Page 844 - Small Animal Internal Medicine, 6th Edition

816 PART VI Endocrine Disorders

diabetic dogs, problems with consistency of effect, variable
and unpredictable timing of the glucose nadir, and pro- BOX 49.6
VetBooks.ir longed duration of effect preclude recommending these Recommendations for Dietary Treatment of Diabetes
insulin preparations for use in the newly diagnosed diabetic
Mellitus in Dogs and Cats
dog. However, these insulin preparations should be consid-
ered when problems caused by short duration of insulin Correct obesity and maintain body weight in an
effect develop with lente or NPH insulin. acceptable range (see Chapter 51).
Control daily caloric intake.
DIET Increase daily exercise.
Diet plays an important role in management of the diabetic Avoid excessive amounts of insulin.
dog. What diet is ultimately fed is dictated, in part, by the Maintain consistency in the timing and caloric content of
meals.
weight of the dog, concurrent disease, and owner and dog Feed within the time frame of insulin action.
preferences. Correction of obesity is the most beneficial step Feed one half the daily caloric intake at the time of
that can be taken to improve control of glycemia. Obesity each insulin injection with q12h insulin therapy or
causes insulin resistance in dogs and is an important factor at the time of the insulin injection and 6 to 10
accounting for variations in response to insulin therapy in hours later with q24h insulin therapy.
diabetic dogs. Weight loss improves insulin resistance in Minimize the impact of food on postprandial blood
obese diabetic dogs. Weight loss usually requires a combina- glucose concentrations.
tion of the following: restricting caloric intake, feeding low- Avoid monosaccharides and disaccharides, propylene
calorie-dense diets, and increasing caloric expenditure glycol, and corn syrup.
through exercise. The reader is referred to Chapter 51 for Let “nibbler” cats and dogs nibble throughout the day
more information on treating obesity. and night; ensure that other pets do not have
access to the food.
Increasing the fiber content of the diet is beneficial for Increase the fiber content of the diet (dogs).
treating obesity and improving control of glycemia in dia- Feed high-protein, low-carbohydrate diets (cats).
betic dogs. Most major pet food companies offer diets
designed for diabetic dogs that contain a mixture of soluble Examples of Veterinary Examples of Veterinary Diets for
Diabetic Cats
Diets for Diabetic Dogs
and insoluble fiber sources that slow glucose absorption Hill’s Prescription Diet w/d High-protein, low-carbohydrate
from the gut and help minimize postprandial hyperglycemia Hill’s Prescription Diet r/d diets:
(Box 49.6). Many diets designed for weight loss contain (obese diabetic dog) Purina DM
higher levels of insoluble fiber than diabetic diets and lower Purina DCO Hill’s Prescription Diet MD
Royal Canin Diabetic
fat content to decrease the caloric density of the food. These Purina OM (obese Fiber-containing diets:
diabetic dog)
diets may be fed to obese diabetic dogs to promote weight Royal Canin Diabetic Hill’s Prescription Diet w/d
loss. High-fiber diets should not be fed to thin or emaciated Royal Canin Calorie Hill’s Prescription Diet r/d
diabetic dogs until control of glycemia is established and a Control CC High Fiber (obese diabetic cat)
normal body weight is attained with a higher-calorie-dense, (obese diabetic dog) Purina OM (obese diabetic cat)
lower-fiber diet designed for maintenance. Complications of Iams Glucose and Weight Royal Canin Calorie Control
Control Plus
(obese diabetic cat)
feeding diabetic diets containing high fiber content are listed
in Box 49.7. Most of these problems will resolve by changing
the type or quantity of fiber consumed (i.e., a change in the BOX 49.7
diet).
Concurrent disease in which diet is an important aspect Common Complications Associated With Feeding Diets
of therapy also dictates the type of diet to be fed. For example, Containing Increased Quantities of Fiber
diabetic dogs with concurrent chronic pancreatitis or exo-
crine pancreatic insufficiency (pancreatic acinar atrophy) Inapetence caused by poor palatability or boredom with
should be fed a low-fat, low-fiber, highly digestible diet. Dia- food
betic dogs with chronic kidney disease should be fed a lower- Increased frequency of defecation
protein diet designed for kidney failure. Diabetic dogs with Constipation and obstipation (insoluble fiber)
concurrent inflammatory bowel disease may need a hypoal- Soft stools and diarrhea (soluble fiber)
Increased flatulence (soluble fiber)
lergenic diet to help control inflammation and clinical signs. Weight loss
Whenever possible, dietary therapy for all disorders should Hypoglycemia
be “blended,” but if this is not possible, dietary therapy for
the most serious disorder should take priority.
Exercise also has a glucose-lowering effect by increasing the
EXERCISE mobilization of insulin from its injection site, presumably
Exercise plays an important role in maintaining glycemic resulting from increased blood and lymph flow, by increas-
control in the diabetic dog by helping to promote weight loss ing blood flow (and therefore insulin delivery) to exercising
and by eliminating the insulin resistance induced by obesity. muscles, and by stimulating glucose transporters in muscle