Diabetes in Dogs and Cats
What is diabetes mellitus?
Diabetes is a lack of insulin. It can be either type one, which is an actual lack of insulin, or type two, which is a receptor problem. In type two diabetes, there is enough insulin, but the cells don't respond when they're acted on by the insulin.
Where does insulin come from?
Insulin comes from the pancreas. The pancreas is an organ inside the body that creates enzymes for digestion as well as hormones like insulin. If the pancreas is damaged, either by bacteria, immune responses, or any other insult, it can prevent the body from creating insulin. It can also affect the quality of insulin produced, leading to either type one or type two diabetes.
How do we diagnose if your pet has diabetes?
We start with clinical signs. Pets are going to drink a lot and pee a lot, often with sticky urine. They will experience weight loss because nutrients aren't getting inside the cells. Pets sometimes walk on their heels, look like they have a headache, or start acting sluggish. In severe cases, they can develop diabetic ketoacidosis, a serious condition we'll cover in another video.
As veterinarians, we diagnose diabetes by running labs, specifically testing for glucose and checking for excess glucose in the urine. There is also a fructosamine test, which provides an overview of glucose levels over a couple of weeks rather than a spot check. This test can be useful if we're having difficulties diagnosing or regulating a patient.
How do we treat diabetes?
We treat diabetes primarily with food, aiming to reduce carbohydrate intake to make insulin and glucose management easier. Insulin is typically given via injection, once or twice a day depending on the type. There are pill forms, like glyphid, sometimes used in cats if needles are difficult. If a pet isn't eating, I would recommend administering half of the prescribed insulin dose. For example, if the dose was six units a day, give three units. If the pet eats again, administer the other three units.
We'll also establish a blood monitoring schedule to regulate glucose levels, which typically requires three or four visits to match the glucose and insulin levels effectively. It's important to understand that glucose and insulin levels fluctuate. Each time we administer insulin, the glucose level should drop to a manageable level.
What are the forms of diabetes insipidus?
Diabetes insipidus happens in two forms or two ways. One, we're either not producing something called an antidiuretic hormone, so we're not producing it in the brain. That could be due to head trauma, tumors, or some sort of insult that has occurred that basically makes that hormone not get produced. The other form is in our kidneys. Basically, something like an eoli endotoxin, hypercalcemia which is too much calcium, hyperkalemia which is too much potassium, hyperaldosteronism, or something like hyperadrenocorticism. ADH is a hormone that goes from our brain, works on our kidneys, and that helps us reabsorb water.
Can you explain how diabetes insipidus affects the body?
I almost like to consider it as a processing error. No matter how dehydrated we get when we have diabetes insipidus, we are going to get rid of water. Basically, if we were in a desert and we were really thirsty, our body would not try and hold back that water because we're missing this antidiuretic hormone.
What are the clinical signs of diabetes insipidus?
A lot of times, the typical clinical signs for diabetes insipidus include the patient losing their house training, peeing a lot, peeing in large puddles, bedwetting, and not being able to control themselves anymore. They drink an excessive amount of water.
How do you measure the ability of kidneys to concentrate urine?
Gravity at normal, well, normal water, so distilled water with absolutely nothing in it, is going to have 1.000 as its weight. I take that as a starting point of zero, and normal as far as the concentrating ability of our kidneys and our bodies is going to be somewhere around 1.035. So I like to eliminate the 1.0, so we have zero and we have 35.
How do kidney issues relate to urine concentration and diabetes insipidus?
Typical disease processes happen around 15, not concentrating a ton, with conditions like Cushing's or thyroid problems. When we get to 10, we are looking more like a kidney issue. Diabetes insipidus is closer to about 5 to 8, almost the equivalent of distilled water. Five is almost as dilute as we can get in the body, and that's what happens when we don't have the ability to absorb the water back into our kidneys using our antidiuretic hormone. Without ADH, we can't absorb water back into our system and recycle it.
How is diabetes insipidus treated?
Diabetes insipidus has one of the safest drugs for treatment, called desmopressin. It comes in a pill form, eye drop form, and a nose spray form. I personally think the pill form is the best and easiest way to administer the medication. It can be done about every 8 to 12 hours. We typically start at a standard dose and then work our way up until the urine begins to concentrate again. If issues arise, it's advisable to return for a check-up to ensure that the specific gravity is where it's supposed to be, as other diseases could be occurring in the body. We want to make sure your pet is as healthy as possible.
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