Page 565 - Small Animal Clinical Nutrition 5th Edition

584 Small Animal Clinical Nutrition

VetBooks.ir Progress Notes b
The urinary tract infection was treated with oral cefadroxil for 10 days and the insulin was changed to 55 IU recombinant human
c
Lente insulin every 12 hours, subcutaneously. The food was changed to a commercial dry veterinary therapeutic food that was
d
lower in fat, higher in digestible carbohydrates and higher in dietary fiber (Prescription Diet w/d Canine ) than the current foods
(Table 1).The estimated daily energy requirement for weight loss was 1,000 kcal/day (4.18 MJ); this was met by feeding 2.25 cups
twice daily shortly after insulin administration.
Reassessment one month later showed that insulin continued to be ineffective despite increasing the dose to 60 IU every 12 hours,
subcutaneously. The owner reported recent lethargy, weakness and excessive shedding in addition to continuing polydipsia and
polyuria. Results of serum biochemistry analysis, urinalysis, blood glucose curves and a complete blood count had not changed from
those values at the initial presentation. Baseline serum thyroxine concentration was low (0.6 µg/dl, reference = 1.5 to 3.5 µg/dl) and
decreased to 0.5 µg/dl four hours following administration of 200 µg of thyrotropin-releasing hormone (TRH). Hypothyroidism
e
with insulin resistance, diabetes mellitus and obesity became the working diagnoses. Levothyroxine sodium (0.8 mg, per os, every
12 hours) was initiated and the insulin dosage was reduced (30 IU, subcutaneously, every 12 hours). The feeding plan was
unchanged.
Over the next three months the insulin dosage was stabilized at 28 IU, subcutaneously, every 12 hours. The dog’s activity level
and coat improved. A weight loss of 5 kg was attained as well. Abnormalities in the serum biochemistry profile were alleviated
except for the hyperglycemia. Serum thyroxine concentration six hours after levothyroxine administration was 4.8 µg/dl (normal =
1.5 to 3.5 µg/dl).

Additional Comments
Diabetes mellitus in dogs is most often insulin-dependent. When conventional therapy fails to work, other disease processes should
be considered as well as other modalities of treatment for diabetes control. The use of a low-fat, high-fiber food in this case was
beneficial for weight reduction and maintaining glycemic control.

Endnotes
a. Friskies Petcare Co, Glendale, CA, USA.
b. Cefa-Tabs. Fort Dodge Laboratories, Fort Dodge, IA, USA.
c. Humulin L. Eli Lilly & Co, Indianapolis, IN, USA.
d. Hill’s Pet Nutrition, Inc., Topeka, KS, USA.
e. Soloxine. Daniels Pharmaceuticals, St. Petersburg, FL, USA.

Bibliography
Nelson RW. Insulin resistance in diabetic dogs and cats. In: Bonagura JD, ed. Current Veterinary Therapy XII. Philadelphia, PA:
WB Saunders Co, 1995; 390-393.
Peterson ME, Sampson GR. Insulin and insulin syringes. In: Bonagura JD, ed. Current Veterinary Therapy XII. Philadelphia, PA:
WB Saunders Co, 1995; 387-390.

Table 1. Nutrient levels in foods fed to a diabetic dog.
Nutrients (DM) Dry grocery Moist grocery Dry veterinary
brand food* brand food** therapeutic food***
Crude fat (%) 13.3 21.8 9.0
Crude fiber (%) 4.3 1.1 17.6
Energy (kcal/g) 3.7 4.4 3.3
Protein (%) 24.8 39.7 18.9
Digestible carbohydrate (%) 52.2 28.3 50.1
Key: DM = dry matter.
*Alpo Beef Flavored Dinner. Friskies Petcare Co, Glendale, CA, USA.
**Cycle Adult. Friskies Petcare Co, Glendale, CA, USA.
***Prescription Diet w/d Canine. Hill’s Pet Nutrition, Inc., Topeka, KS, USA.