2010 Aaha Diabetes Management Guidelines For Dogs And Cats
Renee Rucinsky, DVM, ABVP (Feline) (Chair) | Audrey Cook, BVM&:S, MRCVS, Diplomate ACVIM-SAIM, Diplomate ECVIM-CA | Steve Haley, DVM | Richard Nelson, DVM, Diplomate ACVIM | Debra L. Zoran, DVM, PhD, Diplomate ACVIM | Melanie Poundstone, DVM, ABVP - Download PDF - Introduction Diabetes mellitus (DM) is a treatable condition that requires a committed effort by veterinarian and client. This document provides current recommendations for the treatment of diabetes in dogs and cats. Treatment of DM is a combination of art and science, due in part to the many factors that affect the diabetic state and the animal's response. Each animal needs individualized, frequent reassessment, and treatment may be modified based on response. In both dogs and cats, DM is caused by loss or dysfunction of pancreatic beta cells. In the dog, beta cell loss tends to be rapid and progressive, and it is usually due to immune-mediated destruction, vacuolar degeneration, or pancreatitis.1 Intact females may be transiently diabetic due to the insulin-resistant effects of the diestrus phase. In the cat, loss or dysfunction of beta cells is the result of insulin resistance, islet amyloidosis, or chronic lymphoplasmacytic pancreatitis.2 Risk factors for both dogs and cats include insulin resistance caused by obesity, other diseases (e.g., acromegaly in cats, hyperadrenocorticism in dogs), or medications (e.g., steroids, progestins). Genetics is a suspected risk factor, and certain breeds of dogs (Australian terriers, beagles, Samoyeds, keeshonden3) and cats (Burmese4) are more susceptible. Regardless of the underlying etiology, diabetic dogs and cats are hyperglycemic and glycosuric, which leads to the classic clinical signs of polyuria, polydipsia (PU/PD), polyphagia, and weight loss. Increased fat mobi Continue reading >>
Diabetes In Dogs
Illustration of a dog's pancreas. Cell-islet in the illustration refers to a pancreatic cell in the Islets of Langerhans, which contain insulin-producing beta cells and other endocrine related cells. Permanent damage to these beta cells results in Type 1, or insulin-dependent diabetes, for which exogenous insulin replacement therapy is the only answer. Diabetes mellitus is a disease in which the beta cells of the endocrine pancreas either stop producing insulin or can no longer produce it in enough quantity for the body's needs. The condition is commonly divided into two types, depending on the origin of the condition: Type 1 diabetes, sometimes called "juvenile diabetes", is caused by destruction of the beta cells of the pancreas. The condition is also referred to as insulin-dependent diabetes, meaning exogenous insulin injections must replace the insulin the pancreas is no longer capable of producing for the body's needs. Dogs can have insulin-dependent, or Type 1, diabetes; research finds no Type 2 diabetes in dogs.[1][2][3] Because of this, there is no possibility the permanently damaged pancreatic beta cells could re-activate to engender a remission as may be possible with some feline diabetes cases, where the primary type of diabetes is Type 2.[2][4][5] There is another less common form of diabetes, diabetes insipidus, which is a condition of insufficient antidiuretic hormone or resistance to it.[6][7] This most common form of diabetes affects approximately 0.34% of dogs.[8] The condition is treatable and need not shorten the animal's life span or interfere with quality of life.[9] If left untreated, the condition can lead to cataracts, increasing weakness in the legs (neuropathy), malnutrition, ketoacidosis, dehydration, and death.[10] Diabetes mainly affects mid Continue reading >>
Diabetic Ketoacidosis In Cats And Dogs
Over the last few days the signs have been getting worse. Your pet isn’t doing well; it is depressed, isn’t eating, and may even be vomiting. You thought it would get better, but it hasn’t and in fact your pet looks really sick. So you decide to take your pet into the veterinarian, who runs a bunch of tests. It is most likely that the animal will be whisked away to a treatment room after the veterinarian confirms a diagnosis of diabetic ketoacidosis. What is diabetic ketoacidosis (DKA)? You didn’t even know that your pet was diabetic, so how could it have this problem? Diabetic ketoacidosis most commonly develops in animals with undiagnosed diabetes. However, animals with diabetes can develop this problem as well, if their diabetes gets out of control. The reason that your pet will be quickly taken to the treatment room is because DKA is an emergency. These animals look sick because their whole body is being affected by the problem. If the situation is not addressed quickly, DKA can cause irreversible damage. This doesn’t mean that your pet will be fixed overnight. Even uncomplicated, mild cases of DKA often stay in the hospital for two or three days. Before we explain DKA, let’s review the meaning of diabetes. Diabetes is a situation where the body does not have enough insulin. Insulin is needed for cells to absorb glucose (which is crucial for normal cell function) from the blood stream. When cells don’t have insulin, they don’t absorb enough glucose and the cells starve. This starvation causes the liver to release more glucose into the blood stream. But without insulin, cells cannot absorb the glucose that is in the blood, and they continue to starve. This is how the vicious circle goes on. Usually diabetes is caught at this point, and the pet is star Continue reading >>
Diabetic Ketoacidosis In Dogs
Diabetic ketoacidosis (DKA) is an emergency. DKA develops due to: Long standing undiagnosed canine diabetes Insufficient insulin dose in treated diabetic dogs Reduced insulin action - caused by obesity, concurrent illness or drugs. This is the cause of more than two-thirds of cases of DKA. What causes diabetic ketoacidosis? Due to a lack of insulin, glucose cannot be used by the body cells as an energy source. Instead fat is broken down to provide energy. When fat is used as an energy source, acids known as ketones are produced. Ketones circulating in the blood cause signs of DKA - anorexia, nausea and lethargy. Diagnosis The diagnosis of DKA is based on detecting ketones in the urine and sometimes in the blood along with signs of illness. See Urine Monitoring for more information. Treatment DKA is an emergency and treatment must be started as soon as possible. Your veterinary surgeon will administer intravenous fluids and insulin and correct any underlying disorders to stabilise your dog. Once your dog is stabilised it will be started on long term insulin therapy again. Continue reading >>
Treatment Of Diabetic Ketoacidosis In Dogs By Continuous Low-dose Intravenous Infusion Of Insulin.
Abstract In a prospective clinical trial, low-dose, continuous, IV infusion of insulin (dosage, 2.2 U/kg of body weight, q 24 h) was used to treat 21 dogs with diabetic ketoacidosis. Mean (+/- SD) blood glucose concentration at the onset of treatment was 550 +/- 150 mg/dl and after 6 hours, was 350 +/- 106 mg/dl, with a mean decline of 34 +/- 16 mg/dl/h. By 12 hours, mean blood glucose was 246 +/- 85 mg/dl, with a mean decline of 28 +/- 14 mg/dl/h during the second 6 hours of treatment. Mean duration of treatment required to reach a blood glucose concentration < or = 250 mg/dl was 10 +/- 4 hours, with a range of 4 to 24 hours. Ketonuria was observed for 26 +/- 14 hours (range, 6 to 72 hours). Hypoglycemia developed in 3 of 21 dogs during treatment, but responded to IV administration of a glucose solution and to a reduction in rate of insulin delivery. Potassium supplementation was required in 15 of 21 dogs. Mean bicarbonate concentration was 11.6 +/- 3.4 mEq/L before treatment and was 18.2 +/- 0.7 mEq/L after 24 hours. Fifteen of 21 dogs (71%) survived to be discharged. Mean duration of treatment with the insulin infusion was 50 +/- 30 hours (range, 7 to 124 hours). In this series of dogs, continuous, low-dose, IV infusion of insulin provided a gradual and consistent reduction in blood glucose concentration while ketoacidosis, electrolyte balance, and dehydration were corrected.(ABSTRACT TRUNCATED AT 250 WORDS). Continue reading >>
- Diabetes Complications in Dogs and Cats: Diabetes Ketoacidosis (DKA)
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Diabetes in Dogs: Symptoms, Causes, & Treatment
Hormonal Disorders: Ketoacidosis
Cause of Ketoacidosis When your dog eats, the body breaks the food down into several component parts for absorption into the body. One of those components is sugar (also called glucose). Insulin produced by the pancreas is the bodies mechanism for controlling how much sugar enters each cell for energy. When the insulin level is not correct due to overeating or a disease such as pancreatitis, the cells cannot get the energy they need. This triggers a series of symptoms such as over eating, weight loss and as the sugar accumulates in the blood, thirst and urination. Since enough sugar isn't entering the cells for energy, the body looks for alternate sources such as stored fat in the body. The body doesn't break down fat efficiently resulting in acid compounds that accumulate in the blood. These acid compounds are called ketones and the condition is called ketoacidosis. Symptoms are therefore those associated with diabetes and then additional symptoms caused by the body basically starving for energy and trying to break down fat. Symptoms Diagnosis of this disorder is based on a review of your dog's symptoms including: Symptoms Associated with Canine Diabetes: Excessive Thirst Weight Loss Increased Urination Plus symptoms that are associated with ketoacidosis: Vomiting Anorexia (desire not to eat) Dehydration Weakness Results of certain tests will also confirm the disease: High concentration of glucose (sugar) in your dog's blood (called hyperglycemia) and urine (glucosuria) Ketonuria (presence of ketones in the blood, which are nutrients that are not broken down properly) High acid level in the blood (acidosis) To confirm many of the above symptoms, laboratory is required. Treatment will begin even before test results are in because of the severity of symptoms. Lab tests r Continue reading >>
Clinical Signs Of Diabetes Mellitus In Dogs And Cats
Clinical signs are useful in the diagnosis and monitoring of canine and feline diabetes. Other laboratory tests are also necessary for diagnosis of Diabetes mellitus and the monitoring of treated diabetic pets. There are three distinct clinical pictures in diabetes mellitus: Uncomplicated diabetes mellitus The classical signs are polyuria,polydipsia, polyphagia, cachexia and increased susceptibility to infections (e.g. urinary tract infections). In long term diabetes complications due to protein glycosylation can be seen: cataracts (mainly in dogs) and peripheral neuropathy (mainly in cats). Diabetic ketoacidosis DKA develops due to long standing undiagnosed diabetes mellitus, insufficient insulin dose in treated diabetics and impaired insulin action and/or resistance, caused by obesity, concurrent illness or drugs. This is the cause of more than two thirds of cases of DKA. Due to the lack of insulin, glucose cannot be used as an energy source. Fats are broken down to provide energy. During lipolysis, high levels of ketones are produced. Ketosis and acidosis develop and are accompanied by electrolyte imbalances. Ketosis causes anorexia, nausea and lethargy. Treatment DKA is an emergency and treatment must be started as soon as possible. The goals of treatment are to correct fluid deficits, acid-base balance and electrolyte balance, lower blood glucose and ketone concentrations and recognize and correct underlying and precipitating factors. Therapy includes intravenous fluid therapy with isotonic fluids, e.g. 0.9% saline, and intravenous administration of rapid-acting insulin. If possible the electrolyte concentrations and acid-base balance should be measured and corrected. Caninsulin is an intermediate-acting insulin and is not suitable for intravenous administration. W Continue reading >>
Diabetic Ketoacidosis (dka) In Dogs
Overview Diabetic Ketoacidosis (DKA) in Dogs Diabetic ketoacidosis (DKA), the most severe form of Diabetes Mellitus in dogs, results in severe changes in blood chemicals including imbalances in small, simple chemicals known as electrolytes. Diabetes mellitus (DM) is a chronic condition in which a deficiency of the hormone insulin impairs the body’s ability to metabolize sugar. It is one of the most common endocrine (hormonal) diseases of dogs. For more information on the basics of diabetes, go to Diabetes mellitus in dogs DKA is a life-threatening condition caused by diabetes mellitus resulting from insulin deficiency that leads to excess production of ketoacids by the liver. Subsequent changes in the blood result that includes metabolic acidosis, electrolyte abnormalities producing severe signs of systemic illness. DKA condition can occur in pets with new diabetes or in current diabetics that decompensate. Secondary diseases and/or infections can cause diabetics to decompensate and develop DKA. What to Watch For with Diabetic Ketoacidosis (DKA) Signs associated with DKA depend on the individual pet and the length of time they have been ill. Signs may consist of the classic signs of diabetes including: Increased thirst Increased frequency of urination Weight loss despite a good appetite Sudden blindness Additional signs of DKA include: Lethargy Vomiting Weakness Dehydration Some pets will have a strong smell of acetone from their breath Diagnosis of Diabetic Ketoacidosis (DKA) in Dogs Diagnostic tests for DKA in dogs may include: Complete medical history and thorough physical examination. Serum biochemical profile to determine the blood glucose concentration and to exclude other potential causes of the same symptoms such as pancreatitis. Elevated blood glucose is the Continue reading >>
Diabetes With Ketone Bodies In Dogs
Studies show that female dogs (particularly non-spayed) are more prone to DKA, as are older canines. Diabetic ketoacidosis is best classified through the presence of ketones that exist in the liver, which are directly correlated to the lack of insulin being produced in the body. This is a very serious complication, requiring immediate veterinary intervention. Although a number of dogs can be affected mildly, the majority are very ill. Some dogs will not recover despite treatment, and concurrent disease has been documented in 70% of canines diagnosed with DKA. Diabetes with ketone bodies is also described in veterinary terms as diabetic ketoacidosis or DKA. It is a severe complication of diabetes mellitus. Excess ketone bodies result in acidosis and electrolyte abnormalities, which can lead to a crisis situation for your dog. If left in an untreated state, this condition can and will be fatal. Some dogs who are suffering from diabetic ketoacidosis may present as systemically well. Others will show severe illness. Symptoms may be seen as listed below: Change in appetite (either increase or decrease) Increased thirst Frequent urination Vomiting Abdominal pain Mental dullness Coughing Fatigue or weakness Weight loss Sometimes sweet smelling breath is evident Slow, deep respiration. There may also be other symptoms present that accompany diseases that can trigger DKA, such as hypothyroidism or Cushing’s disease. While some dogs may live fairly normal lives with this condition before it is diagnosed, most canines who become sick will do so within a week of the start of the illness. There are four influences that can bring on DKA: Fasting Insulin deficiency as a result of unknown and untreated diabetes, or insulin deficiency due to an underlying disease that in turn exacerba Continue reading >>
Diabetic Ketoacidosis In Dogs: Symptoms, Causes, & Treatments
Diabetic ketoacidosis in canine, every now and then shortened to DKA, is a dangerous clinical emergency that occurs when there isn’t sufficient insulin within the frame to keep an eye on ranges of blood sugar referred to as glucose. It is a complication of diabetes mellitus that calls for rapid clinical remedy sooner than it turns into deadly. When insulin ranges drop, the frame can’t use glucose correctly, so glucose builds up within the blood whilst the liver produces ketone our bodies to behave as an emergency gas supply. When ketone our bodies are damaged down, they purpose the frame’s pH stability to shift and turn into extra acidic. Dogs can’t deal with their fluid and electrolyte stability, which ends up in fatal signs. If your canine presentations indicators of diabetic ketoacidosis, particularly if they’ve been recognized with diabetes, it is vital that you just see an emergency veterinarian instantly for remedy. Here is what you will have to know in regards to the signs, reasons, and coverings for diabetic ketoacidosis in canine. Symptoms Of Diabetic Ketoacidosis In Dogs (Picture Credit: Getty Image) Sometimes canine that be afflicted by diabetic ketoacidosis best display gentle signs, however the majority of affected animals get very in poor health inside per week of the beginning of the sickness. The signs of diabetic ketoacidosis can resemble the caution indicators of a diabetic situation, which additionally calls for clinical consideration. The distinction is that diabetic ketoacidosis is the frame’s ultimate effort at survival sooner than succumbing to diabetes. Here are a number of signs of diabetic ketoacidosis in canine. Excessive thirst or urination Dehydration Sweet breath Sudden weight reduction Muscle loss Loss of urge for food Fatigue Continue reading >>
Diabetic Ketoacidosis In Dogs
My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>
What Causes High Ketones In A Canine?
A dog with a high level of ketones in his urine suffers from a condition known as ketonuria, usually resulting from a buildup of these substances in the dog's blood. A ketone is a type of acid, which, if allowed to accumulate in the blood, can lead to ketoacidosis, a potentially fatal condition. The main health conditions that can cause high ketone levels in a canine are starvation and diabetes. A dog's body breaks down the food that he eats into sugars, also called glucose, that the cells of the body use for energy. The dog's pancreas then produces the hormone insulin to regulate the amount of glucose that the body will absorb. If the insulin to regulate the glucose is insufficient, typically due to chronic diabetes mellitus, the body breaks down alternate sources of fuel for its cells; a dog's body that is starved of nutrition will do the same. One of these sources is the fat stored in the dog's body. When the body breaks down this fat, it produces as a by-product toxic acids known as a ketones. These ketones then build up in the dog's blood and also his urine, leading to ketoacidosis. Always consult an experienced veterinarian regarding the health and treatment of your pet. A dog suffering from high ketone levels in his blood and urine exhibits symptoms of weight loss, vomiting, increased thirst, decreased appetite, increased urination, lethargy, low body temperature and yellowing of the skin and gums, according to PetMD. The dog's breath may also have a sweet, fruity smell due to the presence of acetone caused by ketoacidosis, says VetInfo. To properly diagnose high ketone levels and ketoacidosis in your dog, a veterinarian will take blood tests and a urinalysis, which will also check your dog's blood glucose levels. Depending on the dog's physical condition, hospit Continue reading >>
Care Of Diabetic And Diabetic Ketoacidotic Patients (proceedings)
Diabetes mellitus is the condition of hyperglycemia (high blood glucose) and glucosuria (glucose in the urine) caused by absence of the hormone insulin, or failure of the cells of the body to be able to respond to insulin. Diabetes mellitus is the condition of hyperglycemia (high blood glucose) and glucosuria (glucose in the urine) caused by absence of the hormone insulin, or failure of the cells of the body to be able to respond to insulin. Diabetes mellitus in veterinary patients can most often be compared to human adult onset diabetes (type 2), and juvenile onset diabetes is rare in veterinary patients. Patients may present with few clinical signs, in relatively good health (uncomplicated diabetes mellitus), or may be weak and dehydrated with severe electrolyte abnormalities (ketoacidotic diabetes mellitus). The most common clinical signs include weight loss, polyuria/polydipsia, increased or decreased appetite, unkempt hair coat, dandruff, sudden onset blindness (in dogs from cataract formation secondary to diabetes), and hind limb weakness (from diabetic neuropathy in cats) . In dogs and cats that have progressed to diabetic ketoacidosis, vomiting, anorexia, and lethargy are common complaints. Physical examination findings can reveal thin body condition, cataracts (dogs), dehydration, and mental dullness. Animals with recent onset diabetes mellitus can have a relatively normal examination. Laboratory testing to diagnose diabetes mellitus is relatively straightforward, and diagnosis can be confirmed at the time of evaluation in some cases with in-house testing. Elevated blood glucose is the mainstay of diagnosis; however keep in mind that hyperglycemia may be from diabetes, or secondary to a stress response, especially in cat. Handheld glucometers that are used by h Continue reading >>
Understanding And Treating Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>
Sugar High: Petplan Pet Insurance On Diabetic Ketoacidosis In Pets
We’ve discussed diabetes before--it’s a condition in cats and dogs caused by either a relative or absolute lack of insulin, which leads to high blood sugar. Blood sugar that is too high for too long results in a serious condition called diabetic ketoacidosis. We see diabetic ketoacidosis (or DKA, for short) in patients who are being under treated for diabetes and in patients whose diabetes was previously undiagnosed. These patients often come into the office on an emergency basis because of severe illness--they are vomiting, lethargic, dehydrated, and sometimes semi-comatose. High levels of glucose (or sugar) are found in both the blood and the urine due to insufficient insulin, and ketones are also present in the urine. In addition to high blood sugar levels, an insulin deficiency also affects the metabolism of fat, resulting in an increase in free fatty acids. These are converted to ketones. When insulin is low, ketones cannot be adequately utilized, so they build up in the body, causing ketosis. Ketosis causes acidosis (or acidifying of the blood), vomiting, dehydration, and sometimes neurological problems. In short, they make your diabetic pet feel pretty terrible. Not all animals with DKA show physical signs of illness. If ketones are present in your diabetic pet’s urine, then she also has ketoacidosis, even if she doesn’t appear to be sick. Non-sick ketoacidotic animals need to have their insulin doses re-evaluated to make sure the diabetes is adequately controlled. DKA can be life threatening, so treatment requires hospitalization. Fluid therapy is an important part of treatment to correct dehydration and addresses electrolyte imbalances. Short-acting insulin is administered frequently to decrease blood sugar levels quickly. Once blood glucose levels are Continue reading >>
