Diabetes Mellitus, Canine - contd.
The goals of treatment are to return the dog to normal health and to prevent complications that can arise from a high blood glucose level. Some possible complications include infections of the urinary tract, respiratory system, and skin; ketoacidosis or severe metabolic disturbance; cataracts which result in vision loss; pancreatitis or inflammation of the pancreas; and other less common disorders. Treatment protocols include proper insulin administration, diet and exercise plans, and control of concurrent disease. Intact female patients need to be spayed as soon as their diabetes is stable to prevent disruption of diabetic control due to fluctuating reproductive hormones. Also, some unspayed diabetic dogs will have complete resolution of their diabetes after an ovariohysterectomy.
The examining veterinarian will choose an appropriate type of insulin for the dog. The most common insulin preparations are derived from a combination of beef and pork, from purified pork, and from recombinant human insulin. Many doctors now use this last form since it is readily available. Insulin types include regular crystalline, NPH, PZI, Lente, and Ultralente. The specific unit dose of insulin the veterinarian selects will be based on several factors, including body weight and type of insulin. The goal is not to achieve perfect control from the onset, but rather to allow the dog and owner to get used to the new routine of insulin injections and dietary changes.
The dog usually is rechecked weekly. It is common for the veterinarian to make adjustments in the insulin protocol during these visits. Insulin doses should not be adjusted at home unless the veterinarian has instructed the change. Blood glucose curves and other tests are required throughout treatment to accurately assess the animal's response to treatment. Some dogs can become regulated with relative ease if they respond well to therapy. Other dogs can take much longer, or never respond, especially if they have a concurrent disease. A "honeymoon period" is noted in some dogs in which they appear to respond initially to the insulin but then lose control within the first six months of therapy.
Close monitoring of the dog's water consumption and urination will alert the owner to problems with diabetic control; the veterinarian should be notified if symptoms fail to improve or if they return. Success of control is defined by the resolution of symptoms including excessive thirst, excessive urination, stability of body weight, normal behavior, and a normal blood glucose range noted in the blood tests.
Many diabetic dogs are overweight. For optimal glucose control, obesity should be corrected slowly in diabetic patients; it should take several months for the dog to reach the ideal weight recommended by the veterinarian. In addition, the veterinarian may suggest a specific diet type. Commercial diets containing higher amounts of fiber and digestible complex carbohydrates usually are advised for diabetic animals because they help decrease the fluctuations in blood glucose levels after a meal is consumed. The total daily caloric intake should be divided into multiple meals and given within the time frame of insulin action.
Exercise is highly encouraged due to its beneficial effects on blood glucose control and weight loss. If the dog has not had a structured routine, then it is recommended to start with short walks and slowly increase to a tolerable level.
