Written by Richard Sandore, MD
Produced and edited by Well Beings - Senior Cat & Dog Products. © 2006 WellBeings.com
Reproduced with permission.

What is Diabetes?

Diabetes mellitus (DM) is the disorder of glucose metabolism that is usually referred to when someone uses the word diabetes. This is a separate disease from diabetes insipidus, a problem with the pituitary gland.

In DM, glucose (sugar) cannot be utilized by the body because of either a decrease in insulin production, or a decreased sensitivity of cells to insulin.

Glucose

Glucose is sugar, and it is the energy source of the cells in our bodies. Glucose is ingested directly when we eat something sweet. Carbohydrates are broken down into glucose by our bodies. Even fats and proteins are converted to glucose by the body. In short, glucose is the direct energy source necessary for the cells of our body to stay alive.

Insulin

Insulin is a hormone produced by beta cells in the pancreas, an organ located beneath the stomach. Insulin allows glucose to enter the cells so it can be used as a fuel. Think of insulin as a key to tiny doors on the surface of cells. Without the key, the doors stay closed and glucose cannot enter the cells. If glucose cannot enter, the cells die. If the key is present to open the door, glucose enters the cells and provides energy for all of their many functions.

The system is finely tuned to maintain the glucose level in a very narrow range. In a normal person, dog, or cat, eating causes an increase in glucose in the blood, which then causes an increase in insulin. The increase in insulin allows the glucose to enter the cells where it is either used or stored. A drop in the level of glucose in the blood signals the pancreas to stop releasing insulin. If the blood glucose drops too low another hormone, glucagon, is released which signal the cells to release some of the stored glucose.

Type I Diabetes

This form of diabetes results from the destruction of beta cells in the pancreas. Since there is no insulin produced, it has to be given in the form of injections. This is the most common form of diabetes in dogs and is frequently referred to as insulin dependent diabetes (IDDM).

Type II Diabetes

In this form of DM, insulin is still produced, but it is either not produced in a large enough amounts, or the cells are not as sensitive to it as they should be. It is frequently referred to as non-insulin dependent diabetes (NIDDM). If the cells are not sensitive enough, then even though insulin is present, glucose cannot enter. This type of diabetes is associated with obesity, and in many cases can be cured with weight loss and exercise. It sometimes can be treated with oral medications, but in most cases insulin is necessary. This form is uncommon in dogs, but seen in up to 40% of cats with diabetes.

How Common is Diabetes?

DM affects about one in every 400 to 500 cats and dogs. The majority of cats affected are over 6 years old, and 75% are between the ages of 8 and 13. In dogs, DM is commonly diagnosed between the ages of 7 and 9, and is usually IDDM. NIDDM is seen in about 40% of cats initially diagnosed with diabetes, but usually progresses to IDDM.

Risk Factors

Obesity is the major risk factor for DM in both cats and dogs. Cats do not appear to have a genetic predisposition, but Keeshond, Puli, Miniature Pinscher and Cairn Terrier are more prone. Medical conditions that are associated with the development of DM include viral infections, autoimmune diseases, pancreatitis, certain drugs and other endocrine diseases.

Signs of Diabetes


There are four classics signs of DM.

• Polydipsia: increased thirst.
  
  
• Polyuria: increased urination.
  
  
• Polyphagia: increased appetite.
  
  
• Weight loss, despite an increased appetite and food consumption.

• Sweet odor on the breath
  
  
• Poor grooming
  
  
• Recurrent urinary tract infections
  
  
• Cataracts (dogs)
  
  
• General lethargy or apathy
  
  
• Skin infections
  
  
• Sores or wounds that do not heal

Making the Diagnosis

Your holistic veterinarian will do a complete history and physical examine. The signs and symptoms are important in making the diagnosis, but the disease is confirmed by laboratory tests.

Blood Glucose

A normal blood glucose is 80 mg/dL to 120 mg/dL. It is normal for the blood glucose to rise above this range immediately after eating, if an animal is excited, or if it is stressed (called stress hyperglycemia), but it will drop to a normal range rapidly. In animals with DM it is not unusual to see a persistent blood glucose of 400mg/dL or greater.

Urine Glucose

Glucose will be present in the urine when the blood level is greater than 180 mg/dL to 220 mg/dL in dogs, and 260 mg/dL to 310 mg/dL in cats. Stress can elevate glucose to 400 mg/dL, but does not usually cause glucose to appear in the urine. Urine may also show the presence of ketones, which indicates the breakdown of fat for energy.

Treating Diabetes

The mainstay of treating DM is replacing the missing insulin. While replacing insulin is critical, there are many things you can do to decrease the amount of insulin required, or sometimes eliminate its need altogether. DM is a disorder where the holistic approach is extremely important because the management of all facets of your companion's life is important for keeping glucose levels in control and achieving the highest quality of life possible.

Insulin

Insulin must be given by injection underneath the skin, and this form of administration is called subcutaneous. Insulin is derived from cow or pig pancreas and usually referred to as beef or pork insulin. Human recombinant insulin is also available, but not often used in cats and dogs.

Additionally, insulin comes in preparations that have different ranges of activity. The effects of Regular insulin begin within 30 minutes of injection, reach a peak in 1 to 3 hours, and last 6 to 8 hours. NPH insulin is considered long-acting. Its onset of activity is 2 hours after injection, peak effect in 4 to 12 hours, and duration is 18 to 26 hours. Lente insulin is intermediate in its activity with an onset 2 to 4 hours after injection, maximum effect at 6-12 hours, and duration of activity 18 to 26 hours.

Insulin is generally given as a mixture of Regular and NPH, either once or twice a day, usually before meals. Your holistic veterinarian will tailor the regimen and doses specifically for your companion.

Prevention

Unlike diabetes, which can be prevented in most cases with proper nutrition, diet and exercise, there are no clearcut measures to reduce the risk of other endocrine conditions. However, proper diet and nutrition and the use of natural rather than synthetic supplements and preservatives will boost the immune system and keep the body in the best health possible.

Glucose Curve

If your dog or cat requires insulin they may need to be hospitalized in order to begin insulin and achieve regulation. Blood glucose will be tested frequently and the response to insulin and feeding determined. This information is plotted on a graph so you can see how meals and insulin are affecting their glucose level.

Oral Medications

Two oral medications, glyburide and glypizide are sometimes used to treat NIDDM. The body must be producing some insulin for them to be effective.

Diet

In addition to a controlled calorie diet, one high in fiber and protein and containing complex carbohydrates and no simple sugars is important. (Complex carbohydrates take longer to breakdown and be absorbed than sugar so less of an increase in glucose occurs.) Dry food should be avoided.

Many owners prefer feeding their companions a raw or home cooked diet. This is an excellent option for animals with DM since the levels of fiber, protein, carbohydrates and sugar can easily be controlled.

Treats must also be high protein, low carbohydrate and no sugar.

Exercise

Regular exercise is important for the general well-being of your companion and if weight loss is necessary. A consistent, daily exercise routine is necessary to help your companion maintain their glucose in the correct range and avoid hyper- or hypoglycemia.

Weight Loss

Obesity is the number one cause of diabetes in older cats and dogs, and it is the easiest to treat and prevent. Weight loss and exercise programs, especially for older animals, should always be supervised by your holistic veterinarian, and include appropriate supplements. A gradual weight loss is usually necessary, however, once your companion returns to an ideal body weight and begins getting a moderate amount of daily exercise, the need for insulin is usually reduced dramatically, and sometimes eliminated.

Prevention

The cornerstone to the prevention of DM is proper diet and nutrition, including supplements. Diets should contain the correct amount of protein, fat, and carbohydrates, little, if any, simple sugar, and the correct number of calories. Just like for us, too many calories leads to weight gain, and an overweight condition predisposes to many medical problems, including DM. Maintaining an ideal body weight results from proper nutrition and daily exercise.

Dietary Supplements

Dietary supplements are necessary so our companions receive all of the nutrients they require. Some supplements are beneficial in managing and preventing diabetes. Vitamin E can decrease the amount of insulin needed. Pancreatic enzymes and glandulars assist the pancreas in its functions, and can reduce the amount of insulin needed. Liquid chlorophyll and lecithin can assist the body in balancing glucose levels. Chromium is a mineral supplement that improves the effectiveness of insulin. Probiotics assist the body in utilizing all of the nutrients in food.

Herb and Homeopathics

Many herbs and homeopathic remedies are available to assist in the treatment and prevention of DM, and are resources many owners overlook.

Herbs

Herbs useful in the treatment and prevention of DM include: Stevia, Holy Basil Leaf and Olive Leaf extract. Yarrow has a chemical composition similar to insulin, and Alfalfa, besides being a superb nutrient and detoxifier, helps balance glucose levels.

Bilberry can reduce glucose levels in Type II diabetes, and Galega Officinalis appears to stimulate the growth of the insulin producing cells in the pancreas.

Other herbs that have been found useful in cats and dogs with DM are Dill Seed, Horsetail Grass, Dandelion, Parsley, Buchu, and the Chinese herb Polygonum Multiflorum. All You Ever Wanted to Know About Herbs for Pets, by Gregory Tilford and Mary Wulff Tilford is an excellent resource for treating disease with herbs.

Homeopathic Remedies

Many homeopathic resources market combination remedies to treat and prevent DM. Some individual remedies are Syzygium, Uran Nit, Iris Vers, and Natrum Muriaticum.

Though the vast majority of supplements, herbs, and homeopathic remedies are extremely safe and effective, it is still necessary to consult your holistic veterinarian before beginning any treatment. Diabetes is a serious disease that is life threatening. It can be complicated to treat in humans and requires constant vigilance. Since animals cannot communicate how they feel at any given moment it is imperative to work closely with your holistic veterinarian on any treatment course.

Consistency

A stable environment and routine are important in managing DM. As we have seen, the body is an incredible, finely tuned mechanism with many systems to keep it in balance. When these systems, like the pancreatic beta cells, are not functioning it relies on us to maintain a stable environment so it can stay balanced. A consistent diet and insulin dose, exercise, supplements, and stable home environment are all necessary to keep the blood glucose level in an appropriate range.

Emergencies

There are two true diabetic emergencies, hyperglycemia and hypoglycemia.

Hyperglycemia

Hyperglycemia occurs when the blood glucose is too high. Minor elevations are treated with an increased dose of insulin. When the glucose is extremely high a condition called ketoacidosis can develop and needs to be treated immediately.

Hypoglycemia

Hypoglycemia occurs when the blood glucose is too low. This can result from your companion not eating a full meal, more exercise or activity than usually, or even accidentally receiving too large a dose of insulin.

Signs of hypoglycemia include:

• Glazed eyes
  
  
• Lack of energy and weakness
  
  
• Restlessness and disorientation
  
  
• Uncoordinated movements or wobbling when walking
  
  
• Shivering, convulsion, seizures, or coma (severe disease)
  
  
• Drooling or coughing
  
  
• Getting stuck while walking through doorways or narrow spaces

The treatment of hypoglycemia is to supply glucose in the form of sugar. Many people use corn syrup (marketed under the name Karo syrup in the US). Drops can be given on the tongue, or rubbed on the gums. Pharmacies sell glucose packets for this purpose and many owners are creative in finding easily accessible supplies of glucose. For example, small tubes of cake icing are easy to carry and almost 100% sugar. As soon as a form of sugar is administered you will still want to seek immediate emergency veterinary assistance to be sure your pet is stable. Most times they will want to monitor your pet overnight as well as provide subcutaneous fluids. A follow-up visit with your regular veterinarian as soon as possible is also important. He/she knows your animal's history and will be more knowledgeable about your pets' particular situation.

The response of hypoglycemia to glucose is usually very rapid. It is important, however, to look for the cause of the hypoglycemia and correct it. Additionally, always know where the glucose is at home, and always carry glucose with you when you leave home with your companion.

Complications

The complications of DM are severe and many times can be avoided with early recognition and treatment.

Cataracts

Cataracts are one of the most common complications of DM in dogs, and frequently the presenting sign that leads to the veterinarian visit and the diagnosis of the underlying disease. Once cataracts have formed, they cannot be reversed, but can be treated surgically.

Kidney Damage

In humans atherosclerosis (damage to blood vessels) is a common complication of DM. Animals are not as prone to this disorder, but DM can lead to severe damage to the kidneys and other internal organs.

Ketoacidosis

This is a serious, life-threatening complication that requires immediate treatment. Ketoacidosis results when there is little or no insulin available to allow the cells to metabolize glucose. Glucose levels get very high, sometimes greater than 800 mg/dL. Even with all of the glucose around, the cells are not getting energy and begin breaking down stored fat to survive. This leads to a build up of metabolic products that the body cannot eliminate and makes the blood more acid than it should be. Additionally, the kidneys attempt to excrete the glucose and produce a great deal of urine, which leads to dehydration. This true emergency must be treated in a hospital.

Somogyi Effect

In some instances, glucose can drop after insulin treatment, then rebound to a very high level. This rebound is the result of an interplay of various hormones, including insulin and glucagon. It is necessary for your holistic veterinarian to evaluate large variations in glucose levels. The treatment of the Somogyi effect is a decreased insulin dose.

Living with Diabetes

Our companion animals, just like us, can lead long, healthy, and active lives with DM. This requires a commitment on our part to provide the necessary care and support. Some simple tips include:

• A tag indicating your pet is diabetic
  
  
• An emergency hypoglycemia kit (some owners keep a small supply of glucose attached to their companion's collar or harness)
  
  
• A plan for emergencies
  
  
• A holistic veterinarian who is experienced with diabetes and willing to tailor a treatment plan, including the use of herbs and homeopathic remedies for your companion
  
  
• Keep a spare bottle of insulin handy
  
  
• Double check the dose before you give insulin
  
  
• Never leave home without sugar
  
  
• Maintain a regular, consistent daily routine
  
  
• Keep a notebook or daily journal
  
  
• Test glucose levels frequently as instructed by your veterinarian

Education

While DM is a complex disorder, it becomes manageable as you begin educating yourself about its causes and treatments. There are many wonderful resources available and an Internet site with a great deal of information is www.petdiabetes.org.

The Commitment

Making a commitment to care for a companion with DM is sometimes a difficult decision. The rewards you receive are increased exponentially as you learn that you can understand concepts and perform actions you never imagined you could, and you assisted your trusted companion to continue living a healthy and active life despite the shadow of a potentially debilitating disorder.

Richard Sandore is a medical writer who has practiced allopathic and alternative medicine. He can be reached at richard(at)richardsandore(dot)com.