Veterinary Medicine - September 2007 - (Page 614)

Diabetes management O P E E R - R E V I E W E D quently. Foods high in simple sugars, such as semi-moist diets and treats, should be avoided. Obesity is a wellrecognized cause of insulin resistance in cats, and gradual weight loss may improve glycemic control and encourage endogenous insulin production. What clients need to know Oral hypoglycemic therapy Dogs with diabetes mellitus are always insulin-dependent, so the oral hypoglycemic drugs are never appropriate. Although some cats respond to glipizide (thought to enhance endogenous insulin production), most are not adequately controlled, and the prolonged hyperglycemia may contribute to glucose toxicity and reduce the chance of eventual diabetic remission.15 I would only prescribe glipizide if a client refused to administer insulin, and I would combine it with appropriate dietary modification and weight loss (if necessary). Acarbose (an enzyme inhibitor that impairs intestinal glucose absorption) may facilitate Diabetes mellitus cannot be cured, but it can be successfully managed. Dogs will always need insulin, usually twice daily, and regular diet and exercise routines are essential. Feline diabetes may be reversible, but weight control and dietary modification are necessary to maintain glycemic control. Owners must be prepared to partner with the veterinary team and take responsibility for the day-to-day management of this disease. Hypoglycemia is deadly; hyperglycemia is not. Owners must clearly understand that too much insulin can kill, and they should call a veterinarian or halve the dose if they have any concerns about a pet’s well-being or appetite. Tell owners to offer food immediately if the pet seems weak or is behaving strangely. Also, show owners how to rub maple syrup on their pets’ gums if their pets are too compromised to eat. Tell owners at the time of diagnosis that most dogs with diabetes develop cataracts. Even well-managed diabetics usually suffer some changes to the lens, with varying degrees of visual impairment. Occasionally, cataracts form rapidly and patients may have difficulty adjusting. However, cataract surgery is now widely available, and is generally successful. glycemic control in cats fed a lowcarbohydrate diet.16 However, the effect seems modest, at best, and it cannot be used in place of insulin. SUMMARY Most dogs and cats with diabetes are successfully managed and continue to be a source of joy and comfort to their families. Effective client communication is essential, as pet owners need to feel supported by the veterinary team, particularly at the time of diagnosis. It is important to stress the benefits of regular rechecks and to explain that dose adjustments are a routine part of diabetic care. Encouraging owners to check glucose concentrations at home can be empowering, and many Web sites offer guidance and support (e.g. petdiabetes.org, caninediabetes.org, felinediabetes.com). Reinforce to owners that diabetes mellitus is a treatable disease, and most patients enjoy an excellent quality of life. O REFERENCES 1. Nelson RW. Diabetes mellitus. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 6th ed. St. Louis, Mo: Elsevier Saunders, 2005;1563-1591. 2. Rand JS, Marshall RD. Diabetes mellitus in cats. Vet Clin North Am Small Anim Pract 2005;35(1):211-224. 3. Peterson ME, Melian C, Nichols R. Measurement of serum concentrations of free thyroxine, total thyroxine, and total triiodothyronine in cats with hyperthyroidism and cats with nonthyroidal disease. J Am Vet Med Assoc 2001;218(4):529-536. 4. Graham P, Nash AS, McKellar QA. Pharmacokinetics of porcine insulin zinc suspension in diabetic dogs. J Small Anim Pract 1997;38(10):434-438. 5. Horn B, Mitten RW. Evaluation of an insulin zinc suspension for control of naturally occurring diabetes mellitus in dogs. Aust Vet J 2000;78(12):831-834. 6. Melendez L, Lorenz M. Canine diabetes mellitus, in Proceedings. Western Vet Conf 2002. 7. Bruyette D. Diabetes mellitus: treatment options, in Proceedings. World Small Anim Vet Assoc World Congress 2001. 8. Davison LJ, Ristic JM, Herrtage ME, et al. Anti-insulin antibodies in dogs with naturally occurring diabetes mellitus. Vet Immunol Immunopathol 2003;91(1):53-60. 9. Rand J. Editorial: glargine, a new long-acting insulin analog for diabetic cats. J Vet Intern Med 2006;20(2):219-220. 10. Ferguson DC, Hoenig M, Klaser DA, et al. Glucose tolerance and lipid profiles in dogs fed different fiber diets. Vet Ther 2001;2(2):160-169. 11. Kimmel SE, Michel KE, Hess RS, et al. Effects of insoluble and soluble dietary fiber on glycemic control in dogs with naturally occurring insulin-dependent diabetes mellitus. J Am Vet Med Assoc 2000;216(7):1076-1081. 12. Graham PA, Maskell E, Rawlings JM, et al. Influence of a high fibre diet on glycaemic control and quality of life in dogs with diabetes mellitus. J Small Anim Pract 2002;43(2):67-73. 13. Bennett N, Greco DS, Peterson ME, et al. Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus. J Feline Med Surg 2006;8(2):73-84. 14. Frank G, Anderson W, Ballam J, et al. Use of a high-protein diet in the management of feline diabetes mellitus. Vet Ther 2001;2(3):238-246. 15. Feldman EC, Nelson RW, Feldman MS. Intensive 50-week evaluation of glipizide administration in 50 cats with previously untreated diabetes mellitus. J Am Vet Med Assoc 1997;210(6):772-777. 16. Mazzaferro EM, Greco DS, Turner AS, et al. Treatment of feline diabetes mellitus using an alpha-glucosidase inhibitor and a lowcarbohydrate diet. J Feline Med Surg 2003;5(3):183-189. EXTRA See for more on interpreting blood glucose curves in dogs and cats. 614 September 2007 VETERINARY MEDICINE http://caninediabetes.org http://petdiabetes.org http://felinediabetes.com http://www.vetstreamfelis.com/ACI/September/VMD1/fre00736.asp http://www.vetstreamcanis.com/ACI/September/VMD2/fre00736.asp

Table of Contents Feed for the Digital Edition of Veterinary Medicine - September 2007

Contents Letters Leading Off The Veterinary Medicine Interview: Dr. William J. Kay Idea Exchange Practical Matters Salivary Mucoceles in Cates: A Retropspective Study of Seven Cases Hyperlipidemia in Dogs and Cats Purina Insert The Latest Management Recommendations for Cats and Dogs with Nonketotic Diabetes Mellitus CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - September 2007

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