Diabetes mellitus in dogs and cats (Proceedings)
Diabetes mellitus is a common endocrine disorder in dogs and cats. Recent data has shed light on the pathogenesis of the disorder in cats and has highlighted the role of diet and oral hypoglycemic therapy. In the majority of cases, the most appropriate therapy in both dog and cats includes the administration of insulin. We will discuss the role of the various insulin preparations currently available and develop a logic approach to the initial and long term management of diabetes.
The key to successful management of the diabetic patient lies in close communication with the pet owner and prompt recognition and treatment of concurrent disorders.
Key Facts1. Insulin is still the mainstay of therapy in the majority of dogs and cats with diabetes mellitus.
2. Diet is an important part of diabetic management especially in obese patients.
3. Oral hypoglycemics may be helpful in lieu of or in combination with insulin to improve glycemic control.
4. Auto-immune disease, pancreatitis and amyloidosis are the most common causes of diabetes in dogs and cats.
Successful management of the diabetic patient involves many factors. An understanding of dietary therapy, insulin preparations, oral hypoglycemic agents and management of concurrent illness, are all required to optimize glycemic control. The goals of therapy are to control clinical signs, prevent or slow the progression of cataracts, avoid hypoglycemia and maintain ideal body weight. The challenge is to address these concerns while attempting to help the owners deal with a time consuming, expensive and chronic medical condition.
Diabetes Mellitus in dogs and cats results from a decrease in insulin secretion from the beta cells of the pancreas and/or a decrease in insulin action. There are three classifications of diabetes:
Type I diabetes is comparable to insulin dependent diabetes mellitus (IDDM) in humans. It results in low basal insulin concentrations with impaired insulin secretion following a glucose load. Treatment requires insulin injections. It is the most common form of diabetes in dogs.
Type II diabetes is similar to non-insulin dependent diabetes (NIDDM) in humans and is managed with dietary therapy and oral hypoglycemic. It causes normal to increased basal insulin concentrations with decreased secretion following a glucose load. Insulin may or may not be required for animals with Type II diabetes.
Type III diabetes is seen most commonly in hormonally-induced diabetes in dogs and cats and is similar to impaired glucose tolerance (IGT) in humans. Diabetogenic hormones (epinephrine, cortisol, glucagon and growth hormone) or medications interfere with insulin action and cause glucose intolerance, which can lead to diabetes.
Etiology and Signalment
There are some distinct differences in the etiology of canine and feline diabetes. In dogs, it is generally thought to be an immune mediated disease with gradual destruction of beta cells. The progression from normal, to glucose intolerant, to diabetes, is generally slow so that most islets (over 90%) are lost before diabetes occurs. Other causes of diabetes in dogs include genetic predisposition, chronic pancreatitis and medication-induced diabetes (glucocorticoids and megestrol acetate).
Genetic predisposition to diabetes is most common in the following breeds: German Shepherd dogs, Schnauzers, Beagles, and Poodles. Golden Retrievers and Keshonds are more prone to juvenile diabetes.
Gender is a factor in dogs with females being three times more likely to develop diabetes than males. Generally, diabetes occurs in dogs in middle age (6-9 years) but can also present earlier for specific breeds, particularly the Golden Retriever and Keeshond.
The most common causes of diabetes in cats are obesity, pancreatitis and most commonly, amyloidosis of the pancreatic beta cells. There appears to be very little gender predisposition to this disease in cats, although it is slightly more common in males than females. As with dogs, the onset of diabetes in cats occurs most often in middle age.