitus. In dogs, diabetes mellitus has been shown to be a "fiber-responsive disease." Fiber is a mainstay of a "low glycemic index" diet. Diabetic patients need to avoid the peaks of blood sugar related to eating a high carbohydrate diet. Fiber rich diets are preferred because they are generally lower in sugar and slower to be digested, meaning that their sugars are absorbed more slowly. This means that the dog does not have to process a large amount of sugar at one time. Additionally, the fiber may helpstimulate insulin secretion in Type II diabetes. Since obesity is a risk factor for diabetes mellitus and can make regulation difficult, a high fiber diet can have the added benefit of promoting appropriate weight loss for the Type II diabetic. Your veterinarian will discuss specific diet recommendations for your pet's needs.
"Your dog's feeding routine is also important."
Your dog's feeding routine is also important. Some owners feed their dogs by leaving food in the bowl at all times, so that the dog can eat whenever it wants (called free choice feeding). However, this is not the best way to feed a diabetic dog. The preferred way is to feed twice daily, just before each insulin injection. If your dog is currently eating on a free choice basis, it is important to try to make the change. If a two-meals-per-day feeding routine will not work for you, you must find some way to accurately measure the amount of food that is consumed and ideally to encourage your dog to eat the majority of the food at or around the time of insulin administration.
"The main treatment for regulating blood glucose is the administration of insulin by injection."
In diabetic dogs, the main treatment for regulating blood glucose is the administration of insulin by injection. Many people are initially fearful of inflicting pain or harm by giving insulin injections. However, this fear is unfounded, since the disposable injection needles are extremely sharp and cause minimal pain, the insulin does not sting or otherwise hurt on injection, and the injections are given under the skin in areas where it is impossible to damage internal structures.
Specific details about the use and storage of insulin are provided in the separate fact sheet.
"Diabetes mellitus - Insulin Treatment". Although the above procedures may at first seem complicated and somewhat overwhelming, they will very quickly become second nature.
How often do diabetic dogs need to be monitored?
It is necessary that your dog's progress be checked on a regular basis. Monitoring is a joint project on which owners and veterinarians must work together.
What is involved in home monitoring?
Your part in the monitoring process involves two types of monitoring. First, you need to be constantly aware of your dog's appetite, weight, water consumption, and urine output. You should be feeding a consistent amount of food each day, which will allow you to be aware of changes in consumption. You should weigh your dog at least monthly and notify your veterinarian if there is any weight loss. It is best to use the same scales each time.
You should develop a way to measure water consumption. The average dog should drink no more than 7 1/2 oz. (225 ml) of water per 10 pounds (4.5 kg) of body weight per 24 hours. Since this is highly variable from one dog to another, keeping a record of your dog's water consumption for a few weeks will allow you to establish what is normal for your dog. You can get a rough estimate whether your dog's drinking is normal by counting the number of times it drinks each day. When properly regulated, it should drink no more than six times per day. If this is exceeded, you should take an accurate measurement.
"Any significant change in your dog's food intake, weight, water intake, or urine output is an indicator that the diabetes is not well controlled."
Any significant change in your dog's food intake, weight, water intake, or urine output is an indicator that the diabetes is not well controlled. We should see your dog at that time for blood testing.
The second method of home monitoring is to determine the presence of glucose in the urine. If your dog is properly regulated, there should be little to no glucose present in the urine.