Diabetes

Short of sounding like Wilfred Brimley, everyone's favorite diabetes spokesperson, I'm going to talk about diabetes and two extremes that I saw this week.

So to start off, there are two forms of diabetes in animals: diabetes inspidus and diabetes mellitus. Diabetes inspidus is rare and is caused by the kidneys not responding to a hormone and so water is not concentrated thus the animal pees a lot. Diabetes mellitus is sugar diabetes where the body can not maintain normal blood sugar control. Animals drink and pee a lot because of the change in the osmotic gradient of urine (or something like that). This is the form we'll talk about.

So anyway, in diabetes (from here on diabetes refers to diabetes mellitus only) there is a lack of insulin which is what helps control blood sugar. Blood sugar spikes after eating and then insulin is released to average it out. Insulin is made in some very specific cells in the pancreas which is this funny little organ that lays near the stomach and small intestine. For a variety of reasons, these cells stop producing insulin and animals become diabetic. These days we see diabetes more and more commonly for the same reason it's on the rise in humans-obesity.

Clinical signs of diabetes include drinking and urinating excessively (PU/PD), weight and muscle loss, poor hair coat, lethargy, and urinary tract infections. With these clinical signs some blood and urine tests will be performed. I like looking at organ function to rule out other causes, blood sugar and to see if there is sugar in the urine. A single blood sugar alone won't tell you if an animal is diabetic. Animals can increase their blood sugar in times of stress and so may look diabetic but may not have sugar in their urine.

Treatment consists if weight loss, diet change and most often insulin. Once on insulin. Monitoring must be done to check sugar levels and insulin doses. We use fructosamine levels in our office which looks at the average blood sugar over the past month. Fasting blood glucoses and glucose curves can be used as well. Insulin is fairly cheap in the grand scheme of things but the testing can be more expensive. Diabetes is a commitment and lifestyle change. This can not be reiterated to the client enough. Animals can live good lives with good control.

So now for the cases...

I was finishing appointments the other night when I was alerted that a diabetic dog that we hadn't seen since October of 2012 was lethargic at home. The owners wanted to bring the dog in. The first thing I wanted to know was what was the dog's blood sugar so the techs pulled that and a bunch of other blood samples for potential testing.
The poor dog's blood sugar was like 41! Normal is somewhere around 70-150. In diabetic animals, I'm okay with up to about 300 in the hospital.
My exam wasn't too exciting so I have the dog a bowl of karyo corn syrup and sent some home. I instructed them to give a midday meal until they heard back from me. Today, we got back the fructosamine results. The number was 143!! This means the dog was suffering from prolonged low blood sugar. I cut the insulin dose by 25% and will recheck the fructosamine again in one month. I'm glad it seemed to be a simple problem with hopefully a simple answer.

My next diabetic animal was a cat diagnosed by another vet who was on vacation. The cat was on a type of insulin that I generally use specifically for dogs. The owner wasn't happy and the cat wasn't looking great. His hair coat was rough, he was thin and the owner complained that he wasn't drinking well. I pulled again a ton of blood for a variety of tests. His blood sugar came back in the 300s which wasn't surprising and some of his electrolytes were off. I sent out a fructosamine on him too. It came back at 703!!! I've never seen one this high before! Needless to say, his diabetes is poorly controlled so I changed his insulin type to what I feel is the proper cat insulin and we are starting as if he was just diagnosed. We'll check him out again in a month. Hopefully, that was his only problem.