Page 133 - Clinical Small Animal Internal Medicine

12 Diabetes Mellitus in Dogs and Cats 101

insulin therapy, median survival time from diagnosis is from insulin deficiency. Most dogs have type 1 diabetes
VetBooks.ir 2–3 years for dogs and 1.5 years for cats. Prognosis is mellitus from immune‐mediated pancreatic destruc-
tion, and most cats have type 2 diabetes mellitus from
likely better for cats that undergo diabetic remission.
Approximately 25–30% of cats relapse and require
ance associated with obesity, inactivity, breed, and
insulin to control blood glucose, and this increases with a combination of beta‐cell failure and insulin resist-
duration of remission. A small proportion of cats (approx- other factors.
imately 22%) achieve a second remission, but most Diagnosis is made by the demonstration of persistent
remain insulin dependent. Factors predisposing to diabe- hyperglycemia and glucosuria along with typical clinical
tes such as obesity and corticosteroid administration are signs of polyuria, polydipsia, and others.
likely also important factors associated with relapse. Treatment is with exogenous insulin administration
Intermittent home blood glucose is recommended for and an appropriate diet, and involves frequent blood
cats in remission to detect deteriorating glycemic status. glucose monitoring (ideally, home blood glucose moni-
Cats with impaired fasting glucose (>117 mg/dL and toring), appropriate dose adjustment, and a stable daily
<180 mg/dL; >6.5 mmol/L and <10 mmol/L) or impaired schedule, together with elimination of factors that
glucose tolerance are at increased risk of relapse. Diabetic promote insulin resistance. In cats, diets that are low in
cats in remission with fasting blood glucose >135– carbohydrate assist with glycemic control. Complications
162 mg/dL (>7.5–9 mmol/L) when measured after over- include diabetic ketoacidosis, cataracts (dogs), muscle
night hospitalization or at home, and blood glucose wasting, plantigrade stance (cats), and urinary tract
>250 mg/dL (>14 mmol/L) three hours after a glucose infections. The treatment goal for diabetic dogs is to
tolerance test (using 1 g/kg glucose IV) have an 86% resolve clinical signs and achieve ideal body condition
probability of relapsing within nine months. In contrast, while avoiding complications and blood glucose
no cat with normal fasting glucose and normal glucose extremes. The primary treatment goal for diabetic cats is
tolerance became diabetic again during the follow‐up diabetic remission and maintenance of euglycemia with-
period (17–37 months). A low‐carbohydrate diet should out the need for insulin therapy. Diabetic remission is
continue to be fed during remission. achievable in 80% or more of newly diagnosed diabetic
cats managed to achieve normal or near normal blood
glucose. For cats that remain insulin dependent, goals of
Conclusion therapy are resolution of clinical signs while avoiding
life‐threatening hypoglycemia. Cats that remain poorly
Diabetes mellitus is a common endocrinopathy in mid- controlled with insulin doses above 1U/kg BID should be
dle‐aged and older dogs and cats. The disease results tested for acromegaly.

Further Reading

American Diabetes Association. Diagnosis and Goossens MM, Nelson RW, Feldman EC, Griffey SM.
classification of diabetes mellitus. Diabetes Care 2010; Response to treatment and survival in 104 cats with
33(Suppl 1): S62–9. diabetes mellitus (1985‐1995). J Vet Intern Med 1998;
Callegari C, Mercuriali E, Hafner M, et al. Survival time 12(1): 1–6.
and prognostic factors in cats with newly diagnosed Guyton AC, Hall JE. Unit XIV: Endocrinology and
diabetes mellitus: 114 cases (2000–2009). J Am Vet Med Reproduction. In: Textbook of Medical Physiology, 10th
Assoc 2013; 243(1): 91–5. edn. Philadelphia, PA: W.B. Saunders, 2000, pp.
Crenshaw KL, Peterson ME. Serum fructosamine 836–98.
concentration as an index of glycemia in cats with Hendrix DVH. Diseases and surgery of the canine anterior
diabetes mellitus and stress hyperglycemia. J Vet Intern uvea. In: Gelatt KN, ed. Veterinary Ophthalmology, 4th
Med 1996; 10(6): 360–4. edn. Ames, IA: Blackwell Publishing Professional, 2007,
Fleeman LM, Rand JS. Long‐term management of the pp. 812–58.
diabetic dog. Waltham Focus 2000; 10(3): 16–23. Hess RS. Insulin resistance in dogs. Vet Clin North Am
Fleeman L, Rand J. Canine diabetes mellitus. In: Rand J, ed. Small Anim Pract 2010; 40: 309–16.
Clinical Endocrinology of Companion Animals. Ames, Kooistra HS. Growth hormone disorders: acromegaly
IA: John Wiley & Sons, 2013, pp. 143–68. and pituitary dwarfism. In: Ettinger SJ, Feldman EC,
Gilor C, Graves TK. Synthetic insulin analogs and their use eds. Textbook of Veterinary Internal Medicine, 7th
in dogs and cats. Vet Clin North Am Small Anim Pract edn. St Louis, MO: Saunders Elsevier, 2010,
2010; 40(2): 297–307. pp. 1711–16.