Diabetic stabilization in dogs

Diabetes is a relatively common disease in people and is being recognized more frequently in pets. If untreated, the disease has serious effects and will ultimately result in the death of your pet. The good news is that most diabetic animals can be successfully treated and many live normal, happy lives. However, caring for a diabetic pet takes a good deal of time and effort to make sure their disease is well controlled, and poorly controlled disease can lead to a variety of complications for your pet.

©Jane Dobson

If diabetes is not well managed your dog will continue to show signs of disease and they are at a high risk of developing medical conditions. In a well-controlled diabetic dog, there is a slow increase in blood sugar levels after eating and blood sugar is neither too high nor too low at all times of the day. If animals are well-controlled the signs of diabetes, such as excessive eating and drinking, should resolve. Keeping blood sugar levels well-controlled is important to avoid complications such as cataracts in the eye and more severe potential problems like ketosis, excessively low blood sugar levels and infections. This gives your pet the best possible outcome and chance to live a normal lifespan.

Difficulty controlling diabetes usually boils down to either:

Problems with insulin

This can be due to problems with the way you are giving insulin, timing of injections or dose of insulin used; or poor handling, incorrect storage of insulin so that the insulin does not work properly. If your dog’s diabetes is not well controlled on their current regime your veterinarian may want to consider changing the dose of insulin or the timing of injections.

Always make sure that insulin injections are given at the same time each day and that timing, of injections is coordinated with a regular feeding regime. If you are having trouble with the injection, ask your veterinarian to show you again how to give it properly and to check your technique. Your veterinarian will probably also check that you are keeping the insulin stored in the fridge and that it is not out of date.

Problems with the body’s response to insulin

The term ‘insulin resistance’ is used when a patient fails to respond properly to an adequate dose of insulin. This can be due to an ongoing problem such as obesity, because obese animals respond less well to insulin than do thinner ones. However, infections, eg urinary tract infections, and some drugs, can also cause insulin resistance which may develop suddenly and then resolve if the drug is stopped or the inflammation settles down. This means that insulin requirements can change over time, so it is very important to keep monitoring how well your pet is controlled on a regular basis. Some hormones, eg progestagens, have a big impact on the action of insulin which is why female diabetic dogs should be neutered to avoid changes in insulin requirement every time they come into season or if they get pregnant.

Most dogs with unstable diabetes have periods when their blood sugar is too high. This means that the signs they initially had, such as excessive eating and drinking, are likely to return. Although more serious problems are rare, dogs with very high blood sugar levels can become quite unwell with vomiting and depression and can fall into a coma. Over the longer-term other effects may be noticed such as development of cataracts (cloudiness of the eyes) or even blindness. If you are taking regular urine or blood samples, you will start to notice sugars appearing in the urine or that blood sugar levels are always high.

Some dogs with unstable disease have times when their blood sugar drops very low. In these periods they may become wobbly and confused and, if levels continue to drop, dogs can start to have fits (seizures), fall into a coma and even die if not treated. This is sometimes called a ‘hypo’ attack. If you are monitoring blood samples at the time of the episode you would see that blood sugar is low and immediate treatment with some form of sugary snack can be given. However, urine samples can be misleading as sometimes dogs that are unstable have times when their blood sugar is very high and then very low in the same day. Since the urine can remain in the bladder for a long time the urine sampled at the time of a ‘hypo’ attack may have been made much earlier in the day when blood sugar was high. It is possible to have sugar in the urine of a dog that is collapsing due to low blood sugar.

If you have a diabetic dog, it’s very important to ask your veterinarian for advice if your pet is unwell in any way.

Dogs with diabetes have problems regulating their blood sugar level. When they eat blood sugar rises but they fail to bring this down to normal levels. These persistent high blood sugar levels start to cause problems throughout the body. Most diabetic dogs are treated with the use of insulin injections which help reduce blood sugar levels. There are many factors that may affect how well this insulin may work in diabetic dogs and many of these can be controlled at home.

Diet

Dietary control is used to improve body condition and flattens the rise in blood sugar levels after eating. Increased dietary fiber may slow stomach emptying and delay the absorption of nutrients which helps reduce the increases in blood sugar. Ideally a feeding schedule is used which results in nutrients being absorbed from the intestine near the time of peak insulin action; however, this may be difficult to achieve consistently as insulin effects vary from day to day. If a dog is willing to eat throughout the day (rather than eating an entire meal rapidly) this may work well. Other methods of spreading out their food intake may include feeding an afternoon “snack” of dog food, if blood glucose concentration tends to fall during the day or using timed feeders either during the day or overnight.

Obesity

Obesity reduces the ability of the body tissues to take up and use sugars from the blood. It is more difficult to control blood sugar in obese diabetic dogs and weight loss is encouraged to improve their response to insulin. Weight reduction must be slow and steady until the desired weight is achieved. High fiber diets can help with the management of obese patients as the fiber also helps to control glucose levels and the extra bulk of the diet helps make your pet feel full after eating. As obese dogs start to lose weight, they require careful monitoring as the dose of insulin they need often reduces as they get slimmer.

Poor body condition

Some diabetic dogs are thin at the time of diagnosis. Your veterinarian will want to do some tests to make sure there is no other condition that is causing weight loss in your pet. In most cases diabetic dogs are thin because they have not been able to take up the calories from their diet without the insulin injections. In these cases, the dog will need to be fed a special diet that will allow weight gain, whilst taking into account the need for a complex carbohydrate and fat content dictated by their diabetes.

Exercise

Exercise is important for all dogs, but it makes insulin work better and additionally promotes weight loss. In diabetic dogs it is important that exercise is consistent from day to day to minimize its effects on blood sugar levels. When an animal exercises their muscles use up sugars from the blood and blood glucose levels drop, so exercise should be avoided at the times of peak insulin activity. Strenuous exercise can potentially result in clinically significant low blood sugar in diabetic patients on treatment.

Oral hypoglycemic agents

Some diabetic people with so called Type 2 diabetes, can manage their blood sugar levels without the use of insulin injections. A number of tablets are available that can help reduce blood glucose levels when combined with an appropriate diet and exercise management. Dogs do not get non-insulin dependent diabetes mellitus (Type 2) and most need insulin injections at the time of diagnosis. Therefore, most of these tablets have no role in the management of diabetic dogs. Some tablets have been tried alongside insulin treatment in dogs, with variable success, and most of the drugs have potential side-effects so their benefits may be outweighed by the risks in dogs.

If your pet’s diabetes is poorly controlled your veterinarian will want to examine them and talk to you about what has been happening at home to try to understand if there could be any health problems or if there is some problem with the insulin administration. Further blood tests and X-rays or ultrasound may be needed for a complete health check.

If your pet is diabetic, you will be familiar with checking urine samples for the presence of sugar and you or your veterinarian will regularly monitor blood sugar levels also. If your pet’s diabetes appears to be unstable your veterinarian may want to take them into the hospital for some more detailed monitoring which involves taking multiple blood samples 1-2 hours apart to see what is happening throughout the day. Alternatively, they may ask you to take more frequent samples at home. Home monitoring has been simplified recently through the use of continuous blood glucose monitoring systems which avoid the need to obtain multiple blood samples. Ask your veterinarian about this option.

With careful monitoring it is possible to identify an unstable diabetic before serious consequences arise. With rapid treatment of the problem, it should be possible to get your pet back on an even keel and hopefully avoid the long-term complications that can go along with unstable disease.