National Pet Diabetes Awareness Month

By Brianna Backlund, DVM, DACVIM

Thursday, November 21, 2013

As the holiday season approaches, thoughts of pumpkin pies, gingerbread houses and sugar plum ferries occupy a lot of our free time. I’ve heard many people joke about going into a diabetic coma after taking in too much sugar. You may not realize that, although it’s not quite as straightforward as that, our canine and feline family members too can have serious consequences from an imbalance in blood sugar levels.

Is your cat or dog drinking a lot of water and urinating more than usual? Is your dog losing weight despite a good appetite or is your cat overweight? If so, then you might take them to your primary care veterinarian for screening for diabetes mellitus. Cats and dogs can also develop diabetes, just as humans can. One in 50 to one in 500 cats have diabetes and one in 100 dogs reaching 12 years of age has diabetes.

Diabetes mellitus results from the body’s cells not being able to use glucose taken in from food or made by the body for energy. This disease can develop due to a variety of underlying causes that can make the disease more complicated, but with uncomplicated diabetes mellitus, its original diagnosis is actually quite straightforward. In order to make the diagnosis, your veterinarian will simply need to collect blood and urine samples for testing with the goal of identifying high blood glucose levels with glucose in the urine. Just like people, diabetic pets often need a diet change as well as injections of insulin to allow glucose to enter the cells and provide them with the needed energy to function. Many of the insulin types used are the same as those used for human diabetics. As you can imagine, it is difficult to manage a human with diabetes. It can be just as difficult, if not more so, to undertake this care for a diabetic dog or cat.

As a general rule, this is a chronic disease condition that can respond well to appropriate insulin injections. If these subtle signs however have gone unnoticed for an extended amount of time, the body can only cope for so long without an appropriate supply of energy to the cells and your pet can develop an emergent condition called diabetic ketoacidosis (DKA). When your pet becomes very ill with DKA, they will most likely need to be taken to the ER for hospitalization, monitoring, supportive care, and starting insulin therapy.

If you have worries about your pet and feel that they are demonstrating some concerning signs, please take them in right away to your veterinarian for evaluation and to discuss diabetes mellitus in more detail.

Why Fat Cats and Dogs are a Problem

By Beth Davidow, DVM DACVECC

Wednesday, October 9, 2013

As the fall sets in, I always feel that I really want to eat more. The colder weather means we are inside, closer to the kitchen. I find I’m baking more and thinking about desserts for upcoming holidays. As we eat more, and spend more time in the kitchen, our furry companions tend to join us and they know just how to meet our eyes, do tricks and convince us, that they too need a little extra something yummy.

But just as extra pounds can be problematic for us, extra pounds can also be problematic for our pets. Because they are smaller than us, we sometimes don’t realize how much the percentage gain really is. While if we average 150 lbs and then went up to 200 lbs over the winter, we would probably be very concerned with our weight gain, we sometimes don’t bat an eye when our 15 lb cat suddenly becomes 20 lbs, a similar proportional gain.

Obesity is a huge problem for animals and has been an increasing problem. As in humans, obesity in our pets can lead to bone and joint problems, increased risk for certain cancers, increased heart and lung problems, increased urinary issues, and much increased risk for diabetes.

At our emergency hospital, one common life-threatening emergency in cats is urinary blockage. There are good studies that show that overweight cats are at a much higher risk for this condition than cats in good body condition. In small dogs, a large portion of the dogs with severe respiratory problems are also overweight. Many of these patients present on emergency needing oxygen and end up on many medications. If owners are successful in having these dogs lose weight, many end up requiring less medications over the long haul.

So why do dogs and cats become obese?  In the vast majority of cases it is because caloric intake is in excess of the calories burned during the day. In a few cases, they have an underlying problem such as hypothyroidism but this is the exception not the rule. Thus, to keep thin, pets either need less calories or more exercise. As in people, often the culprit is not the meals but the in between meal snacks. Remember that if your 10 lb dog usually gets a ¼ cup of food twice a day, two large milk bones probably increased his calories by 10%.

This fall, try not to succumb to that cute little face cocking their head at you to share your muffin. Although extra treats may show them you love them in the short term, the consequence may be higher vet bills and more trips to the emergency room. Instead, pick up their leash, brave the rain, and take them for a walk. You will both be happier and healthier in the long run. 

SEPTEMBER- Healthy Aging Month

By Jennifer Waldrop, DVM DACVECC

What does “healthy aging” mean for your pet? Is it the same as for you? Basically, the answer is yes, with one glaring difference. Your pet cannot be trusted to tell you when something is starting to go wrong. Subtle warning signs of a problem may resemble age-related changes. For example, increased sleeping might be a headache or blurred vision. Difficulty rising could be arthritis, but could also be weakness related to low blood pressure, altered electrolytes, bone pain, or dizziness. We humans also tend to rationalize and “anthropomorphize” our pet’s issues, which can sadly delay diagnosis of many treatable diseases. Then it seems surprising when our pets are really sick and we hear of the degree or chronicity of the problem.

Given the rapidity of animal aging and their short life span, the only way to reliably monitor aging is by frequent visits to the veterinarian with an examination and geriatric lab work including a Complete Blood Count, Chemistry Panel and a Urinalysis. Chronic kidney disease is one of top three diseases of geriatric pets and kidney failure is only reliably diagnosed by checking a urine sample for concentrating ability (urine specific gravity.)  Ideally, this should be every six months for a dog over nine to 10 years (over seven years for Giant Breeds like Great Danes) and every year for cats over 10 years of age. For exotic pets, these recommendations will vary depending on the size and type of pet. This can become expensive and makes a good argument for pet insurance to cover some of the ongoing costs. When choosing a pet insurance, take care to check for geriatric exclusion clauses given that many pet insurance companies are also aware that aging pets require more care.

What else can we do to fend off some of the preventable changes of aging? Just as in humans, a healthy diet and exercise are crucial. Most commercial and many alternative diets are complete, but when in doubt, your veterinarian or a veterinary nutritionist will be able to consult on the appropriateness of the diet. Most “senior” diets do not have significant changes in ingredients or electrolytes that make them better than regular diets. Supplements like fish oil may have a place in treatment of canine osteoarthritis, but their role in prevention of other diseases such as heart disease or dementia is unknown. I still recommend them if there is no fish in the pet’s diet. There are instances when fish oil supplements are discouraged, specifically in some human cancers during chemotherapy.

Exercise of the body and mind are both important to provide your aging pet. Exercising with your dog has been found to improve health for the human in multiple research studies, and the reverse is likely true as well. The cardiovascular and muscular strength that moderate exercise provides is important to keep both healthy, but also serves as a reserve when you are sick. This reserve strength will improve recovery after accidents, surgery or other health issues. Outdoor exercise is also a mental boost for our dogs with input into all their senses. Time spent with their owner is also important for mental health, so part of a moderate exercise program should include an interactive component.

Exercising a cat or exotic pet can be a little more difficult, to say the least, but is extremely important given the high rate of obesity in our pets. Cats may enjoy chasing a toy on a wand or chase toys or balled up socks, but sadly some cats are not interested in chasing. For these cats, a companion cat or dog may provide some impetus for moving around even if it’s just to get away from the other animal. (Conflict can provide good stimulation ;) A younger cat could keep the older cat more active both physically and cognitively. The same is likely true for birds and small mammals.

At home, grooming and petting your cat or dog provides both with the benefits of companionship. Having friends and relationships is as important for our pets as for us. Studies in humans have shown increased longevity and mental health for those people who actively continue human interaction and relationships. Sometimes a pet and their human can become isolated from the rest of the world and this is not healthy for either individual. One of the least judgmental places for dog owners is the dog park where dogs of all sizes, temperaments and interests congregate with their humans of the same variability. For indoor-only cats, frequent household visitors and companionship with other housecats should provide good stimulation.

The best part of living with a pet is having a good friend who lives every day to its fullest. We can follow their example while we age as well and continue to fully enjoy each moment.

Men do not quit playing because they grow old; they grow old because they quit playing.

~Oliver Wendell Holmes  

New Year's Resolutions for Your Pet!

By Dr. Beth Guerra

With the New Year comes the inevitable resolutions. While you are making your own list, consider making one for your pet as well. Whether it’s as simple as learning to trim your pets nails, or focusing on finally getting that extra weight off your beloved companion, remember that you are your pet’s advocate and change starts with you.

Yearly physical exams are important for all pets. In the past, pets usually received a yearly physical when vaccines were due. Because vaccines are not needed as often (every three years is now recommended for adult animals), yearly physicals have sometimes been skipped. Even if your pet has never had an illness, these exams are important to establish a good health baseline and can also be crucial in detecting emerging disease. A thorough exam combined with an extensive history can often aid in disease prevention or help establish a diagnostic and treatment plan early in the progression of a disease. For example, if kidney disease is caught early, a simple diet change can often prolong life for many years.

Obesity has become a major problem in household pets. This may be due to inappropriate diet, lack of exercise, injury, or metabolic disease. If you notice your pet has packed on a few pounds, or seems lethargic, schedule an exam with your veterinarian to discuss weight loss. It may be as simple as reducing the amount of food, switching to a lower calorie/higher fiber or high protein diet, or increasing activity. It is also important for your pet to have an exam to make sure there isn’t another reason for the weight gain, such as hypothyroidism. Consistent weigh-ins with your vet can help chart progress and identify any setbacks.

Dental hygiene is also extremely important. Frequent dental cleanings are recommended for both cats and dogs. Some pet owners may be reluctant due to cost and the need for general anesthesia, but the benefits often outweigh the cost. Dental cleanings focus on removing the tartar visible on teeth and can improve the health of gingiva. Problems with teeth, such as erosions, fractures, or tooth root abscesses can be detected and treated appropriately. The mouth is examined for ulcers or masses that are often not observed by the owner. And, your pet will most likely have fresher breath!

For older pets on medications, a yearly exam is an important part of the monitoring process. Anti-inflammatories for arthritis, thyroid supplements, seizure medications, and insulin are some examples of medications that need to be closely monitored. Bloodwork, such as a complete blood count and serum chemistry, is often an integral part of the monitoring process and may be recommended yearly as well. This also helps to establish a baseline and can provide useful information for comparison if your pet becomes ill.

For 2012, take some time to establish goals for you and your pet. Prevention is the best medicine, and it may keep your pet from having to visit the emergency clinic!

Watch the Litter Box!

By Patrick Miles, DVM

Personally, cleaning the litter box is not one of my favorite chores.  I’ve tried self cleaning boxes and bribing my children.  I have not attempted to train the cats to use the toilet simply because something seems “wrong” about having to share the bathroom with your pet.  Though I’ve heard clients say it works quite well!

However, there is a lot to watch out for with your cat’s use of the litter box.  Houses with multiple cats can be an additional challenge, but can still help to uncover underlying illness in your pet.  Cleaning the litter box on at least a once daily frequency is typically recommended.  The frequency of use, whether there is more or less urine, diarrhea, mucous, blood in urine or stools, all may indicate a developing problem.  Cats that have urinary tract infections or other urinary problems may have an increased urgency and frequency in their use of the box.  Blood or an abnormal odor may be noted in the urine indicating infection, or in some cases complications from diabetes.  Some people are able to detect the smell of “ketones”, which indicate possible complications due to diabetes mellitus.  The amount of urine produced may be decreased if a male cat is developing a urethral obstruction, or increased if diabetes mellitus is present. 

The color and consistency of stools can also help determine the source of problems.  Chronic diarrhea in general may be due to problems involving the small bowel versus the large bowel/ colon.  Small bowel disorders often tend to be larger amounts (cow-pie), may have a dark, tarry consistency if blood is present, and frequency may be normal or increased.  Weight loss tends to be more profound with small bowel disorders.  Large bowel disorders tend to be smaller in volume, increased frequency, mucous and straining may be present, and have visible red (frank) blood.

Though the litter box is not the most enjoyable aspect of cat ownership, attention to its contents and use may be valuable in detecting emerging problems.

Diabetes in Our Companion Animals – An Overview

By Alan Schreiner, DVM, DACVIM

As many of you already know, our four-legged friends are susceptible to some of the same diseases that affect us. One of those diseases is diabetes mellitus or high blood sugar. In animals as in people, diabetes mellitus occurs when the body is not producing enough insulin or because the cells in the body cannot respond to the insulin produced. Insulin is a protein made by the pancreas that helps keep the sugar in the blood within a narrow range.  Like people, animals with diabetes mellitus are classified into two categories: Type 1 diabetics are insulin-dependent and require injections of insulin while Type 2 diabetics are characterized by having insulin resistance and can be insulin-dependent or non-insulin dependent. Both Type 1 and Type 2 diabetics are recognized in dogs and cats.

Occurrences in Cats vs. Dogs

Non-insulin dependent diabetes mellitus (NIDDM) is more frequently recognized in cats than in dogs and accounts for as many as 30-50% of diabetic cats. One big difference between cats and people is the phenomenon of transient diabetes mellitus. Transient diabetes can be seen in approximately 20% of our diabetic cats. These cats will appear to have insulin-dependent diabetes mellitus (IDDM) initially, then revert to a normal state, not requiring any insulin therapy and have normal blood sugar levels. These patients can then swing back to IDDM. This phenomenon can occur multiple times during the cat’s life as a diabetic.

People always want to know if their pet is at risk for developing diabetes mellitus. No one can predict which pets will develop diabetes, but in general we see occurrences in dogs that are four to 14 years-old with a peak between seven to nine years-of-age. In dogs, females are about twice as likely to develop diabetes as males are. Any breed can develop diabetes mellitus, but the breeds that are commonly seen are Miniature Poodles, Cairn Terriers, Dachshunds, Miniature Schnauzers and Beagles.

As for cats, they are typically older than six years-of-age, but diabetes mellitus can show up at any age. The neutered male cat is predominantly seen verses the spayed female cat and there are no apparent breed predispositions reported.

Signs and Symptoms: Diagnosing the Diabetic Pet

The signs and symptoms seen by most pet owners are very similar to what people experience; an increase in water consumption and urination frequency and an increase in appetite but accompanied by weight loss. One way to think of diabetes mellitus is starvation in the face of plenty.

When a dog or cat is presented to their veterinarian for any of these signs or combination of symptoms, the doctor will order some diagnostic tests. These tests usually include a complete blood count (CBC), a chemistry panel, in cats a thyroid level, and a urinalysis (UA). The classic results will show elevation of sugar (otherwise known as glucose) in both the blood and the urine. Other abnormalities may also be present, such as signs of infection on the CBC, elevation of liver enzymes is common, and ketones maybe noted in the urine. A urine culture should always be done because of the high incidence of concurrent urinary tract infections. Additional diagnostic test may be ordered based on physical exam findings, results of the blood work, or previous medical problems.

Treatment and Next Steps

In most animal patients, successful treatment is centered around an ongoing schedule of  insulin injections. Persistence of signs and the development of chronic complications are directly correlated with the severity and duration of the high blood sugar levels. The goals of therapy are to limit blood sugar fluctuations and maintain nearly normal sugar levels to help minimize signs and symptoms. This can be accomplished through proper insulin administration, diet and exercise.  In addition, avoiding or controlling current inflammation, infections, and hormonal changes (intact males and females) is important for maintaining good blood sugar control. Although, we attempt to keep the blood sugar from rising too high, we must also guard against the development of low blood sugar which can be a serious and potentially fatal complication of therapy.

As in people, our four-legged patients can develop, over time, complications associated with diabetes mellitus. In dogs, cataracts are a common complication and cats can develop nerve problems in their legs just like people. Bacterial infections, especially in the urinary tract, are also common and urine cultures are done periodically to monitor for their development.

It is recommended that the treatment be monitored regularly by the veterinarian with blood glucose curves, fructosamine levels, and sometimes glycosylated hemoglobin levels checked. The blood glucose curve is done to monitor the effect of the insulin on the blood sugar levels. The curve is usually done in the veterinarian’s office during the course of a day. Blood samples are taken every few hours throughout the day and the readings are used to create a graph. This graph helps the veterinarian decide if the insulin is adequately controlling the blood sugar level. If not, then changes are made to the insulin dose or type. If a change is made, then the patient’s body will take about seven to 10 days to adjust to the new regime. Another blood glucose curve will be scheduled to recheck the effects of the change.

The other two tests, fructosamine and glycosylated hemoglobin, are used to obtain an average blood glucose level over different periods of time. These tests are helpful in detecting deteriorating blood glucose control, thus allowing intervention before a problem develops.

Conclusion

Identified early, Diabetes Mellitus in dogs and cats can be successfully managed through the right nutrition, exercise, and, if necessary, regular insulin injections.  While there is no cure for the disease, proper managed care can help the pet live a happy, active life. Your veterinarian is an essential partner to this care and can give advice on the best preventative and management programs.

To learn more about the diabetic pet, please visit www.petdiabetesmonth.com.