Diabetic Crises: Recognition And Management (proceedings)
123Next Diabetes mellitus occurs in both dogs and cats and is the most common endocrine disorder in the emergency setting. Three types of diabetic emergencies may occur: (1) Insulin overdose, (2) Diabetic ketoacidosis, and (3) Non-ketotic hyperosmolar diabetes. Historical findings may be similar in all 3 cases, and may include polyuria, polydypsea, weight loss, anorexia, weakness, ataxia, severe depression, stupor, coma, or seizures. Diabetes most commonly occurs in middle-aged female dogs and in older male cats. The initial approach to an animal with suspected diabetic crisis is aimed toward differentiating between the 3 types of diabetic emergencies and determining how "sick" the patient is. An intravenous catheter is placed and 4 capillary tubes of blood are collected to run the hematocrit and total protein, blood glucose (using a Dextrometer, Ames Laboratories, Ames IA), blood urea nitrogen (using a reagent stick), and serum electrolytes. Blood for serum electrolytes must be collected in a lithium heparin capillary tube rather than in a sodium heparin tube. Evaluation of the laboratory work will reveal whether the animal is hypoglycemic or hyperglycemic, and whether or not ketones and glucose are present in the urine, and whether the animal is dehydrated, anemic, azotemic, or has a serious electrolyte imbalance. Other tests which can be run rapidly in an emergency setting include serum osmolality and venous or arterial blood gases. Within a few minutes after the animal is presented to the hospital, the clinician should be able to determine which type of diabetic crisis is occurring and to manage it accordingly. I. Insulin Overdose Insulin overdose can occur through owner error (for example, switching from low dose insulin syringes to tuberculin syringes) or through Continue reading >>
Handling A Diabetes Emergency
Emergencies can happen at any time, so it's best to be prepared and know what to do if an emergency occurs. Talking with your veterinarian is a crucial part of being informed and prepared to handle emergencies. Low blood sugar (hypoglycemia) The most common side effect experienced with insulin therapy is hypoglycemia. Hypoglycemia can be caused by: Missing or delaying food. Change in food, diet, or amount fed. Infection or illness. Change in the body's need for insulin. Diseases of the adrenal, pituitary, or thyroid glands, or progression of liver or kidney disease. Interaction with other drugs (such as steroids). Change (increase) in exercise. Signs of hypoglycemia may occur suddenly and can include: Weakness Depression Behavioral changes Muscle twitching Anxiety Seizures Coma Death See below for a list of other side effects. What to do If your pet is conscious, rub a tablespoon of corn syrup on his or her gums. When your pet is able to swallow, feed him or her a usual meal and contact your veterinarian. If your pet is unconscious or having a seizure, this is a medical emergency. CONTACT YOUR VETERINARIAN. In the meantime, you should immediately treat your pet rather than delaying management. Pour a small amount of a sugar solution (eg, corn syrup) onto your finger and then rub the sugar solution onto your pet's gums. The sugar is absorbed very quickly and your pet should respond in 1 to 2 minutes. The sugar solution should never be poured directly into your pet's mouth since there is a risk that the solution will be inhaled into the lungs. Once your pet has responded to the sugar administration and is sitting up, it can be fed a small amount of its regular food. Once the pet has stabilized, it should be transported to your veterinarian for evaluation. Your pet's diet Continue reading >>
4 Signs Of An Impending Diabetic Pet Emergency
Caring for a diabetic pet can be challenging, but there are certain precautions pet owners can take to prevent a diabetic emergency like hypoglycemia. Preventing a health crisis in a dog or cat with diabetes involves employing a consistent daily routine involving diet, exercise, insulin therapy, and supplementation. It also involves avoiding any and all unnecessary vaccinations. Even the most diligent pet parent can find himself facing a diabetic emergency with a dog or cat. Hypoglycemia is the most common health crisis, and is usually the result of an inadvertent overdose of insulin. Symptoms of hypoglycemia can appear suddenly and include lethargy or restlessness, anxiety or other behavioral changes, muscle weakness or twitching, seizures, coma, and death. At-home treatment for a diabetic pet with hypoglycemia is determined by whether or not the animal is alert. Signs of other potential impending diabetic emergencies include ketones in the urine; straining to urinate or bloody urine; vomiting or diarrhea; or a complete loss of appetite or reduced appetite for several days. By Dr. Becker Caring for a diabetic pet can be quite complex and time consuming. It involves regular monitoring of blood glucose levels, making necessary dietary adjustments, giving insulin injections or oral medications, and keeping a careful eye on your pet at all times. Frequent veterinary visits are the norm for dogs and cats with diabetes, as are the costs associated with checkups, tests, medical procedures, and insulin therapy. And unlike humans with the disease, our pets can’t tell us how they’re feeling or help in their own treatment and recovery. Preventing Diabetic Emergencies The key to preventing diabetic emergencies with a pet involves implementing a consistent daily routine and sti Continue reading >>
Why Did My Dog Pass Away After Her Insulin Was Changed?
Next on The Scoop: Harnessing Homeopathy to Cure Kennel Cough in Dogs Why Did my Dog Pass Away After Her Insulin Was Changed? Dear Dr. Barchas, My 10 - 12 year old Bichon was diagnosed with diabetes in October, 2008. It took about a month of adjustments to... Lifestyle Lets Meet 5 Dogs With Long Ears My 10 12 year old Bichon was diagnosed with diabetes in October, 2008. It took about a month of adjustments to diet and insulin dose, but when it got smooth, it was very smooth. The insulin was Vetsulin. Last month, Daisys sugar was running high, 396 at the highest, and I attributed it to her mining cherries from under the tree, and the vet agreed and asked her to retest in about a month. I had to buy insulin, and they told me Vetsulin had had a quality control problem, and sold me humulin. Daisy started her new insulin on Sunday, a week ago. The frequency and dosage remained the same, 2x per day, and 3.5 marks on the syringe. The new syringes were different, and the marks were closer. Daisy began to have episodes of confusion mid week, and acted as if her hearing had diminished. Late Friday, Daisy was faint, and I got her to eat, and she seemed to recover. After she ate her dinner, I gave her her injection. About three hours later, she began having seizures, and although I rubbed syrup on her gums, she remained lethargic, alternating between being very stiff, and then panting wildly, and howling. She finally lapsed into what appeared to be a coma, and we euthanized her ourselves to alleviate her suffering. I am trying to understand why, when her diabetes was so controlled, this would happen, and if it might have been the new insulin, or if I made the error by administering her injection. How long does poisoning take? One bad dose? Several? She was fairly old, completely b Continue reading >>
Heather Bills Died Of Insulin Overdose, But Who Administered It Remains A Mystery
An Auckland woman died of a brain injury after being mysteriously given a large dose of insulin, an inquest has been told. The coroner's inquiry into the death of Heather Bills began at the Auckland District Court on Tuesday. Bills suffered an "irreversible brain injury" while in the care of Middlemore Hospital after being administered a large dose of insulin, causing her to become hypoglycemic. But how she was administered the fatal dose remains unknown. READ MORE: * Police probe mystery death of burns victim * Coroner to examine mystery death of burns victim Heather Bills Her daughter Michelle Maher opened the inquest by explaining her mother had a love for Cliff Richard and The Beatles. Bills, a mother and grandmother, suffered from a "long and difficult" mental illness, Mahere said. "She was unable to enjoy the simple pleasures of life many of us are able to take for granted." On November 23, 2013, a powerful blaze at Bills' house caused serious damage and blew the car out of the garage on to the road. Neighbours rescued Bills and her two dogs and she was taken to Middlemore Hospital with severe burns to her legs. Following treatment at the hospital, Bills began to recover. Maher told the inquest her family were preparing for her release. "There was a long road ahead ... but Mum was alive," she said. However, on the evening of December 26, Bills became extremely unwell while still in hospital. A house surgeon was called to her bedside, and she was admitted to the intensive care unit. Tests revealed her blood sugar levels were "extremely low", which in turn was injuring her brain. It became clear the hypoglycemic event was caused by an overdose of insulin. "Mum was resuscitated with glucose, but it was too late," Maher said. "I sat at my mum's bedside as she tremb Continue reading >>
Causes And Prevention Of Hypoglycemia (low Glucose) In Dogs
Hypoglycemia can be caused by a number of things. The basic mechanisms of hypoglycemia are either: 1) an abnormally large rate of removal of glucose from the bloodstream, 2) an abnormally low level of glucose in the blood from dietary intake, or 3) decreased production of glucose from glycogen stores by the liver. Most cases of hypoglycemia are caused by excessive use of glucose by normal body cells or by rapidly-dividing cancer cells. 1 Warning: 3 Foods to Avoid These 3 Foods Should Come with a Warning Label Nucific 2 Pancreatic Disorders Breaking news and the latest research on Pancreatic Disorders. healio.com Hypoglycemia often involves abnormally low levels of the hormone, insulin. In healthy dogs, insulin is made by specialized cells of the pancreas called the beta cells of the pancreatic islets of Langerhans. Insulin has a number of important functions, one of the most critical of which is regulating the uptake and storage of glucose from the bloodstream. Blood glucose normally comes from the dog’s intake of food – especially of carbohydrates. There must be a sufficient amount of insulin in circulation for glucose to be able to be moved out of the blood and into cells and tissues, where it is needed as the primary source of a dog’s energy. If the pancreatic beta cells produce too much insulin, then excessive amounts of glucose will be removed from the blood, causing the dog to become hypoglycemic (i.e., to have low blood sugar). Insulin-secreting tumors of the pancreas, called insulinomas or beta-cell tumors, can cause the islet cells to overproduce insulin. Insulinomas are probably the most common cause of hypoglycemia in older dogs. Extra-pancreatic cancer, such as liver carcinoma or sarcoma, leukemia, malignant melanoma or other forms of neoplasia, can be Continue reading >>
What Should I Do If I Accidentally Give My Pet A Double Dose Of Insulin?
My 78 pound Dobe was given her insulin with her normal food at 3:00. At 6:00 my son gave her dinner, again her insulin and normal food amount…upon realizing this we gave her some honey on bread which she hungrly ate….about 2 hours later we gave a bit more food……it has been 7 hours since her original dose and 4 hours since the second “mistake” dose…are we pretty close to being out of danger of an overdose? Sandy Insulin is a medication used to treat diabetes in cats and dogs. Diabetes is a disease characterized by high blood sugar. Insulin causes blood sugar to drop. Too much insulin can lead to dangerously low blood sugar. Dogs or cats that receive more than their usual dose of insulin are at risk of a hypoglycemic crisis that can lead in the worst cases to seizures, coma, and death. Anyone who accidentally overdoses his or her pet on insulin should seek veterinary care immediately. The vet will monitor blood sugar and administer intravenous glucose as needed until the medication has worn off. Different types of insulin have different lengths of duration. Some short acting insulins wear off in a few hours. Other, longer lasting insulins such as glargine (Lantus) can last for 12 to 24 hours. This leads to a variation in the length of time an overdosed pet requires in the hospital. Insulin overdoses can be serious business. Even if your pet seems fine, her blood sugar could be dangerously low. Go straight to the vet. Continue reading >>
Feline Diabetes + Insulin Overdose
“The Case of the Not-So-Resistant Diabetic Kitty” How glucose curves can be invaluable in the management of feline diabetes, and the diagnosis of Insulin Overdose. 1. Referral: “Kitty” is a nine year old DSH who presented for a second opinion on insulin-resistant diabetes. “Kitty” is a 5 kg cat who was diagnosed with diabetes mellitus 6 months ago. She was started on 3 units of NPH q 12hours. The cat had repeated rechecks with her RDVM who would check a blood glucose approximately 6 hours after insulin was given. These values were consistently greater than 350mg/dl. With each visit, the elevated BG was interpreted as meaning the cat needed more insulin and her insulin was increased. In addition, she continued to have signs consistent with unregulated diabetes. She was still PU/PD, polyphagic, and was losing weight. On presentation to me, she was on 7 units of NPH insulin q 12hours. 2. Exam: On physical exam, Kitty was BAR and purring. She weighed 4 kg and had a body condition score of 3.5/9. No other significant findings were noted on physical exam. 3. Procedures: During the exam, I discussed insulin resistance with the owner. Kitty is not at a level of insulin that is absolutely diagnostic for insulin resistance (> 2units/kg) but she is way above a dose which should regulate her. We discussed that the next step was full bloodwork to rule out other underlying diseases and a glucose curve to rule out a somogyi effect. “Kitty’s” owners were instructed to drop her off the next morning for a glucose curve. The owners were instructed to follow her normal morning routine by feeding and giving her insulin dose and then to bring her immediately in. A blood glucose reading was obtained immediately upon arrival and then every 1-2 hours afterwards. 4. Diagnosis: Continue reading >>
Canine And Feline Diabetes - The Somogyi Effect
Canine and feline diabetes is a disease that results in an abnormal increase in blood glucose levels. When treated with insulin, the blood glucose levels are decreased and, hopefully, kept within the normal range. Insulin overdose, however, is possible and can lead to a phenomenon known as the Somogyi effect. What Is the Somogyi Effect and How Does It Affect a Diabetic Dog or Cat? The Somogyi effect occurs when an overdose of insulin occurs. The insulin acts to lower the blood glucose (blood sugar) level. However, because of the fact that too much insulin was given, the blood glucose level may fall lower than the normal range. When the blood glucose becomes too low (a condition known as hypoglycemia), the body has defense mechanisms that go into effect to force the glucose to increase again. However, the dog or cat may not be able to control how high the blood glucose goes and it may rebound to an abnormally high level. This is known as the Somogyi effect. This effect may actually become circular in its effect if the insulin overdosage is ongoing. When the insulin dose is given, the blood glucose level first falls to below normal then rebounds to an abnormally high level. The insulin dose is repeated, which again leads to first an abnormally low glucose level and then a rebound to an abnormally high level. And the circle goes on and on. How Is the Somogyi Effect Diagnosed in Dogs and Cats with Diabetes? A blood glucose curve will be necessary to diagnose this phenomenon. The blood glucose curve is a series of blood glucose measurements taken at regular intervals after the administration of insulin. When evaluating a blood glucose curve for a dog or cat that is experiencing the Somogyi effect, it will be possible to see the blood glucose value drop first to an abnormally Continue reading >>
Hazards Of Hypoglycemia (low Blood Sugar)
Hypoglycemia is a serious risk factor in diabetes management. Recent studies suggest that approximately 10 percent of diabetic dogs experienced hypoglycemic episodes that required hospitalization. One large survey found that the majority of diabetic dogs presented for hypoglycemia were receiving high doses of insulin (0.7 units or more per pound of body weight). Overdosing, double-dosing, and persistent dosing despite weight loss or reduced food intake are common iatrogenic causes of hypoglycemia. (Iatrogenic diseases are caused by medical treatment.) Strenuous exercise or maldigestion caused by EPI, bacterial overgrowth, inflammatory bowel disease, or other digestive disorders can also lead to hypoglycemia in diabetic dogs. If you’re ever uncertain about whether insulin was administered, the safest option is to withhold the injection. The consequences of missing a single insulin dose are negligible, while overdosing can be fatal. Never add more if you are unsure, including if some insulin spills while you give the injection. Changes in body weight may require insulin dosage modifications. Dietary changes, particularly reduced carbohydrates, may require a reduced insulin dosage to prevent hypoglycemia. Severe hypoglycemia resulting from too much insulin can cause seizures, irreversible brain damage, and death. Warning signs include nervousness, hyperexcitability, anxiety, vocalization, muscle tremors, lack of coordination, wobbliness (the dog may appear drunk), and pupil dilation. If these signs are seen, the dog should be fed immediately. If the dog can’t or won’t eat, rub Karo syrup, pancake syrup, honey, or even sugar water on her gums before calling your veterinarian. If immediate improvement is not seen, transport your dog to the vet after feeding for further Continue reading >>
Insulin Overdose
Tweet Taking too much insulin can lead to hypoglycemia. This can become particularly serious if your insulin dose was significantly more than it should have been. If you are worried that you have overdosed on insulin, take ample fast-acting carbohydrate immediately and seek advice from your health team, or the out-of-hours service at your local hospital, if applicable. Symptoms of an insulin overdose The list of symptoms below are symptoms of hypoglycemia which can result from an insulin overdose: Depressed mood Drowsiness Headache Hunger Inability to concentrate Irritability Disorientation Nausea Nervousness Personality changes Rapid heartbeat Restlessness Sleep disturbances Slurred speech Pale skin Sweating Tingling Tremor Unsteady movements Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why people with diabetes are advised to avoid sources of dietary sugar. The good news is for very many people with type 2 diabetes this is all they have to do to stay well. If you can keep your blood sugar lower by avoiding dietary sugar, likely you will never need long-term medication. Type 2 diabetes was formerly known as non-insulin-dependent or adult-onset diabetes due to its occurrence mainly in people over 40. However, type 2 Continue reading >>
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Diabetic Complications
Diabetes mellitus is a disease of glucose dysregulation secondary to relative insulin resistance (non-insulin dependent diabetes mellitus) or an absolute insulin deficiency (insulin dependent diabetes mellitus). The pathophysiology and management of uncomplicated diabetes mellitus is too involved to describe here. Most veterinarians feel comfortable diagnosing diabetes mellitus in dogs and cats, and the diagnostics are straightforward and easy to interpret. Currently the options for long acting insulin include glargine, humulin N, detemir, porcine zinc (Vetsulin™) and protamine zinc (ProZinc™). Most of these products are human recombinant insulins. No insulin type has been definitively shown to be better than another in a single species. Several small studies within the last 4 years have suggested, however, that glargine and detemir may achieve better glycemic control and remission rates in cats when compared to humulin N and protamine zinc insulins. Several excellent resources to turn to for more information include Feline Internal Medicine (August JR 2010), Textbook of Veterinary Internal Medicine (Ettinger SJ, Feldman EC 2010), Current Veterinary Therapy XIII, XIV (Bonagura JD, Twedt DC 2009). Table 1 compares the most commonly used long acting insulins in dogs and cats. Table 1. Comparison of different types of insulin most commonly used in dogs and cats. Insulin Syringe Source Dose Humulin N u-100 Human recombinant Dogs and cats 0.1-0.2 u/kg q 12 hr Protamine Zinc, ProZinc™ u-40 Human recombinant Cats only 0.2 – 0.7 u/kg q 12 hr Glargine, Lantus ™ u-100 Synthetic 0.25 – 0.5 u/kg q12 hr Detemir , Levemir ™ u-100 Human recombinant Cats 0.25 – 0.5 u/kg q 12hr Dogs 0.1 – 0.2 u/kg q 12 hr Porcine Zinc, Vetsulin ™ u-40 Porcine Cats 1 – 2 u/kg q 12hr Continue reading >>
Diabetes Mellitus
If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site By Wendy C. Brooks, DVM, DipABVP Educational Director, VeterinaryPartner.com What is Diabetes Mellitus? In order to understand the problems involved in diabetes mellitus, it is necessary to understand something of the normal body's metabolism. The pancreas is nestled along the stomach and small intestine. It secretes digestive enzymes into the small intestine but it also secretes hormones into the bloodstream to regulate blood sugar. The cells of the body require a sugar known as glucose for food and they depend on the bloodstream to bring glucose to them. They cannot, however, absorb and utilize glucose without a hormone known as insulin. This hormone, insulin, is produced by the pancreas. Insulin is like a key that unlocks the door to separate cells from the sugars in our bloodstream. Glucose comes from the diet. When an animal goes without food, the body must break down fat, stored starches, and protein to supply calories for the hungry cells. Proteins and starches may be converted into glucose. Fat, however, requires different processing that can lead to the production of ketones rather than glucose. Ketones are another type of fuel that the body can use in a pinch but the detection of ketones indicates that something wrong is happening in the patient's metabolism. Ketones may therefore be detected in the urine of starving animals because of massive fat mobilization is required for ketone formation. Ketones can also be detected in diabetic ketoacidosis, a severe complication of unregulated diabetes so it is helpful to periodically monitor for ketones in a diabetic patient's urine. The point is, for now, that in times of extreme fat burning (such as in sta Continue reading >>
Consider This Case An Uncontrolled Diabetic Dog
Ann DellaMaggiore, DVM, DACVIM University of California, Davis QUESTIONS: Investigating the Unstable Diabetic Dog What are possible causes of poor diabetic control in this dog? Are there problems with insulin handling and administration? Is this dog receiving an appropriate insulin type and dose? What and when is the dog being fed, and does the dog receive any additional treats or table scraps? What are possible causes of insulin resistance in this dog? What additional diagnostics would help in better assessing diabetic control? Buster, a 7-year-old male castrated beagle mix weighing 18 kg, was presented for evaluation of uncontrolled diabetes. HISTORY Previous Diagnosis Six months before presentation, Buster was presented to his primary veterinarian for polyuria, polydipsia, and weight loss. Physical examination and complete blood count (CBC) were unremarkable, while the serum biochemical profile (Table 1) demonstrated: Mildly increased alkaline phosphatase (ALP) Mild hypercholesterolemia Hyperglycemia The urinalysis showed glucosuria, with no evidence of ketones, white blood cells, or bacteria. Based on these findings, Buster was diagnosed with diabetes mellitus. Medical Therapy After diagnosis, Buster’s primary veterinarian initiated therapy with neutral protamine Hagedorn (NPH) insulin at 9 U (0.5 U/kg) SC q12h. Intermittent spot blood glucose monitoring was used to determine adjustments in insulin dose and, based on variably high results (>350 mg/dL), Buster’s insulin dose was increased approximately every 3 days. Upon presentation for a second opinion on diabetic control, Buster was receiving 30 U of NPH insulin q12h. The insulin was from a new prescription, stored in the refrigerator, and the administration technique (visualized as part of history collection) Continue reading >>
Hypoglycaemia In Canine And Feline Diabetes
If the insulin dose is too high, clinical signs of hypoglycaemia may be observed. Hypoglycaemia can be triggered by events causing a relative insulin overdose loss of appetite vomiting excessive exercise clinical remission of diabetes in cats Clinical signs The clinical signs of hypoglycaemia, in increasing order of severity, are hunger, restlessness, shivering, ataxia, disorientation, convulsions and coma. Some animals may just become very quiet and inappetent. Treatment Emergency Treatment of Hypoglycaemia Immediate oral administration of glucose solution or honey (1 g per kg body weight). Animals that are collapsed should not have large volumes of fluid forced into their mouths as this may result in aspiration pneumonia: here it is preferable to rub a small amount of the glucose solution or honey onto the animal’s gums or under its tongue. Intravenous dextrose solution (50%) can be administered in severe cases or if oral therapy has been ineffective. Dose for hypoglycaemia 1-5 ml 50% dextrose by slow intravenous injection (over 10 minutes)* - not aimed to correct blood glucose concentration but to reverse clinical signs. *(Ref: BSAVA Small Animal Formulary. Ed Tennant B. 4th Edition. BSAVA, UK. p 124) Owners of diabetic pets need to always have a source of glucose readily available. Following the successful emergency administration of oral glucose, small amounts of food should be offered at intervals of 1-2 hours until the effects of the insulin overdose have been counteracted. If the insulin dose is too high, it should be reduced, e.g. by at least 10%. It may be necessary to construct a serial glucose curve to enable appropriate adjustment of the insulin dose. Continue reading >>
