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CANINE DIABETES MELLITUS AND ITS MANAGEMENT
Dr.Sourabh KantDr.Sourabh Kant Veterinary college, Veterinary college, Palampur,H.P., india Palampur,H.P., india
Higher risk Moderate risk Neutral risk Low risk
•Cairn Terrier•Samoyed
•Bichon Frise•Border Collie•Border Terrier
•Collie•Dachshund•English Setter•Poodle•Yorkshire Terrier
• King Charles Spaniel•Cocker Spaniel•Doberman
• Russell Terrier•Labrador Retriever•Mixed Breed•Rottweiler
• Boxer•English Springer Spaniel
•German Shepherd•Golden Retriever•Bull Terrier•Weimaraner• Springer Spaniel
Pathogenesis
Destruction of beta cells of pancreas
Deficiency of insulin in the body
Without insulin, glucose unable to enter into the cell
Prevent the muscles and organs from converting glucose to energy
Excessive amounts of glucose in the blood [hyperglycemia]
Disorder of carbohydrate, protein, and fat metabolism caused by an absolute or relative insulin deficiency
Appropriate insulin function will trigger the liver and muscles to take up glucose from the blood cells and converting it to energy
Glucose is not making it to the brain due to deficiency of insulin
Insulin is not giving the muscles and organs the signal to convert glucose to energy
Excess glucose in the blood will be carried to the urine instead of being used for energy
Cause concurrent lack of energy.
There is also increased thirst as a result of the increase in urine.
Main organ affected are liver, eyes , kidneys At higher risk are obese dogs and female dogs. While
many cases of diabetes are seen in older dogs, it can occur at any age.
Disease complicationsKetones – ketoacidosis A dangerous and often quickly fatal condition
Ketones are produced by the liver as part of fat metabolism
When glucose is not available as an energy source because of untreated or poorly treated diabetes
Body start to use fat for energy Fat metabolism produce more ketone production
For diagnosis purpuse,fresh sample required. Ketones evaporate quickly, so there is a chance of getting a false negative test result if testing older urine
2.Dehydration
Body fluid loss is measured in two major ways–sensible and insensible.
Sensible is measured as vomiting, urination and defecation
Ability to be measured.
An insensible loss e.g. is breathing because while there are some fluid losses ,not possible to measure the amount of them.
Pet's gums and skin can indicate dehydration
Gums are tacky and dry and skin does not snap back quickly when pinched if dehydration is present.
When the skin at the back is lifted, a dehydrated animal's does not fall back into place quickly
Serious dehydration (loss of 10–12% of body fluids)
Symptoms
Excessive thirst
Excessive urination
Hunger
Weight loss even with normal appetite
Later signs.Anorexia
Lethargy and depression
Vomition Cataract
Other sign…..
Obesity
Enlarged liver
Liver and Kidney infection
Cataract
mg/dl Blood Glucose Guidelines
<50Readings at or below this level are considered hypoglycemic when using insulin,even without visible hypoglycemia symptoms. Immediate treatment is needed
62-108 Normal glucose values range for dogs who do not have diabetes
90 Minimum safe value for the lowest target blood sugar of the day when insulin-controlled
100-180 Target range for diabetics
180Renal threshold for dogs when excess glucose in the blood spills into the urine.The kidneys are unable to reabsorb it all ,diabetic symptoms appear
Mg/dl Blood Glucose Guideline
250
Maximum safe value for the highest blood sugar of the day.
Dogs can form cataracts at this level and need to be checked for ketones using urine strips
Higher blood glucose levels indicate a lack of sufficient insulin.
300
Ketone monitoring is needed at this level
High blood glucose values increase the risk of the body
switching to using ketones for energy
>360
Ketones need frequent monitoring due to the increasing insulin deficit illustrated by high glucose readings
As blood glucose values increase, so does the possibility for ketone production
Both short and long-term ill effects are possible-see hyperglycemia
DIAGNOSIS Age of the animal and symptom
Urine should be analysed for glycosuria by benedict’s test
Fasting blood glucose 150mg/dl and above are diagnostic importance
Ketonuria
Elevated level of cholesterol
Low level of alanine amino transferase[ALT]
Treatment
Inj. Insulin -@ 0.5-1 U /kg body weight
If showing 1-2% glycosuria require extra dose 0.5 -1 unit insulin
If no glycosuria require 1 unit less insulin
Inj. Insulin given at the interval of 12 hours and after 10-15 min. 25% of the daily food given
The effectiveness of the insulin dose at controlling blood glucose needs to be evaluated This is done by a series of blood glucose tests called a curve.
Blood samples are taken and tested at intervals of one to two hours over a 12- or 24-hour period
The results are generally transferred into graph form for easier interpretation. They are compared against the feeding and insulin injection times for judgment
ManagementEarly diagnosis and interventive treatment can mean reduced incidence of complications such as cataracts and neuropathy
Since dogs are insulin dependent, oral drugs are not effective for them
Most of the commercially available prescription diabetes foods are high in fiber, in complex carbohydrate
Feed the dog on body weight basis and energy requirement
Small dog requirement is 75 kcal/kg body wt.
Large dog 55 kcal/kg body weight
Regular exercise reduce the dose requirement of insulin
The use of an inexpensive glucometer and blood glucose testing at home can help avoid dangerous insulin overdoses
Treatment complications
Hypoglycemia, or low blood glucose, can happen even with care, since insulin requirements can change without warning.
Some common reasons for hypoglycemia include increased or unplanned exercise, illness, or medication interactions, where another medication potentiates the effects of the insulin.
Vomiting and diarrhea episodes can bring on a hypoglycemia reaction, due to dehydration
Simply a case of too much insulin and not enough properly digested food
Symptoms of hypoglycemia need to be taken seriously
Since serious hypoglycemia can be fatal, it is better to treat a suspected incident than to fail to respond quickly to the signs of actual hypoglycemia
Symptoms
Depression or lethargy
Confusion or dizziness
Trembling
Weakness
Ataxia (loss of coordination or balance)
Loss of excretory or bladder control (sudden house accident)
Vomiting, and then loss of consciousness and possible seizure
Treatment
Food should be offered at the first signs of possible hypoglycemia
If the animal refuses it, a sugar solution (corn syrup honey pancake syrup etc.) should be poured on the finger and rubbed on its gums or under the tongue (sublingually)
The solution must be applied this way to prevent possible aspiration of it
As per vet suggestion, one tablespoon of a sugar solution rubbed onto the gums, regardless of the size of the dog.
Contd….
Hypoglycemia formula is 1 gram of glucose for every kilogram (2.2 lb) of the animal's body weight
Sugar acts quickly, a response should be seen within a minute
Honey, syrup, or sugar, as simple carbohydrates act rapidly and will make the blood glucose rise, but the rise will not last very long, as they are broken down quickly by the body
Feeding something containing complex carbohydrates
Contd…..When the pet is able to eat will make sure another hypoglycemia event does not overtake the rapid rise in blood glucose levels from the sugar solution.
Complex carbohydrates take longer to be broken down by the body, so they do not raise blood glucose levels until some time after being eaten.
A small meal should be fed and the animal taken for medical evaluation to determine if further treatment is needed.
Case no.
Ca/902
Owner name
Vivek Sharma
Address Alampur
species Canine
Age 8 year
Sex Male
Reduced appetite since one month
Drinks more water
Urination is more than normal
Vaccination and dewarming done
Already treated at local dispensory, but no improvement seen
As per owner,patient not able to see properly and strike here and there
Whitish color also appear in the eye ball
Loose feces also observed
Clinical parametre
Body wt. 36 kg
Rectal tem. 103.2ºF
Heart rate 94/min
Respiration rate 20/min
Conjunctiva mucus mem. Light pink
Dehydration status ++
Nose[Muzzle] Dry
Blood profile Value Biochemical profile
Value
Hb 9.2 g% ALT 730 U/L
PCV 36% AST 550 U/L
TLC (x 103 / µl) 11.95 Bilirubin 0.9 mg%
DLC Lymphocyte 15% BUN 18 mg%
Neutrophil 84% Creatinine 1.7 mg%
Eosinophil 1% Glucose 47 mg%
Monocyte Nil
Treatment on 3/1/2014
Inj. Ringer Lactate 500ml i/v Inj. Polybion 2ml i/v Inj. Ondopil 4ml i/m Inj. Sulbactomax 750mg i/m Inj. Insulin 30 I.U. /o.6 ml s/c Adv… Inj. Sulbactomax 750mg i/m # 2days
Rx on 6/1/2014 H/O - acc. To owner , patient showing improvement
Inj. Insulin 0.6 ml s/c b.i.d. #3 daysTab. Rabdoc-D 1 tab p.o.b.d. # 3dyasTab. VM-365 1 tab p.o.b.d. #2monthAdv… Bring the Patient fasted after 3 days
15/1/14H/O – animal showing improvement in Polydyspia and polyurea. slightly improvement in feeding habit
Rx… Inj. Insulin 0.9 ml s/c [11:00 am] Inj. Belamyl 2.5 ml i/m
Adv…. Inj. Insulin 0.7ml s/c b.i.d. # 2 week Tab. Hepa- 20 1.5 tab p.o.o.d. # 7 days
Biochemical profile…..
ALT -81U/L Blood Glucose -310 mg % [11:00 am] Blood Glucose -170mg % [1:00pm] Blood Glucose - 84mg % [3:00pm]
Patient normal till 4:30 pm
22/2/14 H/O- Marked improvement in overall health status.feeding habit increased..
Rx- Inj. Insulin 0.7 ml s/c
Adv.. Inj. Insulin 0.6 ml s/c #3 weeks Bring the patient after 3 weeks ALT 75 U/L Blood Glucose 62 mg
20/3/14 Rx.. Inj. Insulin 0.6 ml s/c Blood Profile….
Hb - 10.4 g% PCV - 38 % ALT - 65U/L AST - 25U/L Blood Glucose 550mg% [11:00am] Blood Glucose 350mg % [2:10 pm]
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