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Diabetes Mellitus 251

TREATMENT It is recommended that pets not have free used in place of Uosm. However, Uosm
access to water immediately after each dose. measurements are preferred because homeo-
Treatment Overview
VetBooks.ir Therapy is aimed at improving patient and • Thiazide diuretics may cause hypokalemia. electrolyte balance are related to osmolality. Diseases and Disorders
static mechanisms maintaining water and
• Mild conjunctival irritation can occur with
topical ocular DDAVP.
Moreover, in approximately 15% of samples,
owner quality of life through reduction or
USG is not a correct reflection of Uosm.
resolution of PU/PD. Treatment is expected
hypovolemic, and hyperosmolar very quickly
to be lifelong unless an underlying cause can • Untreated animals can become dehydrated, • Complete emptying of the bladder after a
be identified and resolved. if denied access to water or in cases of urine sample has been collected is essential
vomiting/regurgitation. during a water deprivation test because the
Acute General Treatment decision about whether to continue the test
None generally required Recommended Monitoring depends on a correct determination of urine
• Clinical response should be monitored in concentration during the previous period.
Chronic Treatment patients receiving DDAVP therapy. When urine volume is small, catheterization
• The treatment of choice for CDI is • Serum electrolytes should be periodically may be needed to obtain a sample and to
exogenous ADH administration (DDAVP monitored if thiazide diuretics are used. ascertain that the bladder is emptied. In cats,
as tablets [0.1 mg/DOG PO q 8h or the use of an indwelling urinary catheter
0.025-0.05 mg/CAT q 8-12h; increase dose PROGNOSIS & OUTCOME may be necessary.
if no response within 1 week] or intranasal • Head trauma can result in transient CDI
drops administered into the conjunctival sac • In patients with idiopathic CDI, clinical signs that resolves on its own.
[1 drop/patient q 8-12h]). Patients with NDI generally resolve completely with DDAVP
are usually unresponsive to DDAVP therapy. therapy, and patients can have a normal life Technician Tips
• For NDI, thiazide diuretics (hydrochlo- expectancy. Lifelong treatment is not feasible The water deprivation test requires extremely
rothiazide 2-4 mg/kg PO q 12h) with a for some pet owners due to the expense of diligent monitoring for the entire duration of
low-sodium diet to reduce total-body sodium DDAVP. the test. Without it, there is a very real risk
concentration. This increases renal sodium • CDI secondary to an intracranial neoplasm of progressive, life-threatening dehydration in
and water resorption and reduces urine has a guarded prognosis because progressive these patients.
volume, albeit often without a significant neurologic signs may develop in the ensuing
change in Uosm. months. Client Education
• If PU/PD is not disruptive to the owners • The PU/PD of primary NDI is often dif- Patients with diabetes insipidus must always
and the animal has free access to water and ficult to manage medically and is therefore have free access to water.
a place to urinate, treatment may not be associated with a guarded prognosis.
required. SUGGESTED READING
PEARLS & CONSIDERATIONS Meij BP, et al: Hypothalamus-pituitary system. In
Possible Complications Rijnberk A, et al, editors: Clinical endocrinology
• Cellular overhydration can occur in patients Comments of dogs and cats, ed 2, Hannover, Germany, 2010,
that consume large volumes of water shortly • Hypercortisolism is a likely differential in a Schlütersche, pp 13-54.
after receiving DDAVP because of a decreased patient that initially responds to exogenous AUTHOR: Hans S. Kooistra, DVM, PhD, DECVIM
ability to excrete the free water after DDAVP DDAVP therapy but later has recurrence of EDITOR: Ellen N. Behrend, VMD, PhD, DACVIM
reaches therapeutic effect. Neurologic signs PU/PD.
(ataxia, depression, tremors, seizures) can • Because they are highly correlated, USG
occur as a consequence of cerebral edema. measurements by refractometry can be

Diabetes Mellitus Bonus Material Client Education
Sheet
Online

BASIC INFORMATION • Classification of DM in small animals ○ Occasionally seen in animals < 1 year of
according to cause is recommended, as is age (juvenile DM)
Definition done for diabetic people.
Project Agreeing Language in Veterinary Endo- • The final stage in DM development is a GENETICS, BREED PREDISPOSITION
crinology (ALIVE), endorsed by the European relative or absolute deficiency of insulin Cats:
Society of Veterinary Endocrinology and Society production by pancreatic beta cells. • Any cat can develop DM.
for Comparative Endocrinology, defines diabetes • Clinical signs result from a combination of • Tonkinese, Norwegian Forest, and Burmese
mellitus (DM) as follows: insufficient insulin action in the body and the cats are predisposed compared with crossbred
• A complex syndrome identified by the resulting hyperglycemia and hyperlipidemia. cats.
presence of pathologic hyperglycemia • Melanocortin-4 receptor gene (MC4R)
• Best seen not as one disease but rather as a Epidemiology implicated in susceptibility to DM
consequence of one or more primary disease SPECIES, AGE, SEX Dogs:
processes • Cats: middle-aged to older (>6 years); male • Any dog can develop DM.
• Many factors can contribute to development neutered cats may be overrepresented • Various breeds are associated with increased
of DM, including patient genetics, presence • Dogs: middle-aged to older (>6 years); risk of DM (e.g., terriers, Samoyed, miniature
of pancreatic disease, or conditions causing no sex predisposition (except diestrus- or schnauzer); others have a decreased risk (e.g.,
insulin resistance. pregnancy-related DM) boxer, German shepherd).

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