Diabetes mellitus - dogs and cats comparison Flashcards
At what age do pets get diabetes
Peak in dogs 7-10 yo, can get juvenile onset <1 year
Cats >4
What is the sex predilection for diabetes?
possibly more female in dogs
approx 65% male in cats
Which dogs are predisposed to diabetes?
Australian terrier standard and miniature schnauzer, bichon fries, spitz, fox terrier, miniature and toy poodle, Samoyed, Cairn terrier, Keeshond, Maltese, Lhasa Apso, Yorkshire terrier
In which breeds of dog is diabetes rare?
GSDs Golden Retrievers Boxer Collie Shetland Sheepdog
Which breeds of cat are affected?
Predisposition varies dependent on location - Burmese (in Australian, NZ and UK); Maine coon, Russian blue and Siamese (in USA)
Burmese - approx 10% over 8 are affect - 4x other breeds
What is the pathophysiology of diabetes in dogs?
Resembles type 1 DM in humans - insulin dependent
• Type 2 extremely rare, or may not exist
• Congential β-cell hypoplasia/abiotrophy; immune-mediated β-cell destruction; β-cell loss; βcell exhaustion
What is the pathophysiology in cats?
• Resembles non-insulin dependent DM in people
• Type 2 most common: 80-90% of cases
• “Other specific type”, or Type 3 DM <20% of cases in primary practice, due to:
pancreatitis,
pancreatic neoplasia,
acromegaly,
HAC
• Heterogeneous disease attributable to a combination of insulin resistance and β-cell failure
What factors may be involved in the aetiopathogenesis of diabetes in dogs?
Genetics Immune-mediated insulitis Pancreatitis Obesity* Concurrent hormonal disease (HAC, dioestrus-induced excess of GH, hypoT4) Drugs (glucocorticoids, progestogens) Infection Concurrent illness (CKD, cardiac disease) Hyperlipidaemia
What factors may be involved in the aetiopathogenesis of diabetes in cats?
Islet amyloidosis Obesity Pancreatitis Concurrent hormonal disease (HAC, HS, hyperT4) Drugs (progestogens, glucocorticoids) Infection Concurrent illness (CKD, cardiac disease) Hyperlipidaemia (?) Genetics (Burmese cat) Immune-mediated insulitis (?)
What is the means of diagnosing diabetes in dogs/ cats?
Persistent fasting hyperglycaemia and glucosuria (renal threshold for glucose 10-12mmol/L in a dog, 14-16mmol/L in a cat)
What are the goals of therapy in dogs?
- Reduce or resolve clinical signs, prevent short-term complications and good QoL
- Good control – BG maintained between 5-14mmol/L
- Consistency in timing of injections, meals, type and amount of food, and exercise
What are the goals of therapy in cats?
- Diabetic remission, resolve clinical signs, avoid clinical hypoglycaemia
- Maintaining ideal body weight and avoiding insulin-antagonistic drugs is important for maintaining remission
What is the starting treatment for diabetes in dogs?
• Caninsulin® has a duration of effect of 10-14h in most
dogs (8-10h in most cats)
• Start on 0.25-0.5 IU/kg q12h
What is the starting treatment for diabetes in cats?
- The duration of Caninsulin® is not adequate for most cats
- ProZinc® is the insulin of choice (based on the cascade; glargine is also an ideal choice, but is off cascade)
- ProZinc® 0.2-0.4 IU/kg q12h
Outline the principles of feeding a diabetic dog
- Diets containing increased amounts of dietary fibre
- Dry food
- Nutritional requirements of any concurrent disease should take precedence
- Regardless of diet, most diabetic dogs can be well managed with feeding a consistent diet at consistent times with concurrent administration of an appropriate amount
Outline the principles of feeding a diabetic cat?
- Dietary therapy very important
- High protein, low carbohydrate (or ultra-low) diet
- Wet food
- Meal-fed or grazer
What are the methods/ aims of monitoring
• Control of clinical signs (PU/PD, PP, weight loss)
• Aim to keep BG below the renal threshold (10-12mmol/L in a dog, 14-16mmol/L in a cat) and to avoid hypoglycaemia
• Options for glycaemic monitoring
Glucose curve (in-clinic vs at-home)
Fructosamine
Glycated haemoglobin
Which other conditions typically cause a severe insulin resistance?
- Hyperadrenocorticism
- Acromegaly (cat)
- Progesterone excess (dioestrus in an intact female dog)
- Diabetongenic drugs (most notably glucocorticoids and progestins)
Which conditions typically cause a mild or fluctuating insulin resistance?
- Obesity
- Infections
- Chronic pancreatitis
- Chronic inflammation
- CKD
- Hepatic dysfunction
- Cardiac dysfunction
- Hypo-/hyperthyroidism (dog/cat)
- EPI
- Hyperlipidaemia
- Neoplasia
- Glucagonoma
- Phaeochromocytoma
- Insulin autoantibodies
What are the main canine diabetic complications
- Hypoglycaemia
- Cataract formation ** most common
- Diabetic neuropathy (subclinical more common)
- Diabetic nephropathy
What are the main feline diabetic complications?
- Hypoglycaemia
- Systemic hypertension
- Diabetic neuropathy
- Diabetic nephropathy
What is the prognosis for diabetes?
- Dependent on owner’s commitment, ease of glycaemic regulation, presence of reversibility of concurrent disorders and avoidance of chronic complications
- In a study of 347 dogs 1, 2 and 3 year survival was 40%, 36% and 33%, respectively; highest mortality in the first six months of treatment (similar life expectancy to a non-diabetic if survive this period)
- In a study of 114 cats median survival time was 516 days (range 1 – 3468 days), with 16.7% mortality in the first 10 days
- Cats achieving diabetic remission have longer survival times than cats that are persistently diabetic
