Diabetes mellitus strikes 1 in 400 cats and a similar number of dogs, though recent veterinary studies note that it is becoming more common lately in cats. Symptoms in dogs and cats are similar to those in humans. Generally, most dogs and about 5-20% of cats experience type-1 (insulin-dependent) diabetes, rather than the type-2 that's now becoming common in obese humans. The other 80-95% of cats experience type-2 diabetes.. The condition is definitely treatable, and need not shorten the animal's life span or life quality. In type-2 cats, prompt effective treatment can even lead to diabetic remission, in which the cat no longer needs injected insulin. Untreated, the condition leads to blindness in dogs, increasingly weak legs in cats, and eventually malnutrition, ketoacidosis and/or dehydration, and death.
Symptoms
Cats and dogs will generally show a gradual onset of the disease over a few weeks, and it may escape notice for a while. The condition is unusual in cats less than seven years old, though younger dogs are more susceptible to Type-1 (juvenile) diabetes. The first obvious symptoms are a sudden weight loss or gain, accompanied by excessive drinking and urination; for example, cats can appear to develop an obsession with water and lurk around faucets or water bowls. Appetite is suddenly either ravenous (up to three-times normal) or absent. In dogs, the next symptom is vision problems and cataracts, while in cats the back legs may become weak and the gait may become stilted or wobbly. A quick test at this point can be done using urine keto/glucose strips (the same as used on the Atkins diet) with the animal. If the keto/glucose strips show glucose in the urine, diabetes is indicated. If a strip shows ketones in the urine, the animal should be brought to an emergency clinic right away. A test can also be performed with a home glucose meter by obtaining a blood sample with a lancet via an ear prick, paw prick or, in dogs, a lip prick.
Owners should watch for noticeable thinning of the skin and apparent fragility: these are also serious and indicate that the animal is metabolizing (breaking down) its own body fat and muscle to survive. Dehydration is also common by this point and death can follow quickly.
Treatment
Diabetes can be treated but is life-threatening if left alone. Early diagnosis and treatment by a qualified veterinarian can help, not only in preventing nerve damage, but in some cases, in cats, can even lead to remission. Cats usually seem to do best with long-lasting insulins and low carbohydrate diets, while dogs have varying "best" treatments depending on the individual case.
Diet
Diet is a critical component of treatment, and is in many cases effective on its own. For example, a recent mini-study showed that many diabetic cats stopped needing insulin after changing to a low carbohydrate diet. The rationale is that a low carbohydrate diet reduces the amount of insulin needed and keeps the variation in blood sugar low and easier to predict. Also, fats and proteins are, in dogs and perhaps cats, turned into blood glucose much more slowly and evenly than carbohydrates, reducing blood-sugar highs right after mealtimes.
Latest veterinary good practise is to recommend a low carbohydrate diet for cats, and a high-fiber, moderate-carb diet for dogs. In dogs another alternative is to feed a normal healthy diet but give mealtime insulin bolus supplements. Dogs with pancreatitis, a fairly common condition for diabetic dogs, often need a restricted-fat diet.
It's now becoming clear that lower carbohydrate diets will significantly lower insulin requirements for diabetic cats. Carbohydrate levels are highest in dry cat foods (even the expensive "prescription" types) so cats are best off usually with a low carbohydrate healthy canned diet. Some prescription canned foods made for diabetic cats are effective, but some ordinary ones work just as well. Between 3 and 9% calories from carbohydrates seems to be optimal. These lists of common commercial cat foods and their carbohydrate energy content are kept up-to date. You can use the cat food calculator found at http://www.scheyderweb.com/cats/catfood.html to determine the carbohydrates and calories in any cat food, though numbers in American brands are given as minimums and maximums rather than actual estimates, and may be very inaccurate
Pills
Oral medications like Glipizide that stimulate the pancreas promoting insulin release, (or in some cases, reduce glucose production) work in some small proportion of cats (Most dogs are Type I diabetics so oral hypoglycemic drugs are not effective for them), but these drugs may be completely ineffective if the pancreas is not working. Worse, these drugs have been shown in some studies to damage the pancreas further, reducing the chances of remission for cats. They have also been shown to cause liver damage. Many are reluctant to switch from pills to insulin injections, but the fear is unjustified; the difference in cost and convenience is minor, (many cats are easier to inject than to pill) and injections are more effective in almost all cases.
Insulin injections
Humans with Type-1 diabetes are often treated with a "basal plus bolus" method, where a long-acting insulin is injected once or twice daily to provide a "basal" insulin level, then shorter-acting insulin is used just before mealtimes.
For cats, a "basal" method is usually employed instead—a single slow-acting dose, twice daily, along with a very low carbohydrate diet, attempts to keep the blood sugar within a recommended range for the entire day. In this case it's important for the pet to avoid large meals, since they can seriously affect the blood sugar. (Meals may also be timed to coincide with peak insulin activity.) Once-daily doses are not recommended for most cats, since insulin usually metabolizes faster in cats than in dogs or humans; an insulin brand that lasts 24 hours in people may only be effective for about 12 in a cat.
For dogs, either of the above two methods may be used. For example, a basal-only method combined with a high-fiber diet, or a basal-bolus method along with a normal canine diet, can be effective.
Cats and dogs may be treated with animal insulins (pork-based is most similar to a dog's natural insulin, beef-based for a cat), or with human synthetic insulins. The best choice of insulin brand and type varies between pets and may require some experimentation. One of the popular human synthetic insulins, Humulin N /Novolin N/ NPH, is reasonable for dogs, but is usually a poor choice for cats, since cats' metabolize (most) insulin about twice as fast. The Lente and Ultralente versions were therefore very popular for feline use until summer 2005, when Eli Lilly and Novo Nordisk both discontinued them.
Until the early 1990s, the most recommended type for pets was beef/pork-derived PZI, but that type was phased out over the 1990s and is now difficult to find in many countries. There are sources in the US and UK, and many vets are now starting to recommend them again for pets, but they have been discontinued by most manufacturers as of 2007-2008.
Caninsulin ,known in the USA as Vetsulin, made by Intervet is a brand of pork-based insulin, which is approved for dogs and cats, and is available both through veterinarians and pharmacies with a veterinarian's prescription, depending on the country. Caninsulin can also be used for the ex-label treatment of diabetes mellitus in pet rabbits and guinea pigs. According to the manufacturer's website, Caninsulin's action profile is long and flat in dogs, but in cats very similar to that of NPH insulins, and lowers blood sugar quickly, but for only about 6-8 hours.
Two new ultra-slow time-release synthetic human insulins are just becoming available in 2004 and 2005 for improving basal stability, generically known as Insulin Detemir ("Levemir") and Insulin Glargine ("Lantus"). A mini-study at the University of Brisbane, Australia has had remarkable results with Insulin Glargine in cats. Followup research Roomp and Rand, Vet Intern Med 2008, 22 (3):791 shows that Levemir can be used with a similar protocol and that either insulin, on this protocol, leads in most uncomplicated feline cases to remission.
Neuropathy in cats
The weak legs syndrome found in many diabetic cats is a form of neuropathy, in particular caused by damage to the myelin sheath of the peripheral nerves caused by glucose toxicity and cell starvation. (There are other conditions that can cause weak legs too, consult your vet before assuming neuropathy.) Most common in cats, the back legs become weaker until the cat displays "Plantigrade stance", standing on its hocks instead of on its toes as usual. The cat may also have trouble walking and jumping, and may need to sit down after a few steps. Some recommend a specific form of vitamin B12 called methylcobalamin to heal the nerve damage. Neuropathy often heals on its own within 1 to 3 months once blood sugar is regulated, but anecdotal evidence points to a faster recovery rate with methylcobalamin supplements.
Cataracts in dogs
Cataracts are a frequent occurrence in diabetic dogs. Hyperglycemia in dogs can cause both cataracts and retinopathy; cataracts can cause blindness in a few days or weeks. Blood glucose levels as low as 250mg/dL (14.0 mmol/L) can cause cataracts in dogs.
Dosage and regulation
Cats and dogs may in some cases have their mealtimes strictly scheduled and planned to match with injection times, especially when on insulins
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