Canine Diabetes Overview

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Introduction to Diabetes Mellitus

Diabetes mellitus is a common endocrinopathy in middle-aged and older dogs and is a complex disorder of carbohydrate, protein, and lipid metabolism. This disorder, which is the result of a relative or absolute insulin deficiency or of peripheral cell insensitivity to insulin, is characterized by high blood glucose concentrations such that the renal threshold is exceeded. As a result, glucose is excreted in the urine.

The osmotic action of glucose leads to polyuria and, through response to loss of fluid, to polydipsia. In addition, metabolism is impaired so that the general condition of the animal deteriorates, ultimately leading to death if untreated.

Insulin is synthesized in and released from beta cells in the pancreatic islets. Insulin assists with cellular uptake of glucose from the bloodstream, thus exerting a glucose-lowering effect. Within cells, insulin promotes anabolism (such as synthesis of glycogen, fatty acids, and proteins) and counters catabolic events (reduces gluconeogenesis and inhibits fat and glycogen breakdown).

Whereas insulin lowers blood glucose, there are opposing hormones (glucagon, cortisol, progesterone, adrenaline, thyroid hormone, and growth hormone) that act to increase blood glucose. It is important to consider these counter-regulatory hormones, because changes in their blood concentrations will interfere with insulin actions. Changes in these hormones can occur in natural physiological conditions, in disease states, or as a consequence of drug administration.

In the absence of sufficient insulin, dogs with diabetes will switch from glucose to fat metabolism for cellular energy. While this is initially beneficial, fat metabolism in unrecognized or untreated diabetes typically progresses to ketoacidosis and ultimately to death.

Diabetes mellitus is not related to diabetes insipidus, an uncommon condition that occurs when the kidneys are unable to regulate fluids in the body. Diabetes insipidus is characterized by a deficiency or inadequate response to a hormone called vasopressin.

Disease Prevalence and Risk Factors

Estimates of the prevalence of diabetes mellitus in dogs is up to 23.6 canine cases per 10,000.¹⁵

Certain breeds appear to be at greater risk for developing canine diabetes:

• Cocker Spaniels
• Dachshunds
• Doberman Pinschers
• German Shepherds
• Golden Retrievers
• Labrador Retrievers
• Pomeranians
• Terriers
• Toy Poodles
• Miniature Schnauzers
• Keeshond
• Samoyeds

Diabetes typically occurs when dogs are between 4 to 14 years of age. Unspayed female dogs are twice as likely as male dogs to suffer from diabetes.

Management and Prognosis

The prognosis for diabetes mellitus depends mainly on the cause of it, early diagnosis and adequate therapy. In general, the prognosis is very good, provided that diagnosis is made at an early stage and therapy is administered properly.

Most forms of diabetes can be successfully managed with insulin, the cornerstone of successful management, but dietary adjustments and a regular lifestyle are also important.

Open communication between client and veterinarian is also extremely important. Your encouragement will largely influence the dog owner’s motivation and compliance with therapy. Clients need to fully understand the disease to help achieve and maintain good diabetic stability and be highly motivated and committed to the management of their dog.

The clinical staff should also understand the basics of diabetes and its management. They have an important role in providing detailed client education, instruction, and encouragement.

Help Your Practice Manage Diabetes Mellitus

View and download resources and tools that will assist your hospital, inform your team, and help with clients.

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Important Safety Information:

Vetsulin^® should not be used in dogs known to have a systemic allergy to pork or pork products. Vetsulin is contraindicated during periods of hypoglycemia. Keep out of reach of children. As with all insulin products, careful patient monitoring for hypoglycemia and hyperglycemia is essential to attain and maintain adequate glycemic control and prevent associated complications. Overdosage can result in profound hypoglycemia and death. The safety and effectiveness of Vetsulin in puppies, breeding, pregnant, and lactating dogs has not been evaluated. See package insert for full information regarding contraindications, warnings, and precautions.

References:

1. Martin GJ, Rand JS. Pharmacology of a 40 IU/ml porcine lente insulin preparation in diabetic cats: findings during the first week and after 5 or 9 weeks of therapy. J Feline Med Surg. 2001;3(1):23–30. 2. Vetsulin^® (porcine insulin zinc suspension) [Freedom of Information Summary]. Millsboro, DE: Intervet Inc.; 2008. 3. Data on file, Merck Animal Health. 4. Graham PA, Nash AS, McKellar QA. Pharmacokinetics of porcine insulin zinc suspension in diabetic dogs. J Small Anim Pract. 1997;38(10):434–438. 5. Martin GJ, Rand JS. Pharmacokinetic and Pharmacodynamic Study of Caninsulin in Cats with Diabetes Mellitus. 2000: Internal Study Report. 6. Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. 3rd ed. St. Louis, MO: Saunders; 2004:539–579. 7. Tennant B, ed. BSAVA Small Animal Formulary. 4th ed. Gloucestershire, UK: British Small Animal Veterinary Association; 2002. 8. Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. 3rd ed. St. Louis, MO: Saunders; 2004:486–538. 9. Reusch C. Feline diabetes mellitus. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, MO: Saunders; 2010:1796–1816. 10. Nelson RW. Canine diabetes mellitus. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, MO: Saunders; 2010:1782–1796. 11. Burgaud S, Riant S, Piau N. Comparative laboratory evaluation of dose delivery using a veterinary insulin pen. In: Proceedings of the WSAVA/FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 121. 12. Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic dogs. In: Proceedings of the WSAVA/ FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 122. 13. Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic cats. In: Proceedings of the WSAVA/FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 45. 14. Davison LJ, Walding B, Herrtage ME, Catchpole B. Anti-insulin antibodies in diabetic dogs before and after treatment with different insulin preparations. J Vet Intern Med. 2008;22:1317-1325. 15. Banfield State of Pet Health 2016 Report. p 12-13. 16. Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA Diabetes management guidelines for dogs and cats. J Am Anim Hosp Assoc. 2018; 54:1–21.