Juvenile Onset Diabetes Mellitus (Sugar Diabetes) in Dogs & Puppies 당뇨

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Juvenile Onset Diabetes Mellitus (Sugar Diabetes) in Dogs & Puppies

Located near the stomach and small intestine, the pancreas is a small gland that provides two important functions. It produces digestive enzymes, which are necessary for the proper digestion of food within the small intestine. And, it produces hormones, which help regulate the blood sugar (glucose) levels.

When starches and carbohydrates are eaten, they are broken down into the sugar glucose. This is absorbed through the wall of the digestive tract and passes into the bloodstream. Insulin allows glucose to leave the bloodstream and enter the body's tissue. Glucose can then be utilized as energy for the cells. When glucose levels are high, glucagon causes it to be stored in the liver and muscles as glycogen.

Diabetes mellitus is generally referred to as diabetes or sugar diabetes. Simply put, diabetes mellitus is the result of the pancreas producing insufficient quantities of the hormone insulin.

If the pancreas was producing normal amounts of insulin, then failed during adulthood (after one year of age), we refer to this as adult onset diabetes mellitus. When the pancreas does not develop normally in the puppy (usually prior to one year of age) with the result being inadequate insulin production, it is referred to as juvenile onset diabetes mellitus. Regardless of cause or age of onset, the result is, the pancreas does not produce sufficient quantities of the hormone insulin.

Insulin is necessary to move glucose into the cells from the bloodstream. Most brain cells, as well as intestinal and red blood cells, do not need high levels of insulin for glucose transport across their walls. It is the body tissues such as the liver and muscles which need insulin to move the glucose into their cells and provide energy. However, with diabetes, the glucose simply builds up in the bloodstream and causes an elevated blood sugar level.

It is not known why juvenile onset diabetes occurs. Some cases may be the result of autoimmune disorders and/or damage to the pancreas by puppyhood diseases such as infectious canine parvovirus. Genetics also plays a role, and juvenile onset diabetes is thought to be an inherited trait in Golden Retrievers.

What are the symptoms?

Juvenile onset diabetes usually results in a failure of proper growth in the puppy. The puppy is usually smaller than normal. Affected puppies not only fail to grow properly, but eventually lose weight despite being hungry and eating ravenously. Weight loss is a common symptom as the body burns muscle for energy to compensate for the body's inability to utilize glucose. Some puppies may become weak or paralyzed, especially noticed in the rear limbs.

Elevated blood sugar (glucose) can affect many systems of the body. Excess blood sugar will be lost through the kidneys, causing increased urination and thirst. Elevated blood sugar also alters the lens of the eye, leading to diabetic cataracts. A loss of muscle mass combined with inadequate energy levels within the cells lead to generalized weakness. The most common signs of diabetes are weakness, weight loss, and increased thirst and urination.

What are the risks?

The elevated blood sugar is toxic to many body systems and organs, including the blood vessels, nervous system (brain), liver, etc. A dog with uncontrolled diabetes will not live a normal life span. At the first indication of diabetes, a blood test should be performed by a veterinarian to determine the blood sugar level. The earlier treatment is initiated, the better.

What is the management?

Unlike humans, simply controlling the diet is seldom beneficial in the dog. Similarly, oral insulin tablets are not commonly effective in dogs. The treatment for a diabetic dog involves daily insulin injections. Dogs must be carefully monitored with blood and urine sugar tests to help determine the proper amount of insulin. Daily feeding must be on a regular schedule to provide a consistent supply of sugar so that insulin remains at the required level.

Some dogs with diabetes can live relatively normal lives with proper care. Maintaining the diabetic pet requires dedication on the

part of the owner. Many pet owners have found the experience to be a rewarding one.

Diabetes Mellitus in Dogs

 

 

Diabetes mellitus is a common illness in dogs. It is caused by either a decreased production of insulin or decreased functioning of the insulin. Insulin is a hormone produced by the pancreas that helps glucose move from the blood stream into the cells of the body where it can be used for energy.

What causes diabetes in dogs?
There appear to be many factors that can contribute to the development of diabetes in dogs. Genetics plays a role. Some diabetes may be immune-mediated. This means the dog's immune system works against the pancreas as it tries to produce insulin.

What dogs are most at risk of developing diabetes?
Dogs of any age can develop diabetes, but most are between 7 and 9 years old. Females appear to be at increased risk. Certain breeds appear to be more at risk, including Samoyeds, Australian terriers, miniature schnauzers, pugs, and miniature and toy poodles. Dogs who have had multiple episodes of pancreatitis also appear to be more likely to develop diabetes mellitus.

What are the signs and symptoms of diabetes in dogs?
Most dogs with diabetes will have increased thirst and urination. Although the appetite is usually good or increased, there is often weight loss. Some dogs, however, may become obese. In some cases, blindness due to cataracts may be the first indication to an owner that there is a problem. Cataracts would appear as cloudy eyes with vision loss.

Several diseases often occur in conjunction with diabetes mellitus, including Cushing's disease (hyperadrenocorticism), urinary tract infections, hypothyroidism, acute pancreatitis and cancer. The presence of these diseases can complicate the diagnosis and effective treatment of diabetes.

Dogs may develop a serious complication of diabetes known as ketoacidosis. In this emergency condition, the blood glucose becomes very high and breakdown products of fat (ketones) accumulate in the blood. This can cause severe lethargy, weakness and vomiting.

How is diabetes in dogs diagnosed?
Diabetes in dogs is diagnosed based on the clinical signs as described above, the finding of glucose in the urine, and laboratory testing of the blood that demonstrates the blood glucose is persistently high. Because there are often complicating diseases present, a complete blood count, chemistry panel, urinalysis and urine culture are generally recommended.

How is diabetes in dogs treated?
Diabetes cannot be cured, but it can be managed. Diabetes in dogs is managed through a combination of regular and controlled exercise, diet, and insulin.

Exercise
The amount of insulin needed by an animal is directly affected by the diet and energy output of the animal. A dog who jogs several miles with his owner each day will have much different insulin needs than a dog who is basically a "couch potato." When regulating a dog on insulin, it is important that the dog receive approximately the same amount of exercise each day.

Diet
Diet is another factor that greatly influences insulin requirements. The dog should receive the same dog food each day and be fed the same amount at the same time each day. Generally the dog is fed twice a day before she receives her insulin. Most diabetic dogs do best on a diet that is high in insoluble fiber, such as Hill's w/d or Purina DCO. You will need to eliminate treats according to your veterinarian's directions.

Insulin
There are several types of insulin used in the treatment of dogs with diabetes mellitus. The characteristics differ as to source, duration of action, concentration, and the frequency of administration. The most common insulin used in dogs is NPH (Humulin-N or Novolin-N).

Usually the first dose of insulin is given while the dog is in the hospital and the blood sugar is measured every 2-4 hours. The subsequent doses may be adjusted depending on the levels of blood sugar and the duration of the effect. It may take a few weeks to two months and multiple laboratory tests to find the most appropriate insulin dose for an individual dog.

Your veterinarian and staff will show you how to properly handle, measure, and give insulin to your dog. We also have an article on insulin administration.

Home monitoring
Diabetic dogs will need careful monitoring at home. If you are willing and able, your veterinarian may recommend that you monitor your dog's blood sugar level through the use of a glucose monitor. A small lancet is used to puncture the skin and obtain a small amount of blood that is drawn into the machine. A display then shows the glucose concentration in the sample. A second method of monitoring is through checking the urine for glucose and ketones using special dipsticks available for home use. Finally, you should take daily notice of your dog's eating, drinking and urinating habits. If these change after your dog has been regulated on insulin, it may indicate a need to more closely look at the insulin dosage. NEVER change the insulin dose based on any home monitoring unless specifically told to do so by your veterinarian.

Treatment of concurrent diseases
Dogs with concurrent diseases, especially hypothyroidism and Cushing's disease, may be very difficult to regulate on insulin unless these diseases are also treated.

Considerations in the management of diabetes in dogs: Before treatment is started, it is important that the owner be well-informed and have the time necessary to make the correct decision since regulating a diabetic dog requires commitment. Owners should know:

• It will take some time (weeks) and multiple laboratory tests to determine the best insulin dose for your dog.
• For dogs, insulin is almost always given twice a day, every day at specific times, probably for the life of the dog. Always follow your veterinarian's directions as to type, amount, and when to give the insulin.
• Insulin must be handled properly (refrigerated, not shaken, etc).
• There is a proper technique for administering insulin to a dog that must be followed.
• The type of insulin and insulin syringe that are used should not be changed unless under guidance by the veterinarian.
• The type and amount of food and when it is fed must be consistent.
• The type and amount of exercise must be consistent.
• The dog will need to be carefully monitored at home on a daily basis; when to seek veterinary advice and return for rechecks will depend on what signs the dog may be showing.
• Insulin requirements often change over time and the dose of insulin may need periodic adjustments based upon laboratory testing.
• Emergency conditions of low blood sugar (hypoglycemia) can be seen if too much insulin is given in relation to food intake. The owner must be aware of when this could occur, the signs of the condition, and how to manage it.
• A blood sugar level that is too high is better than one that is too low.
• Diseases or procedures the dog may have in the future (e.g., surgery, teeth cleaning) may need to be managed differently because of diabetes.

Hyperglycemia (high blood sugar) is always better than hypoglycemia (low blood sugar.

Hypoglycemia

You should carefully monitor your dog for signs of hypoglycemia. This is a condition in which the blood glucose level becomes too low. This most commonly occurs when the insulin dose is too high in relation to the food intake, or in cases of increased exercise. This can be a serious and even fatal condition, so you need to understand what signs to look for and what to do if you see them.

Causes of hypoglycemia: Most of the causes of hypoglycemia in diabetic dogs can be prevented or predicted. Hypoglycemia can result from:

• Administration of too much insulin. This can occur if the wrong insulin or wrong type of syringe is used, or a second dose of insulin is given due to miscommunication between family members or to try to make up for a first dose that was improperly given. Rarely, a dog may undergo spontaneous remission of their diabetes, i.e., he suddenly produced enough insulin on his own and does not need supplemental insulin. How or why this occurs is not well-understood, and it may be only a temporary phenomenon.
• Change in food intake. If insulin was administered but the dog did not eat her entire meal, the excess insulin in relation to the amount of glucose available to the body will cause the blood glucose to go too low. Similarly, if the meal is not given on time, or a different food was fed, hypoglycemia could occur.
• Increased exercise or calorie consumption. If the body is using more glucose for energy, it may pull too much glucose out of the bloodstream.
• Poor regulation. If the dog is poorly regulated or insulin changes are made too rapidly in the regulation process, low blood glucose can occur.
• Metabolism changes caused by other diseases. Infections, some medications, heat cycles and other hormonal diseases (or their treatment) can result in a change of the body's insulin requirements.

Signs of hypoglycemia: Dogs with hypoglycemia will act depressed and lethargic; may show weakness, muscle twitching, or incoordination; progress into a stupor or coma; and ultimately develop seizures and die. The earlier the signs are recognized, the easier and more successful the treatment.

Treatment of hypoglycemia: Home management of hypoglycemia depends upon recognizing the signs of hypoglycemia early. If the dog is able to eat, offer her her normal food. If she refuses to eat but can still swallow, have her lick some Karo? (corn) syrup. If she is unable to swallow, apply the corn syrup to her gums. Once she has responded, feed her a meal. Contact your veterinarian who can determine what other treatment or hospitalization may be necessary.

Further complications of diabetes in dogs
In addition to hypoglycemia, there are other diseases that become more common in dogs with diabetes.

Urinary tract infections: Because the urine is dilute and often contains sugar, bacterial infections of the urinary tract are more common in diabetic dogs. If you notice your dog has increased urination, is straining to urinate, is urinating only small amounts, or has discolored urine, contact your veterinarian.

Other infections: It appears that the immune systems of diabetic dogs may not function as well as those of a normal dog. As a result, they may be more susceptible to other infections.

Cataracts: Cataracts ultimately develop in up to 80% of dogs diagnosed with diabetes mellitus. These can be effectively treated through surgical removal.

Others: Although rare, dogs with diabetes may also develop increased blood pressure, uveitis (inflammation of the eye), kidney disease, and atherosclerosis (hardening of the arteries).

Summary
Dogs with diabetes are generally middle-aged females, and show signs of increased thirst, urination and appetite. Diagnosis is based on clinical signs and laboratory testing of blood and urine for glucose levels. Treatment consists of insulin and a consistent diet and exercise regimen. Hypoglycemia (low blood sugar) is a dangerous complication when treating diabetes and owners should know the signs and home treatment. Other diseases, especially hypothyroidism and Cushing's disease may complicate the treatment of diabetes. Urinary tract infections and cataracts are more common in diabetic dogs.

 Blood Glucose Curves in the Diagnosis & Regulation of Diabetes in Dogs

A blood glucose profile (or curve) is a graph of blood glucose levels over time. It is the most effective way to determine the type, dose, and frequency of administration of insulin, necessary to keep the blood glucose at acceptable levels. Each dog responds very differently to insulin, and so the appropriate insulin therapy must be determined for each individual dog. In addition, a dog's insulin needs may change dramatically over time, so blood glucose profiles may need to be performed periodically for the lifetime of the dog.

Blood glucose profiles are necessary because each dog reacts differently to the types of insulin, dosage, and intervals at which insulin is given. By performing a blood glucose profile, we can determine if an insulin was effective, when the peak effect occurred (i.e., when the glucose level was at its nadir (lowest point), how long the effect lasted, and the degree of fluctuation in the glucose level. Changes can then be made in the type of insulin, the dosage or the dosing intervals in order to maintain the blood glucose at the optimal level throughout a 24-hour period. In some cases, up to five or more blood glucose curves may need to be performed before a satisfactory regimen is determined. Because of the cost, abbreviated profiles (fewer samples) are sometimes used. In addition to the blood glucose profile, the response of the dog is noted. The amount the dog is eating, drinking, and urinating; activity level; and weight all help determine if the insulin regimen is effective.

How is a blood glucose profile performed?

To perform a blood glucose curve, a blood sample is taken to check the blood glucose level, the dog is fed and the insulin is administered. Additional blood samples are taken at regular intervals throughout the day to monitor the blood glucose level. It is recommended that a dog be on that specified insulin dose for 4-7 days before the glucose profile is performed to give her body time to equilibrate.

Diet and exercise greatly affect the dog's need for insulin. During the regulation process, it is important to feed the dog the same food, in the same amounts, at the same time, that it will be fed at home. The dog's activity level should also mirror what she will be doing at home. The timing of the administration of insulin should also be consistent with when the owner will be able to give the insulin at home.

How is the blood glucose measured?

The glucose level in the blood is determined through laboratory testing. This may occur in your veterinarian's office, or the sample may be sent to an outside laboratory. Since many blood samples must be taken, your veterinarian may use a hand-held glucometer. To use this device, several drops of the blood sample are placed on a chemically-impregnated paper strip. A chemical reaction occurs that changes the color of the strip depending upon the amount of glucose present. The wavelength of the color is read by placing the strip in the glucometer.

Why can't we just measure the amount of glucose in the urine?

Glucose will appear in the urine of dogs if the blood glucose level exceeds 180-220 mm/dL. A determination of blood glucose tells us what the blood glucose level is at that particular time. A urine glucose test does not tell us what is going on at the time the urine sample was obtained; it is an average of the glucose level in the urine which was formed since the dog last urinated - that could be 8 or more hours ago. Insulin dosages should NOT be changed based solely on urine glucose levels.

 Handling, Storing & Administering Insulin to Dogs

Insulin is available in concentrations of 40, 100, and 500 units/ml. There are corresponding syringes to use for the measurement of the three concentrations of insulin. If using insulin with 40 U/ml, you must measure and administer it with a U-40 syringe; using a U-100 or U-500 syringe would result in the wrong amount of insulin being given, with perhaps a fatal outcome. There may be several types of U-40 syringes available, manufactured to deliver low or high doses. The measurements marked off on those syringes designed for giving a low dose are often easier to read. Find out from your veterinarian (or pharmacist) what syringes are available for you to use with the concentration of insulin your dog is receiving.

How is insulin stored and handled?

Insulin comes in a glass vial with a rubber stopper, and must be stored in the refrigerator. Do not use the insulin beyond its expiration date.

How is a dose of insulin measured?

The concentration of insulin is measured in units. Insulin syringes are marked in units, and may also be marked in milliliters. Be sure to use the unit scale. Also, be sure you are using the appropriate insulin syringe for the concentration of insulin you are using.

An insulin syringe has 4 basic parts: the barrel, plunger, needle, and needle guard. Many brands of syringes have the needle permanently attached to the syringe barrel so it cannot be removed.

1. Prior to removing a dose of insulin from the vial, mix and warm the contents by gently rolling the vial between the palms of your hands. DO NOT SHAKE INSULIN as that will cause air bubbles to form, and it will be more difficult to get an accurate measurement. NOTE: We have used a pink solution instead of insulin to better illustrate the steps. 2. Hold the vial stopper-side-down, remove the needle guard from the insulin syringe, and insert the needle of the syringe into the vial through the rubber stopper. 3. Pull back on the plunger of the syringe to draw the insulin into the syringe once, then inject it back into the bottle. Redraw the proper dose back into the syringe. This is helpful in accurately dosing as insulin may stick to the inside of the plastic syringe or an air bubble may be present in the syringe. If any air enters the syringe, you can also expel that back into the vial by keeping the vial upside down, and the needle of the syringe pointing up. 4. Recheck that you have withdrawn the proper amount of insulin. 5. Remove the syringe from the vial and replace the needle guard. 6. Return the insulin to the refrigerator. 7. You are now ready to administer the insulin.

How is an insulin injection given?

To acquaint yourself with what giving an insulin injection may feel like, it is often recommended to practice by injecting water from an insulin syringe into an orange.

To be sure your dog gets his insulin, and does not receive extra doses (from other members of the family who may not know the insulin was given), record the time of each insulin injection on a designated calendar.

1. When giving your dog an insulin injection, you may, at first, want someone to help you hold and/or distract the dog while you are giving the injection. Scratching the dog on his head, getting his attention with a toy, or placing an enticing treat (very small piece of cooked chicken) near his nose may help focus his attention away from the injection. The needle is extremely thin, and the injection almost painless.

2. Remove the needle guard from the syringe filled with the appropriate dose of insulin.

3. If you are right-handed, hold the syringe in your right hand. With your left hand, pick up fold of skin along your dog's back or shoulders (use a different site every time). Some veterinarians recommend giving the injections under the skin on the sides of the chest and abdomen, since it may be better absorbed from these sites.

4. Push the needle through the skin at about a 45º angle. Be careful not to push the needle through the entire fold of skin and out the other side, or accidentally into your finger.

5. Pull back slightly on the syringe plunger to be sure the needle is not in a blood vessel (if it is, blood will enter the syringe as you pull back the plunger), and then administer the insulin by pushing the plunger with your thumb.

6. Withdraw the needle from the dog's skin, and replace the needle guard.

7. Reward your dog by scratching his head (if he likes it!), giving him the very small piece of cooked chicken, and talking to him. (Once you are more comfortable giving him injections and do not have to concentrate on what you are doing quite so hard, talk to him throughout the procedure.)

8. Record the time of the insulin injection on the designated calendar.

9. Place the needle and syringe in a puncture-resistant container. These are available, sometimes free of charge, from your veterinarian or pharmacist. Follow your local regulations regarding disposal.

If the dog does not receive the entire dose of insulin, (e.g., some leaked out of the injection site, the needle went through the entire fold of skin and the dose was injected into the air, etc.) do NOT, we repeat, do NOT give more insulin. Wait to give more insulin until the next scheduled dose. Occasional missed doses are easily tolerated, overdosage can be fatal.

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