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Diabetes mellitus

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Sections available in full article	Introduction, Presenting signs, Acute presentation, Age predisposition, Sex predisposition, Breed predisposition, Cost considerations, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Monitoring, Subsequent management, Prevention, Control, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors	Dr David Bruyette DVM DipACVIM
Synonyms	Sugar diabetes, DM

Introduction

Generally >6 years old. Rare in young.
Cause : syndrome characterized by relative or absolute lack of insulin.
Signs : polyuria/polydipsia, weight loss, polyphagia.
Diagnosis : glycosuria, hyperglycemia.
Treatment : insulin therapy .
Print-off the owner factsheet on Diabetes in your dog to give to your client.

Diagnosis

Clinical signs

Uncomplicated diabetes

Hepatomegaly, muscle wasting.

Bacterial infections (urinary tract, respiratory tract).

Cataract , retinopathy (rare).
Peripheral neuropathy.
Glomerulosclerosis (rare).
Cutaneous xanthomata, ulcerative dermatosis.

Ketoacidosis

See diabetic ketoacidosis .

Hyperosmolar coma

Weakness.
Lethargy.
Coma. See: Hyperosmolar coma for more detail.

Diagnosis

Differential diagnosis

Other causes of polydipsia

Hyperadenocorticism .
Renal disease .

Hyperosmolar diabetes mellitus .

Hepatic disease .
Neoplasia.
Hypercalcemia .
Diabetes insipidus .
Psychogenic polydipsia .

Sequelae

Prognosis

Median survival time of 2.71 years has been reported.
Survival rates can equal non-diabetic dogs of same age and sex.
Complications: cataract , pancreatitis , hepatic lipidosis, bacterial infections.
Rare complications: peripheral neuropathy , retinopathy , EPI , diabetic dermatopathy, diabetic glomerulonephropathy .

Expected response to treatment

Reducing water consumption (within days).
Improving demeanor.
Weight gain in thin animals (cessation of weight loss in obese animals).

Reasons for treatment failure

Inadequate treatment of diabetic ketoacidosis may be fatal.
Inadequate frequency or dose of insulin.
Reduced absorption of insulin.
Out of date or poorly stored insulin.
Owner non-compliance - improper administration technique.
Other complications include:
- Insulin-induced hyperglycemia.
- Rapid metabolism of insulin.
- Insulin resistance.

Sources

Publications

Refereed papers

Recent references from PubMed.
Rucinsky R, Cook A, Haley S, Nelson R, Zoran D L & Poundstone M (2010) AAHA diabetes management guidelines. JAAHA 46 (3), 215-224 PubMed.
Davison L J, Herrtage M E & Catchpole B (2005) Study of 253 dogs in the United Kingdom with diabetes mellitus. Vet Rec 156 , 467-471.
Davison L J, Catchpole B, Kennedy L J, Barnes A, Thomson W & Ollier W E (2003) Research into canine diabetes mellitus. Vet Rec 152 (5), 148.
Fleeman L M & Rand J S (2003) Evaluation of day-to-day variability of serial blood glucose concentration curves in diabetic dogs. JAVMA 222 (3), 317-21.
Guptill L, Glickman L & Glickman N (2003) Time trends and risk factors for diabetes mellitus in dogs: analysis of vet medical data base records (1970-1999). Vet J 165 (3), 240-247.
Watson P J (2003) Exocrine pancreatic insufficiency as an end stage of pancreatitis in four dogs. JSAP 44 (7), 306-312.
Bennett N (2002) Monitoring techniques for diabetes mellitus in the dog and the cat. Clin Tech Small Anim Pract 17 (2), 65-69.
Connally H E (2002) Critical care monitoring considerations for the diabetic patient. Clin Tech Small Anim Pract 17 (2), 73-78 .
Graham P A, Maskell I E, Rawlings J M, Nash A S & Markwell P J (2002) Influence of a high fibre diet on glycaemic control and quality of life in dogs with diabetes mellitus. JSAP 43 (2), 67-73.
Mathes M A (2002) Home monitoring of the diabetic pet. Clin Tech Small Anim Pract 17 (2), 86-95.
Stein J E & Greco D S (2002) Portable blood glucose meters as a means of monitoring blood glucose concentrations in dogs and cats with diabetes mellitus. Clin Tech Small Anim Pract 17 (2), 70-72.
Webb C B (2002) Troubleshooting the diabetic small animal patient. Clin Tech Small Anim Pract 17 (2), 79-85.
Peikes H, Morris D O & Hess R S (2001) Dermatologic disorders in dogs with diabetes mellitus. JAVMA 219 ,460-466.
Schachter S, Nelson R W & Kirk C A (2001) Oral chromium picolinate and control of glycemia in insulin-treated diabetic dogs. J Vet Intern Med 15 (4), 379-384.
Hess R S, Saunders H M & Van Winkle T J et al(2000) Concurrent disorders in dogs with diabetes mellitus: 221 cases (1993-1998). JAVMA 217 , 1166-1173.
Nelson R W (2000) Oral medications for treating diabetes mellitus in dogs and cat. JSAP 41 (11), 486-490.
Sottiaux J (1999) Atherosclerosis in a dog with diabetes mellitus. JSAP 40 (12), 581-584.
Hess R S & Ward C R (1998) Diabetes mellitus, hyperadrenocorticism, and hypothyroidism in a dog. JAAHA 34 , 204-207.
Elliott D A, Nelson R W & Feldman E C et al(1997) Glycosylated hemoglobin concentrations in the blood of healthy dogs and dogs with natrually developing diabetes mellitus, pancreatic B-cell neoplasia, hyperadrenocorticism and anemia JAVMA 211 , 723-727.
Ling G V, Lowenstine L J, Pulley L T & Kaneko J J (1977) Diabetes mellitus in dogs. A review of initial evaluation, immediate and long-term management and outcome. JAVMA 170 , 521-530.
Miller E (1995) Long-term monitoring of the diabetic dog and cat; clinical signs, serial blood glucose determinations, urine glucose and glycosylated blood proteins. Vet Clin N Am 25 , 571-575.
Reusch C E, Liehs M R, Hoyer M, & Vochezer R (1993) Fructosamine - a new parameter for diagnosis and metabolic control in diabetic dogs and cats. JVIM 7 , 177-182.