What are the symptoms of Diabetes?

Diabetes What is Diabetes? Diabetes Mellitus ("sugar diabetes") is an inability to regulate normal sugar levels in the body. In dogs it is similar to ...
Author: Warren Harmon
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Diabetes What is Diabetes? Diabetes Mellitus ("sugar diabetes") is an inability to regulate normal sugar levels in the body. In dogs it is similar to type I diabetes in humans, this is a lack of insulin. Insulin is a hormone produced by the pancreas. The pancreas is an organ located next to the stomach, which controls lots of hormones and enzymes involved in digestion. Insulin is very important in regulating blood sugar (glucose) levels. Glucose is like fuel for cells, without it they cannot function properly. If you imagine cells are like a factory, glucose is the fuel for the factory, delivered by the van which represents the blood stream. Insulin is like the key that unlocks the factory door. Without it the glucose is stuck inside the van...not much use for the factory.

GLUCOSE

What are the symptoms of Diabetes? • increased thirst • increased urination • increased appetite • weight loss • smelly urine • lethargy

How is Diabetes Diagnosed? Diagnosis is normally quite straight forward. Based on assessment of your dog's symptoms and an examination we would normally recommend blood tests and urine tests. We look for high levels of glucose. Occasionally blood glucose levels can be affected by other diseases. Even just the stress or excitement of visiting the vets can raise a dog's blood glucose level outside the normal range. If we are unsure of the diagnosis after blood and urine tests, we often send a special blood test (fructosamine) to lab for confirmation. Fructosamine is a measure of the average blood glucose levels for the last two to three weeks, so cancels out that natural fluctuation in glucose levels.

What next? Once we've diagnosed diabetes it's important for us to check for any other diseases that may be contributing to the diabetes. There are a few conditions that are commonly seen at the same time as diabetes:

Cushing’s syndrome is in imbalance of natural steroid hormone in the body. In high levels steroid hormone can cause insulin resistance....back to the factory analogy, it’s like someone putting glue in the locks on the factory door, so the key won't work. There are various different blood tests to diagnose Cushing’s syndrome. Often confirming a diagnosis is very difficult. Diabetes and Cushing’s have the same set of symptoms. Diabetes can affect the results of blood tests for Cushing’s and vice versa. Pancreatitis is inflammation of the pancreas. As we've already discussed the pancreas makes insulin, so if it is unhappy and inflamed it does not function correctly and does not produce insulin. Urinary tract infections are very common in diabetic patients. Often dogs won't even show any symptoms of a urinary tract infection. Diabetic dogs’ urine is not as concentrated as normal and is full of sugar, the perfect breeding ground for bacteria. Any kind of infection or inflammation can affect insulin requirements, so it's important we check for this and treat it.

Why should I treat my dog? Diabetes is a serious, life-threatening disease. When glucose is not being used up by cells it builds up to high levels in the blood stream, this has a damaging effect on various organs. Unable to use glucose as fuel, the body will start breaking down muscle and fat to use instead. Muscle and fat is broken down into ketones, when ketones start to build up the body they cause a very serious condition call Diabetic Ketoasidosis (DKA). This is an emergency. Symptoms include: Vomiting, lethargy, not eating, excessive thirst and urination, progressing to coma and then death.

Treatment Diabetes requires lifelong management, there is no cure for it. In theory it is a simple disease to treat, we just have to supplement the insulin the dog has stopped producing. In reality it's often a bit more tricky than this. Treating a diabetic dog is undoubtedly a big commitment and can be an expensive process; it's not something to embark upon without careful consideration. Every diabetic dog is different and treatment is tailored specifically to each dog's individual needs. There is often a lot of “tinkering” with dosing and diet etc in the initial “stabilisation” period, don't expect a quick fix. For most dogs it will take a few months to stabalise them on the correct dose of insulin, during which time they will require regular follow up checks and bloods tests. Dogs that are very unwell with their diabetes or have diabetic ketoacidosis need hopitalisation and intensive care before they can start on insulin treatment at home. Dogs that are essentially well otherwise, can start treatment at home.

General Treatment Plan: Insulin Injections (caninsulin) This is the core aspect of treatment. Dogs normally need two injections a day. Giving your dog injections may sound scary, but it’s actually quite straight forward. The needles are so tiny, most dogs don't even notice the injection. We'll teach you how to give injections correctly and how to look after needles, syringes and insulin bottles. A bottle of insulin costs about £45 and lasts about a month normally. The special insulin syringes used for injections cost

about £20 for 30 syringes, they are supposed to be single use syringes, but some owners a happy to use them twice. Diet There are specially formulated diabetic diets available. Dogs that have pancreatitis may have slightly different dietary needs, again there are specially formulated diets for these patients. Many dogs can be kept on a standard commercial diet, provided we can stabilise them ok initially. It’s ok to give diabetic dogs treats, but within moderation and this has to be factored in to a daily “ration” so that every day is the same. Exercise Diabetic dogs still need regular exercise. Exercise helps maintain a healthy weight and helps regulate normal blood sugar levels. It's just important to keep a regular daily routine when it comes to exercise. Don't go for a 5mile run every Saturday and do nothing for the rest of the week, it would be better to break it down to 10-30mins each day. Neutering When female dogs come into season the changes in hormones can affect insulin requirements and cause insulin resistance. We recommend spaying female diabetic dogs. For male dogs neutering is less important.

What is a “Hypo” (hypoglycemia)? Hypoglycemia is when blood glucose levels go too low. This will happen if too much insulin is given. It could be that the dose of insulin is simply too high or could be that too high a dose was given in error, for example owners accidentally giving two doses of insulin by mistake. If your dog does not eat a meal but is given insulin anyway this may cause a “hypo”, so we advise you to ALWAYS FEED FIRST, then inject insulin 30-60mins later. If your dog does not eat DO NOT GIVE INSULIN, wait until the evening and offer a meal again. If your dog eats give a normal dose of insulin, DO NOT DOUBLE DOSE. If your dog does not eat again, make an appointment to get them checked over. If you forget to give a dose, DO NOT DOUBLE DOSE when it’s next due. Signs of a hypo: •lethargy •weak/wobbly •collapsing •twitching/fits

If you think your dog is having a hypo, give them some glucogel (or anything sweet, eg honey/jam). If they are not able to eat or swallow, just rub whatever sugary substance you have on their gums and CALL US IMMEDIATELY

Monitoring Diabetic patients need lots of monitoring. Some of this can be done by yourself at home, some needs to be done by your vet. It may be helpful for you to keep a diary monitoring everyday things such as: • Amount of water being drunk • Frequency/volume of urination • Amount of food eaten • Bodyweight • Glucose/ketones in urine – measured using a special urine dipstick  there should be no ketones  there should be small amounts of glucose, no glucose risks a hypo

Glucose Curves This is the best way to monitor your dog's progress and response to insulin. Blood glucose levels fluctuate a lot during the day, for example it goes up after food or in response to excitement. So a one off spot check blood test measuring blood glucose will just give a snippet of information. We need to monitor their blood glucose throughout the whole day. This involves the dog staying with us in the hospital for the day so we can take a blood sample every 1-2hrs measuring blood glucose. We can then make a chart of the results, like this: Blood Glucose

Ideal Glucose Curve

We normally recommend a glucose curve about 1 week after starting on insulin. We nearly always need to adjust the insulin dose based on the results. We are always very cautious with insulin dosing, too high a dose can cause a serious hypoglycemic episode. Slightly too high blood glucose is much safer in the short term. Every time we change the insulin dose or if your dog doesn't seem to be doing well on their current insulin dose we recommend another glucose curve. So often in the early stages of diabetes management, dogs require multiple glucose curves. Each curve costs about £160. However, we appreciate for some owners this may not be an affordable option, so the second best option is a “fructosamine” sample.

Fructosamine is another type of blood sugar. It gives us an idea of the average blood glucose levels over the last 2-3weeks, cancelling out that daily fluctuation in blood glucose. It’s a one off blood sample that we send to the lab, costing about £30.

Complications Cataracts - Most diabetic dogs will develop cataracts at some point, most within a year or so. Many will go completely blind. Dogs can have cataract surgery to restore their vision; this requires referral to a specialist eye vet and costs around £1-2000. Dogs actually cope surprisingly well with their loss of vision, blind dogs can still lead a relatively normal life. Infections - Diabetic patients often suffer urinary tract infections and eye infections because of the higher sugar levels in urine and in tears.

Neuropathy - Nerve damage causing weakness Nephropathy - Kidney damage We generally see more complications in patients with poor control of their diabetes. Complications are less likely if we are able to monitor properly and adjust treatment when necessary.

Somogyi Effect This is a bit complicated, but worth knowing about because it does happen from time to time. If an insulin dose is too high it can cause blood glucose levels to plummet rapidly. The body's response is to empty as much glucose into the blood stream as possible to get back to a normal level. As we've already discussed low blood glucose is serious and can cause seizure, coma or even death, the body obviously does its best to avoid this. But the body often goes a bit too far, so we see a “rebound hyperglycemia”, ie blood glucose goes much higher than normal. This can give really confusing results for us. Essentially the dog looks like an uncontrolled diabetic who's blood glucose is too high, so should need an increase in insulin dose. But increasing the dose just makes things worse! We need to catch that short period of low blood glucose by checking a glucose curve. From the chart is easy to see how the somogyi effect can be easy to miss. If we were to just check blood glucose at any of the red points on the chart we'd just see too high blood glucose, we'd miss that low purple point. Somogyi Effect

What’s the long term outlook? If all goes well and we can achieve good stabilisation, most diabetic dogs do really well. They lead relatively normal lives, with a good quality of life and a fair life expectancy. However this is a life limiting disease and at some point most dogs develop complications. Most diabetic dogs do develop cataracts within a year of diagnosis and will go blind. Vision can be restored with surgery, but for some owners this just isn't an option and some of these dogs sadly need to be put to sleep. Even

so, most dogs live with loss of vision remarkably well. Diabetes can a very rewarding illness to treat, in most dogs we can treat it very successfully. If you have any questions or concerns regarding diabetes please just ask one of our team and we'll do our best to help you

01527 831 616

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