CANINE DIABETES MELLITUS AND ITS MANAGEMENT

Dr.Sourabh KantDr.Sourabh Kant Veterinary college, Veterinary college, Palampur,H.P., india Palampur,H.P., india

Higher risk Moderate risk Neutral risk Low risk

•Cairn Terrier•Samoyed

•Bichon Frise•Border Collie•Border Terrier

•Collie•Dachshund•English Setter•Poodle•Yorkshire Terrier

• King Charles Spaniel•Cocker Spaniel•Doberman

• Russell Terrier•Labrador Retriever•Mixed Breed•Rottweiler

• Boxer•English Springer Spaniel

•German Shepherd•Golden Retriever•Bull Terrier•Weimaraner• Springer Spaniel

Pathogenesis

Destruction of beta cells of pancreas

Deficiency of insulin in the body

Without insulin, glucose unable to enter into the cell

Prevent the muscles and organs from converting glucose to energy

Excessive amounts of glucose in the blood [hyperglycemia]

Disorder of carbohydrate, protein, and fat metabolism caused by an absolute or relative insulin deficiency

Appropriate insulin function will trigger the liver and muscles to take up glucose from the blood cells and converting it to energy

Glucose is not making it to the brain due to deficiency of insulin

Insulin is not giving the muscles and organs the signal to convert glucose to energy

Excess glucose in the blood will be carried to the urine instead of being used for energy

Cause concurrent lack of energy.

There is also increased thirst as a result of the increase in urine.

Main organ affected are liver, eyes , kidneys  At higher risk are obese dogs and female dogs. While

many cases of diabetes are seen in older dogs, it can occur at any age.

Disease complicationsKetones – ketoacidosis A dangerous and often quickly fatal condition

Ketones are produced by the liver as part of fat metabolism

  When glucose is not available as an energy source because of untreated or poorly treated diabetes

Body start to use fat for energy Fat metabolism produce more ketone production

For diagnosis purpuse,fresh sample required. Ketones evaporate quickly, so there is a chance of getting a false negative test result if testing older urine

2.Dehydration

Body fluid loss is measured in two major ways–sensible and insensible.

Sensible is measured as vomiting, urination and defecation

Ability to be measured.

An insensible loss e.g. is breathing because while there are some fluid losses ,not possible to measure the amount of them.

Pet's gums and skin can indicate dehydration

Gums are tacky and dry and skin does not snap back quickly when pinched if dehydration is present.

When the skin at the back is lifted, a dehydrated animal's does not fall back into place quickly

Serious dehydration (loss of 10–12% of body fluids)

Symptoms

Excessive thirst

Excessive urination

Hunger

Weight loss even with normal appetite

Later signs.Anorexia

Lethargy and depression

Vomition Cataract

Other sign…..

Obesity

Enlarged liver

Liver and Kidney infection

Cataract

mg/dl Blood Glucose Guidelines

<50Readings at or below this level are considered hypoglycemic  when using insulin,even without visible hypoglycemia symptoms. Immediate treatment is needed

62-108 Normal glucose values range for dogs who do not have diabetes

90 Minimum safe value for the lowest target blood sugar of the day when insulin-controlled

100-180 Target range for diabetics

180Renal threshold for dogs when excess glucose in the blood spills into the urine.The kidneys are unable to reabsorb it all ,diabetic symptoms appear

Mg/dl Blood Glucose Guideline

250

Maximum safe value for the highest blood sugar of the day.

Dogs can form cataracts at this level and need to be checked for ketones using urine strips

Higher blood glucose levels indicate a lack of sufficient insulin.

300

Ketone monitoring is needed at this level

High blood glucose values increase the risk of the body

switching to using ketones for energy

>360

Ketones need frequent monitoring due to the increasing insulin deficit illustrated by high glucose readings

As blood glucose values increase, so does the possibility for ketone production

Both short and long-term ill effects are possible-see hyperglycemia

DIAGNOSIS Age of the animal and symptom

Urine should be analysed for glycosuria by benedict’s test

Fasting blood glucose 150mg/dl and above are diagnostic importance

Ketonuria

Elevated level of cholesterol

Low level of alanine amino transferase[ALT]

Treatment

Inj. Insulin -@ 0.5-1 U /kg body weight

If showing 1-2% glycosuria require extra dose 0.5 -1 unit insulin

If no glycosuria require 1 unit less insulin

Inj. Insulin given at the interval of 12 hours and after 10-15 min. 25% of the daily food given 

The effectiveness of the insulin dose at controlling blood glucose needs to be evaluated This is done by a series of blood glucose tests called a curve.

Blood samples are taken and tested at intervals of one to two hours over a 12- or 24-hour period

The results are generally transferred into graph form for easier interpretation. They are compared against the feeding and insulin injection times for judgment

ManagementEarly diagnosis and interventive treatment can mean reduced incidence of complications such as cataracts and neuropathy

Since dogs are insulin dependent, oral drugs are not effective for them

Most of the commercially available prescription diabetes foods are high in fiber, in complex carbohydrate

Feed the dog on body weight basis and energy requirement

Small dog requirement is 75 kcal/kg body wt.

Large dog 55 kcal/kg body weight

Regular exercise reduce the dose requirement of insulin

The use of an inexpensive glucometer and blood glucose testing at home can help avoid dangerous insulin overdoses

Treatment complications

Hypoglycemia, or low blood glucose, can happen even with care, since insulin requirements can change without warning.

Some common reasons for hypoglycemia include increased or unplanned exercise, illness, or medication interactions, where another medication potentiates the effects of the insulin.

Vomiting and diarrhea episodes can bring on a hypoglycemia reaction, due to dehydration

Simply a case of too much insulin and not enough properly digested food 

Symptoms of hypoglycemia need to be taken seriously

Since serious hypoglycemia can be fatal, it is better to treat a suspected incident than to fail to respond quickly to the signs of actual hypoglycemia

Symptoms

Depression or lethargy

Confusion or dizziness

Trembling

Weakness

Ataxia (loss of coordination or balance)

Loss of excretory or bladder control (sudden house accident)

Vomiting, and then loss of consciousness and possible seizure

Treatment

Food should be offered at the first signs of possible hypoglycemia

If the animal refuses it, a sugar solution (corn syrup  honey pancake syrup etc.) should be poured on the finger and rubbed on its gums or under the tongue (sublingually)

The solution must be applied this way to prevent possible aspiration of it

As per vet suggestion, one tablespoon of a sugar solution rubbed onto the gums, regardless of the size of the dog.

Contd….

Hypoglycemia formula is 1 gram of glucose for every kilogram (2.2 lb) of the animal's body weight

Sugar acts quickly, a response should be seen within a minute

Honey, syrup, or sugar, as simple carbohydrates act rapidly and will make the blood glucose rise, but the rise will not last very long, as they are broken down quickly by the body

Feeding something containing complex carbohydrates

Contd…..When the pet is able to eat will make sure another hypoglycemia event does not overtake the rapid rise in blood glucose levels from the sugar solution.

Complex carbohydrates take longer to be broken down by the body, so they do not raise blood glucose levels until some time after being eaten.

 A small meal should be fed and the animal taken for medical evaluation to determine if further treatment is needed.

Case no.

Ca/902

Owner name

Vivek Sharma

Address Alampur

species Canine

Age 8 year

Sex Male

Reduced appetite since one month

Drinks more water

Urination is more than normal

Vaccination and dewarming done

Already treated at local dispensory, but no improvement seen

As per owner,patient not able to see properly and strike here and there

Whitish color also appear in the eye ball

Loose feces also observed

Clinical parametre

Body wt. 36 kg

Rectal tem. 103.2ºF

Heart rate 94/min

Respiration rate 20/min

Conjunctiva mucus mem. Light pink

Dehydration status ++

Nose[Muzzle] Dry

Blood profile Value Biochemical profile

Value

Hb 9.2 g% ALT 730 U/L

PCV 36% AST 550 U/L

TLC (x 103 / µl) 11.95 Bilirubin 0.9 mg%

DLC Lymphocyte 15% BUN 18 mg%

Neutrophil 84% Creatinine 1.7 mg%

Eosinophil 1% Glucose 47 mg%

Monocyte Nil

Treatment on 3/1/2014

Inj. Ringer Lactate 500ml i/v Inj. Polybion 2ml i/v Inj. Ondopil 4ml i/m Inj. Sulbactomax 750mg i/m Inj. Insulin 30 I.U. /o.6 ml s/c Adv… Inj. Sulbactomax 750mg i/m # 2days

Rx on 6/1/2014 H/O - acc. To owner , patient showing improvement

Inj. Insulin 0.6 ml s/c b.i.d. #3 daysTab. Rabdoc-D 1 tab p.o.b.d. # 3dyasTab. VM-365 1 tab p.o.b.d. #2monthAdv… Bring the Patient fasted after 3 days

15/1/14H/O – animal showing improvement in Polydyspia and polyurea. slightly improvement in feeding habit

Rx… Inj. Insulin 0.9 ml s/c [11:00 am] Inj. Belamyl 2.5 ml i/m

Adv…. Inj. Insulin 0.7ml s/c b.i.d. # 2 week Tab. Hepa- 20 1.5 tab p.o.o.d. # 7 days

Biochemical profile…..

ALT -81U/L Blood Glucose -310 mg % [11:00 am] Blood Glucose -170mg % [1:00pm] Blood Glucose - 84mg % [3:00pm]

Patient normal till 4:30 pm

22/2/14 H/O- Marked improvement in overall health status.feeding habit increased..

Rx- Inj. Insulin 0.7 ml s/c

Adv.. Inj. Insulin 0.6 ml s/c #3 weeks Bring the patient after 3 weeks ALT 75 U/L Blood Glucose 62 mg

20/3/14 Rx.. Inj. Insulin 0.6 ml s/c Blood Profile….

Hb - 10.4 g% PCV - 38 % ALT - 65U/L AST - 25U/L Blood Glucose 550mg% [11:00am] Blood Glucose 350mg % [2:10 pm]

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