Clinical Signs
In a diabetic pet you will see a number of signs related to hyperglycaemia. One of the primary signs of diabetes is increased thirst and urination, as glucose spills over into the urine and draws water with it. Your pet will also be hungry, but ultimately will lose weight due to the breakdown of protein and fat stores. Diabetics cats can also develop a plantigrade stance (dropped hocks) and dogs can develop cataracts leading to blindness. Diabetics are also prone to urinary tract infections due to all that glucose in the urine.

Dignosis
Your veterinarian will do a number of blood and urine tests to diagnose diabetes. A stressed or sick animal will often develop hyperglycaemia, so a on-off measurement of blood glucose is not sufficient to diagnose diabetes. A serum fructosamine level can detect persistent hyperglycaemia in the 2 weeks prior to the test and is the most accurate diagnostic test for diabetes. This test is also used for monitoring diabetic pets.

Diabetic Ketoacidosis
As diabetics are unable to utlise glucose, they are placed into a catabolic state where they have to use fat and protein for energy. Ketones are acids that are temporary energy sources formed from the breakdown of fat. Ultimately, if many ketones are produced, the body can go into a general state of acidosis, which can be fatal. A sick diabetic with large number of ketones (usually detected in the urine), will require emergency treatment for stabilisation. Signs of diabetic ketoacidosis include vomiting and diarrhoea, lethargy, collapse, dehydration and coma.

Type I and II
Diabetes is a common disease in humans as well. There are 2 main classifications for diabetes. In type I, juvenile onset or insulin dependent diabetes, no insulin is produced and daily injections are required for life. In type II, adult onset or non-insulin dependent diabetes there is some insulin, but not enough or it is unable to work effectively. Type II diabetes tends to be related to genetics, diet and obesity and is the same condition that occurs in our feline friends. Most dogs have type I diabetes.

As in people, diabetes can be reversible in some cats. In humans this can sometimes be done through diet alone, however cats tend to at least initially require insulin injections to stabilise their blood glucose enough that remission is able to occur. Unfortunately not all cats achieve diabetic remission and often insulin is required for life.

Treatment
If your pet is generally well and has not developed ketoacidosis, he or she can be stabilised simply with insulin injections and diet. Your pet will need to be fed a special diet which is higher in protein and lower in carbohydrates (cats), and higher in fibre (dogs). At the same times as feeding, 12 hourly insulin injections are given to attempt to match the amount of energy consumed with the level of insulin required to utilise that energy. Each pet has different insulin requirements, so usually stabilisation is performed in hospital to ensure hypoglycaemia does not occur.

Hypoglycaemia
Hypoglycaemia is actually more dangerous than hyperglycaemia. For this reason diabetic people and diabetic animals must always have a source of sugar available should their blood glucose drop too low. If your pet seems weak and wobbly, first try feeding, but if food is refused, it may be necessary to rub glucose syrup onto the gums. It is to avoid hypoglycaemia that your pet is started on a relatively low dose of insulin intially, and is then monitored closely to determine the correct dose.

Monitoring
Regular monitoring is required to stabilise your pet and ascertain the correct dose of insulin required. Your pet will be admitted for a blood glucose curve and weight check on a weekly basis or after each insulin dose change. Regular fructosamine levels are also monitored to detect overall hyperglycaemia even in pets that appear stable. We may also ask you to test urine glucose and ketones at home if you are comfortable with this. The appearance of ketones in the urine can be a sign that a diabetic crisis is on the way. We will also ask you to monitor appetite and thirst throughout treatment.

Insulin Injections
Most people are a little apprehensive at first about giving their pet injections. With a little practice, you will probably find that giving an insulin injection is much easier than giving that worming tablet! Insulin needles are very small and fine and most pets barely notice the injection, particularly as it is associated with food. You and your pet will soon master the technique and routine of twice daily injections. Your veterinarian will sit down with you and give some pointers, and there will be ample time to practice prior to discharging your pet for injections at home. A separate handout has been prepared to discuss the technique.

What to do if Your Pet Doesn’t Eat
Contact your veterinarian if you pet is refusing to eat. If your pet is otherwise well you may be able to give half the normal dose of insulin and leave food available. In pets that do not eat reliably, it is important to feed them prior to giving the injection. If your pet is at all weak and you suspect hypoglycaemia, do not give insulin.

More Information
Further information can be obtained from your veterinarian and the following websites also have some useful information:
www.felinediabetes.com/
www.fabcats.org
www.caninediabetes.org

© Eloise Cotton, Livingstone Road Animal Health Centre