Diabetes in dogs

Diabetes appears when the quantity of insulin in the blood decreases (type I diabetes) or when the organs' cells resist its action (type II diabetes). As a result, glucose (sugar) and other nutrients no longer enter the cells and their level increases in the dog's blood. Dogs are more likely to have type I diabetes than type II diabetes.

The disease occurs following the destruction of pancreatic cells that secrete insulin, either by the immune system or by inflammation of the entire pancreas during pancreatitis.

The 4 typical symptoms of diabetes in dogs are:

• Increased thirst
• Increased hunger
• Need to urinate more often
• Weight loss

Dogs sometimes suffer from these conditions too:

• Infections (e.g. skin, urine)
• Cataracts

Dogs with these symptoms often do not look "sick". The diabetes is then said to be "uncomplicated".

Diabetes becomes "complicated" when metabolic wastes such as ketone bodies accumulate in their blood and poison them. Other symptoms then appear and the dogs look "sick":

• Loss of appetite
• Depression
• Dehydration
• Vomiting
• Possible death when glucose is extremely low

The condition of the animal at the time of diagnosis will determine whether it can be treated at home or whether it will need to be hospitalized first.

For example, if the dog is suffering from "complicated" diabetes, also called diabetic ketoacidosis, he will first need to be hospitalized so that is condition can be stabilized. Before he can go home, his appetite will have to be back to normal, his vomiting needs to have stopped, his hydration status needs to be normal and there must be no more ketone bodies in his blood.

In humans, the blood glucose level needs to be controlled perfectly all the time. In dogs, the goals of treatment are rather to:

• Improve dogs' symptoms as well as theirs and their owners quality of life (e.g. stop urine "accidents" in the house or frequent exits during the night);
• Prevent, as much as possible, glucose from getting in the urine;
• Avoid the occurrence of complications related to diabetes (e.g. cataracts, accumulation of ketone bodies in the blood, etc.).

To achieve these objectives, we use:

• insulin injections
• dietary modification
• physical activity
• environment enrichment

Synthetic insulin is used in diabetic dogs to replace their natural insulin which is no longer produced by their pancreas. It needs be administered subcutaneously twice a day for the rest of the animal's life.

There are several types of insulin available on the market. The difference between them is mainly related to their speed and their duration of action.

The 2 types of insulin we use most in dogs are Caninsulin^® (Zinc Insulin Zinc) and Levemir® (insulin detemir) because they better control the blood glucose level of most dogs than other types of insulin.

The main risk associated with the use of insulin is hypoglycemia. This means that the glucose level goes down too low. This situation occurs especially when the insulin dose is too high or if there is an error in dosage.

Here are the symptoms of hypoglycemia to watch for:

• depression and weakness,
• faltering step,
• dizziness,
• stiffness,
• seizures,
• coma,
• death in severe cases.

If you notice any of these symptoms in your pet, contact a veterinarian immediately to get directions on what to do.

Here are 7 tips for keeping and handling insulin appropriately :

• Keep the vial in the refrigerator between injections;
• Before taking a dose, invert the vial a few times to thoroughly mix the product. Do not shake it;
• When inserting the needle into the vial and pulling on the syringe plunger, an air bubble will enter at the same time as the insulin. Expel this air bubble by "flicking" the tip of the syringe;
• Lift the skin on the side of the dog's chest with thumb and forefinger to form a small tent;
• Insert the needle at the base of the tent. Make sure to sit close to the skin. If the needle is well positioned under the skin, and not in its thickness, it should move freely;
• Push the plunger all the way down;
• Change the syringe and injection site each time.

When a dog develops diabetes, it is very important to feed him with a diet that will help improve his glucose metabolism and utilization, as well as maintain normal insulin activity in the cells.

The animal should eat mostly wet food because it contains less sugars and more water than dry food. The water in the can helps replace the large amount of water lost in the urine and keeps the animal well hydrated.

It is crucial to accurately calculate and respect the amount of food the dog needs to eat. A dog who is overweight should eat food intended for weight loss so that he can lose 1-2% of his weight each week. Once he has reached his ideal weight, he will have to eat a diabetic food.

The quantity and type of treats offered will also need to be closely monitored. Too much can interfere with the dog's diabetes control and weight loss. The amount of treats should not exceed 10% of the number of calories to which the animal is entitled to per day.

If you give your dog treats, you will have to let his vet know the type and quantity. He or she will determine if these treats are compatible with the treatment of his diabetes. If this is not the case, he or she can recommend treats that suit his condition and calculate how much he can eat.

A feeding toy is an object into which kibbles or treats can be put. The dog must work and move to get them out of the toy and eat them. These toys help diabetic dogs lose weight and keep it off because they:

• Exercise more;
• Eat only small portions of food at a time, which prevents large amounts of sugar from being in their blood at once and then being turned into fat;
• Eat more slowly, which promotes better digestion and a feeling of fullness.

The diagnosis is confirmed when an animal has typical symptoms, when glucose is seen in his urine and when high glucose levels are found in his blood.

Some factors predispose dogs to develop diabetes or prevent it from being well controlled:

• Obesity
• Certain diseases (e.g. hyperadrenocorticism, pancreatitis, infections, etc.)
• Some medications (e.g. cortisone)
• Pregnancy
• The breed (e.g. Schnauzers).

It is therefore important to identify and treat any other condition or disease that the dog might have that could impair the control of his diabetes. To do this, some tests should be done:

• Hematology to detect the presence of anemia, inflammation or infection;
• Biochemistry to check the condition of the kidneys, liver, thyroid gland, etc;
• A urine analysis with culture. To detect an infection, stones, abnormal cells, etc;
• Blood pressure;
• A measure of the level of pancreatic enzymes. To detect pancreatitis;
• Any other test deemed necessary.

Several ways are available to monitor the evolution of the disease. However, none are perfect and none apply to all patients in the same way. Each animal is different and the follow-up must be adapted to each one.

These means include monitoring:

• the animal's symptoms and weight;
• his blood and urine glucose levels;
• his blood fructosamine levels.

Measuring a "blood glucose curve" involves measuring the blood glucose level of the animal a few times during a day. This makes it possible to verify that the insulin dose is effective. In addition, the curve makes sure that the glucose level does not decrease too much. The results should then be forwarded to the veterinarian for analysis.

It is strongly recommended to use a specially designed glucose meter for animals such as AlphaTRAK₂^® to do the curve at home. Glucose meters for humans are not calibrated for animals. They should not be used because the measures they provide are not reliable for them.

A blood glucose curve must also be made:

• Approximately 2 weeks after each dose change or insulin;
• Every 3-6 months;
• When hypoglycemia is suspected;
• If the symptoms of diabetes reappear.

Blood and urine tests should also be repeated at the beginning of treatment and twice a year.

Here are the 5 steps to follow to use the glucometer:

1. With one hand, hold the end of the ear and flip it over so that the inside is exposed and the vein along the edge is visible;
2. Nick the vein with the lancet supplied with the device. A small drop of blood should appear;
3. Lightly touch the drop of bloo with one of the two black areas of the strip;
4. Wait for a beep to tell you that enough blood has been collected;
5. Read the result in the gray meter window.

At home, you can measure the amount of glucose in the dog's urine. When this test is done regularly, it can help determine if diabetes is well controlled. However, you cannot just trust the one result to decide whether to change the insulin dose or not because the results may indicate different things:

• The absence of glucose. This may indicate that the blood glucose is perfectly controlled or that the insulin dose is too high;
• A small amount of glucose. Indeed, this indicates that the level of glucose in the blood is too high, but it impossible to know if this has been the case for a long time or not.
• A lot of glucose. This probably indicates the need to increase the insulin dose.

It usually takes additional tests to arrive at the right conclusion.

Fructosamine is a protein that attaches to excess glucose in the dog's blood. Its level increases when there has been too much glucose for 6 to 12 hours. The measurement of fructosamine indicates the average amount of blood glucose from the previous 2-3 weeks.

A high value usually indicates that hyperglycemia has been going on for a long time. However, sometimes blood glucose levels are high even when diabetes is well controlled. On the other hand, a low level may indicate chronic hypoglycemia.

To properly interpret the results of fructosamine, several values ​​must be obtained over time and compared with each other.

Diabetes is a common disease in dogs. The main symptoms are increased thirst, hunger, urge to urinate and weight loss. To control their diabetes, dogs need insulin and a food that is adapted to their condition. It is very important that these dogs reach and maintain a healthy weight.

You think your dog might be suffering from diabetes? Contact one of our establishments to make an appointment with one of our veterinarians.