Diabetes in Dogs

Any breed of dogs can be affected, but small breed dogs (for example Schnauzer, Bichon Frise, Cairn Terriers) are more at risk.

Middle aged pets are commonly affected.

Obesity and inactivity cause insulin resistance; it is important to keep your dog in good shape and provide plenty of exercise.

• Increased thirst
• Frequent urination
• Weight loss
• Cataract formation
• Frequent, difficult to control infections
• Weakness
• In uncontrolled severe cases vomiting, collapse, seizures and coma

• We will always begin with a thorough discussion of the onset and nature of the problem
• Clinical examination often reveals weight loss, cataract formation and other signs of complications associated with high blood glucose
• Blood tests showing a high blood glucose level (as the glucose is not able to move into the cells as normal). Blood tests are also used to eliminate other diseases
• Urine test showing a high urine glucose level, sometimes showing signs of urine infection
• Abdominal imaging (usually an ultrasound scan) can also be performed to eliminate other diseases that complicate the control of blood sugar levels (and therefore complicate diabetes control).

The goal of treatment is to eliminate the clinical signs and to prevent complications associated with high blood glucose levels.

Insulin injections

Unfortunately, Insulin cannot be given by tablet and must be given by injection under the skin. This is the main method of diabetes therapy.
Injections need to be given twice daily at home; we can teach you how to do this so that you feel comfortable.

Diet stabilisation

Blood glucose is derived from intake of food. The diet must therefore be stabilised to assist with control of diabetes.

Ideally a high fibre low sugar diet (e.g. Royal Canin Diabetic food or Hills w/d) should be introduced. However, the most important thing is that your pet must eat any food given to provide the glucose for the insulin to work.

A good meal twice daily is needed to provide a stable platform for the insulin injections to work from.

Exercise standardisation

• Exercise lowers the level of glucose in the body and reduces your pet’s insulin requirement.
• Dogs need regular walks, of similar duration each day to reduce fluctuations in insulin requirements.
• Intensive sporadic exercise is not recommended as this can induce a hypoglycaemic episode (see later).

Weight management

Obesity causes significant problems in controlling diabetes through insulin resistance. A good body condition is crucial to success in tackling this disease.

This will be achieved through a combination of regular exercise and dietary management.

Treatment of any other diseases

Infections and other diseases cause insulin resistance and fluctuating insulin requirements, making diabetes very difficult to stabilise. Such conditions include dental disease, Cushing’s disease, pancreatitis and urinary tract infections. These need to be identified and treated before adequate control can be achieved.

Treatment of diabetes can be a daunting prospect at first, but don’t worry we are here to help you.

Every dog has a different requirement for insulin, so it will take a while to stabilise the diabetes fully, but once stable you should see good improvement in the clinical signs and return to a good quality of life.

We start insulin dosing conservatively to avoid overdose and will need to perform a blood test within the first month of starting on the insulin to determine how effective this dose is.

From there adjustments to the dose can be made to optimise blood glucose control.

Various tests can be performed to assess progress:

Blood tests

• A protein called Fructosamine binds glucose in the blood and measurement of this protein provides a good indication of long-term blood glucose levels
• A “glucose curve” can be performed. This consists of a series of small blood tests once every hour between insulin injections to assess the blood glucose levels.

Urine tests

• Measuring the level of glucose and ketones in the urine can be very helpful to assess blood glucose control.
• Glucose in the urine predisposes to bacterial infections, so urine culture tests are important to ensure these are kept at bay

These tests are performed frequently until the disease is stabilised, then the frequency of testing can be reduced for ongoing management.

We shall demonstrate to you the correct technique during a consultation.

There are 7 steps:

• Holding the bottle upside-down, insert the needle into the bottle through the rubber cap
• Pull back on the syringe, you will see the liquid come into the syringe
• Initially draw up more than you need, then allow the liquid to settle. Carefully tap the syringe with your finger to disperse any bubbles, then return the plunger to the correct dose.
• Pull the skin of the scruff of the neck upwards away from the body. This will form a tent of skin with a depression towards the back
• Insert the needle at right angles to the skin tent in the depression.
• First, draw back on the syringe – if blood appears (rare) start again with a fresh syringe
• If all clear, slowly depress the plunger to inject the fluid

Insulin hormone is fragile, so has specific requirements for correct use:

• Insulin must be kept in the fridge, but must not ever freeze
• Insulin must be stored upright (so it cannot react with the rubber cap)
• The bottle should be gently mixed by rolling before use, do not shake the bottle.
• Do not use a bottle for longer than 28 days

Cataracts are a very common complication of diabetes, forming to varied degrees in up to 80% of patients.

Better control of long term blood glucose levels will reduce the likelihood and severity of cataract formation. If severe an operation can be performed to correct this problem, but most commonly pets are still able to cope very well with reduced vision and this is rarely needed.

Other long-term complications can be seen such as kidney and neurological impairment. If you suspect any problems, please let us know.

Uncontrolled or poorly controlled diabetes increases the risk if your pet needs to undergo an anaesthetic as blood glucose levels are altered by sedatives. If surgery is needed, we shall monitor this very closely and can give intravenous glucose supplements to help prevent problems.

One potential complication of insulin therapy that you should be prepared for is when blood glucose levels fall too low, known as hypoglycaemia. This is dangerous as the brain needs glucose to function.

Signs of hypoglycaemia include:

• Lethargy
• Weakness
• Shivering and muscle twitching
• Fits
• Unconsciousness
• Progressing to life threatening coma if not treated promptly

If you see signs of hypoglycaemia

• Provide food immediately.
• If they don’t eat straight away, give a glucose solution into the mouth or rub glucose powder onto the gums and under the tongue (taking care not to get bitten). These solutions and powders are available from the pharmacy.
• Call us on 0208 337 2214 for advice as soon as possible.

Ketoacidosis (or ketosis) is a state where the body detects that the glucose levels in the body's cells are falling too low and instigates hormonal mechanisms to alter this state.

The body starts to break down fats to release energy and as a by-product produces ketones. Ketones cause blood acidosis, dehydration and electrolyte disturbances that quickly become life threatening.

Signs include:

• Lethargy and weakness
• Fast breathing, eventually progressing to slow deep laboured breathing
• Vomiting
• Abdominal pain

If you notice any of these signs, or if your diabetic pet is at all unwell, then please call us on 0208 337 2214 as soon as possible.

Ketosis is very serious and rapid treatment is needed. We have emergency out of hours vets available any time of the day.