Diabetes is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood.



What causes diabetes to develop?

Diabetes is considered to be a multifactorial disease, meaning that a number of different factors contribute to its development. Factors which have been linked with the development of diabetes include:

• Genetics
• Immune-mediated disease – This is currently thought to be the leading cause of diabetes in dogs and involves the body’s immune system destroying the insulin-producing cells located in the pancreas
• Pancreatitis – Chronic pancreatitis can lead to destruction of the insulin-producing cells within the pancreas
• Exposure to excessive levels of certain hormones (e.g. progesterone, cortisol, growth hormone etc.) can lead to insulin resistance whereby normal levels of insulin are produced, but the body no longer responds appropriately to this insulin
  
  
  
  Symptoms of diabetes
• Increased thirst
• Urinating large volumes of unconcentrated urine
• Increased frequency of urination
• Increased appetite
• Weight loss
• Lethargy
• Cloudiness within the eyes (cataract formation)
• Sudden blindness
• Vomiting and diarrhoea may be seen if your pet is also suffering from pancreatitis
  
  
  
  How do we diagnose diabetes?
  
  Diabetes is most commonly diagnosed by taking bloods from your pet and analysing a sample of their urine. Other tests may be required to test for pancreatitis or any concurrent diseases which may be causing insulin resistance.
  
  
  
  How is diabetes treated?
  
  Diabetes, in general, is an incurable condition that requires life-long treatment. The mainstay of treatment is insulin therapy. Typically, owners will need to inject insulin into their pet once or twice per day. Your vet may also recommend some dietary changes to assist in controlling the blood glucose levels of your pet or even weight loss.
  Your pet will require hospitalisation from time to time so that vets can perform a ‘blood glucose curve’. This test involves serially measuring an animal’s blood glucose levels after they have been given insulin so that the optimal dose of insulin for that particular animal is found. Once the optimal dose is found, fewer blood glucose curves need to be performed.
  
  
  
  Additional treatments may be required if your pet has pancreatitis or another hormonal condition which has led to the development of diabetes.

Inappetance is probably one of the most common reasons for people to bring their pets to the vet. Obviously not eating is one of the first indicators of a very large number of illnesses. We recommend seeing any pet that is significantly off their food. For a pet that is otherwise active and well and perhaps only partly eats their food, or may miss one meal, it is not unreasonable to wait 12-24 hours and see what happens. I often get clients ringing for advice on what to do and if this is the case I recommend, just give them a little time. If the pet is quite lethargic, or vomiting, then ideally they should be seen.

Like us humans, a pet can always just have an “off day”. Hence you don’t need to rush down to see us if that’s the case. If, however, they are still not right the next day, then of course a visit to the vet is warranted.

In itself a pet not eating is non-specific. We often get clients ringing and asking “what has my pet got, if he’s not eating?” Obviously this is an impossible question to answer without seeing the patient! Often going a little off the food can be the first sign of a large number of problems, including the following list:

• Gastro-enteritis
• Metabolic disease such as hepatitis or renal disease
• Pancreatitis
• Viral or bacterial disease
• Mouth pathology, including infected teeth or gums<
• Diabetes
• Thyroid disease
• Cancer (Advanced, because most cancers in their early stages do not cause inappetance, hence get all those lumps checked early! Don’t wait until they’re off the food!)
• Allergic dermatitis
• Almost any other illness you can think of!

Hence the take home message for a pet off their food is: If it is only for one day and they are not vomiting or too lethargic, give them 12 hours and just monitor. If they are quite lethargic or continues into the next day, then bring them in for a check up.

Lethargy would have to be the most “non-specific” symptom that our pets could have. When to worry and when not to worry about our pets being “lethargic” can be a tricky question for many pet owners.

The following list is a general guideline to help you to decide when and when not to worry:

• First rule: if in doubt, ring your vet. A phone call costs nothing.
• If pets are young, with no history of problems and they are a little off for a day only, then monitoring is reasonable
• If there is a little diarrhea, but no vomiting, monitoring is reasonable (see under vomiting and diarrhea)
• If there is vomiting, then seek veterinary advise
• If lethargy is mild to moderate then monitoring for 24 hours is reasonable
• If lethargy lasts more than 24 hours, then seek advice
• If a pet is older or has a known condition, such as a heart murmur, or ongoing organ disease, then seek advice immediately.
• If there is potential known access to toxins or snakes etc, then seek advice.

Again, lethargy is a tricky one, with no right or wrong answer, The big mistake many pet owners make is presenting their lethargic vet for a consultation after more than 2 days of being so. We get some clients presenting their pets after 5 or more days of being lethargic and not eating! Often at this stage pets are severely compromised.

Just like us, our pets can just have an “off” day every now and then. Give them a day, call for advice if longer than 1 day, or if there is another reason for concern, call straight away.

Certainly vomiting and diarrhoea are very common causes for a trip to the vet and a little like inappetance can be a sign of very many problems. At the top of the list is gastro-enteritis which in itself can be caused by a number of things, including many viruses and bacteria just like us.

My general advice for vomiting is the following. If it is a one off and the pet is otherwise well, just monitor and give them 12 hours without food and see what happens. Never deny water. If water is given and can’t be kept down, they should be seen. If the pet is quite lethargic or vomiting continues, take them immediately to the vet. For diarrhoea: If bright and well, give them 24 hrs, access to water at all times and a bland boiled chicken and rice diet in small feeds for 2-3 days. If the diarrhoea is resolving by the next day, keep this diet up for a few days. If diarrhoea is worsening or persisting beyond 24 hours, then bring your pet in.

Dogs in particular are what we call scavengers. They have evolved to live off all sorts of food including rotten material. Often if a dog eats a bad bacteria, they handle it quite well. Occasionally it may cause a mild transitory gastro-enteritis. Hence I’m happy to give them 12-24 hours to see what happens. If they’re not getting over it in this time, or if in fact they are quite lethargic, then they need to be seen.

The following is a brief list of the common causes of gastro-enteritis:

• Bacterial infections
• Viral infections
• Food reactions
• Intestinal foreign body
• Cancer
• Toxins
• Parasites (intestinal worms)

In order to diagnose which of the above is causing the problem we may need to consider tests such as x-rays, fecal pathology, blood tests, endoscopy or even ultra-sound. All of these diagnostics are available to us depending on our initial diagnosis and response to treatments.

Weight loss is terrific if we have an overweight pet that is on a specific diet in order to reach our ideal weight. Other than this it is of course a potentially serious problem, and an indicator of many potential diseases.

The list includes, depending on age:

• Cancer
• Heart disease
• Metabolic disease such as diabetes
• Organ failure such as hepatitis and renal failure
• Gastro-intestinal disorders
• Worms
• Arthritis
• Hyperthyroidism (very common in aging cats)

Hence again our list is extensive. The take home message is that if we have weight loss, it is almost always a sign of some sort of significant ongoing problems and should be investigated and worked up.

Often pet owners make the mistake of allowing weight loss to go on too long before being worked up, as the pet may otherwise be quite well and have a good appetite. Cancer for instance may often cause weight loss before it actually causes inappetance or lethargy. If unsure as to whether your pet has weight loss, weighing them regularly is important. Make sure you always use the same scales as different scales may have slightly different inaccuracies to each other. Of course if weight loss is obvious without the need for weighing, then see your vet and work the problem up.

Old pets: Pet owners often put weight loss down to the fact that a pet is ageing. This is in fact rarely the case. Even for ageing pets, weight loss is usually a sign of further problems and really should be worked up. If initial clinical examination and tests reveal no problem, then it may be a result of just ageing, but this is in fact far less likely than being an indication of an actual disease process.