Monitoring the diabetic dog: 2) restoring good diabetic control in problem cases

Six cases of diabetic dogs illustrating ways to tackle problem cases

source: Grant Petrie
In Practice vol 26 no 8, September 2004
starts p 421, 8 pages long

Dogs with diabetes have hyperglaecamia, or high glucose levels, which result from a deficiency of, or insensitivity to insulin. At high levels, glucose appears in urine, leading to frequent urination and thirst. Calorie loss from excretion of glucose leads to weight loss and hunger. Vets and owners need to monitor dogs to resolve clinical signs and prevent complications. Urine tests, glycated blood protein measurement, and estimations of serial blood glucose all help with management.

Six cases show how management can be improved in problem cases with poor control. A ten-year-old keeshond, reassessed after three weeks with twice daily insulin therapy, appears stabilised, with a glucose curve showing good absorption of insulin, and a safe glucose nadir. He needs follow-up reassessments, and owners need to report symptoms such as increased thirst or weight loss. A six-year-old boxer appeared resistant to insulin, not responding after she was rehomed. Infections, or poor storage of insulin are among possible causes of dogs not responding. In this case, it emerged that the owner had not been taught how to inject insulin, and was squirting it onto the dog's skin. A third dog, an eight-year-old crossbreed, became lethargic and thirsty. Her dose of insulin was increased, and her condition improved and stabilised. An eight-year-old beagle given insulin once a day was also lethargic, and serial glucose measurements showed that the insulin dose was only lasting 10 hours. He improved after moving to twice-daily injections. The case of a five-year-old labrador was more complex. Her symptoms persisted, and a glucose curve showed a dramatic drop in levels followed by a rise as a reaction. Her insulin dosage was too high, leading to a too-steep drop in glucose levels, followed by a rise to abnormally high levels. After a reduction in her dosage, her condition improved. Urine tests alone would not have revealed the problem. The last case was a seven-year-old male Irish wolfhound, who was lethargic, thirsty, and urinating excessively. He appeared to have insulin resistance. He was diagnosed with discospondylitis, and a urinary tract infection. He was treated with painkillers, intravenous fluids, and an antibiotic. His insulin dose was reduced, and his diabetes stabilised. His disc disease was also resolved, and his quality of life returned to normal.