Diabetes in dogs

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Illustration of a dog's pancreas. Cell-islet in the illustration refers to a pancreatic cell in the Islets of Langerhans, which contain insulin-producing beta cells and other endocrine related cells. Permanent damage to these beta cells results in Type 1, or insulin-dependent diabetes, for which exogenous insulin replacement therapy is the only answer. Gray1105.png
Illustration of a dog's pancreas. Cell-islet in the illustration refers to a pancreatic cell in the Islets of Langerhans, which contain insulin-producing beta cells and other endocrine related cells. Permanent damage to these beta cells results in Type 1, or insulin-dependent diabetes, for which exogenous insulin replacement therapy is the only answer.

Diabetes mellitus is a disease in which the beta cells of the endocrine pancreas either stop producing insulin or can no longer produce it in enough quantity for the body's needs. The disease can affect humans as well as animals such as dogs.

Contents

The condition is treatable and need not shorten the animal's life span or interfere with the quality of life. [1] If left untreated, the condition can lead to cataracts, increasing weakness in the legs (neuropathy), malnutrition, ketoacidosis, dehydration, and death. [2] Diabetes mainly affects middle-aged and older dogs, but there are juvenile cases. [3] [4] [5] The typical canine diabetes patient is middle-aged, female, and overweight at diagnosis. [6]

The number of dogs diagnosed with diabetes mellitus has increased three-fold in thirty years. In survival rates from around the same time, only 50% survived the first 60 days after diagnosis and went on to be successfully treated at home. Currently, diabetic dogs receiving treatment have the same expected lifespan as non-diabetic dogs of the same age and gender. [7]

The condition is commonly divided into two types, depending on the origin of the condition: type 1 and type 2.

Gestational diabetes can develop in dogs as well. It can be prevented by behavioral and dietary management. [13] Diabetes insipidus, which has nothing to do with blood sugar, but is a condition of insufficient antidiuretic hormone or resistance to it, also exists in dogs. [14] [15]

Classification and causes

At present, there is no international standard classification of diabetes in dogs. [16] Commonly used terms are:

While the occurrence of beta cell destruction is known, all of the processes behind it are not. Canine primary diabetes mirrors type 1 human diabetes in the inability to produce insulin and the need for exogenous replacement of it, but the target of canine diabetes autoantibodies has yet to be identified. [18] Breed and treatment studies have been able to provide some evidence of a genetic connection. [19] [20] [21] [22] Studies have furnished evidence that canine diabetes has a seasonal connection not unlike its human Type 1 diabetes counterpart, and a "lifestyle" factor, with pancreatitis being a clear cause. [23] [24] This evidence suggests that the disease in dogs has some environmental and dietary factors involved. [16] [25] [26] Canine obesity causes the corresponding diabetes in dogs also known as canine diabetes (Hoeing 2014).

Secondary diabetes may be caused by use of steroid medications, the hormones of estrus, acromegaly, (spaying can resolve the diabetes), pregnancy, or other medical conditions such as Cushing's disease. [17] [27] [28] [29] In such cases, it may be possible to treat the primary medical problem and revert the animal to non-diabetic status. [30] [31] [32] Returning to non-diabetic status depends on the amount of damage the pancreatic insulin-producing beta cells have sustained. [33] [34]

It happens rarely, but it is possible for a pancreatitis attack to activate the endocrine portion of the organ back into being capable of producing insulin once again in dogs.[ citation needed ] It is possible for acute pancreatitis to cause a temporary, or transient diabetes, most likely due to damage to the endocrine portion's beta cells. [23] Insulin resistance that can follow a pancreatitis attack may last for some time thereafter. [35] Pancreatitis can damage the endocrine pancreas to the point where the diabetes is permanent. [23]

Genetic susceptibility of certain breeds

This list of risk factors for canine diabetes is taken from the genetic breed study that was published in 2007. Their "neutral risk" category should be interpreted as insufficient evidence that the dog breed genetically shows a high, moderate, or a low risk for the disease. All risk information is based only on discovered genetic factors. [36] [37]

Gene therapy

In February 2013 scientists successfully cured type 1 diabetes in dogs using a pioneering gene therapy. [38] [39]

Pathogenesis

The body uses glucose for energy. Without insulin, glucose is unable to enter the cells where it will be used for this and other anabolic ("building up") purposes, such as the synthesis of glycogen, proteins, and fatty acids. [40] [41] Insulin is also an active preventor of the breakdown or catabolism of glycogen and fat. [42] The absence of sufficient insulin causes this breaking-down process to be accelerated; it is the mechanism behind metabolizing fat instead of glucose and the appearance of ketones. [40] [43]

Since the glucose that normally enters the cells is unable to do so without insulin, it begins to build up in the blood where it can be seen as hyperglycemia or high blood glucose levels. The tubules of the kidneys are normally able to re-absorb glucose, but they are unable to handle and process the amount of glucose they are being presented with. At this point, which is called the renal threshold, the excess glucose spills into the urine (glycosuria), where it can be seen in urine glucose testing. [44] [45] It is the polyuria, or over-frequent urination, which causes polydipsia, or excessive water consumption, through an osmotic process. [40] Even though there is an overabundance of glucose, the lack of insulin does not allow it to enter the cells. As a result, they are not able to receive nourishment from their normal glucose source. The body begins using fat for this purpose, causing weight loss; the process is similar to that of starvation. [40] [43]

Symptoms

Dog with a cataract in its left eye. Cao com catarata.jpg
Dog with a cataract in its left eye.

The main symptoms which occur in nearly all dogs with diabetes mellitus are: [46]

Sometimes, the first sign of diabetes noticed by the owner may be that their dog either has become blind (due to the formation of cataracts in the eyes), or has vomiting, anorexia, lethargy and weakness (due to ketoacidosis). [47] Diabetes mellitus can be a threat to the health of the dog since it may cause urinary tract infections.

Checkups

Although the symptoms of diabetes mellitus such as frequent urination, thirstiness, greater appetites and inactiveness are easily visible, frequent checking of the dog for the disease is required. The dog's body weight should be determined and calculated once every two weeks using weight scale. [48] The daily caloric requirement by the dog's body and BCS should also be determined using a scale as part of dietary management in maintaining average body weight. The protein intake by the dog should also be considered and checked twice a month.

Blood pressure of the dog should also be constantly and daily checked in order to predict any future occurrence. The blood sugar level may also be checked using glucometer to check the glucose level in the body of the dog.

Management

Early diagnosis and treatment can reduce the incidence of complications such as cataracts and neuropathy. [49] Since dogs are insulin dependent, oral diabetes drugs, which require a functional endocrine pancreas with beta cells capable of producing insulin, are ineffective. [11] [50] [51] [10] Diabetic dogs require insulin therapy, [52] which must be continued for life. [11] [53]

The goal of treatment is to regulate blood glucose using insulin and some probable diet and daily routine changes. [54] The process may take a few weeks or many months and is similar as in type 1 diabetic humans. The aim is to keep the blood glucose values in an acceptable range. The commonly recommended dosing method is by "starting low and going slow" as indicated for people with diabetes. [55]

During the initial process of regulation and periodically thereafter, the effectiveness of the insulin dose at controlling blood glucose is evaluated. [56] This is done by a series of blood glucose tests called a curve. Blood samples are taken and tested at intervals of one to two hours over a 12- or 24-hour period. [52] [57] [58] The results are generally transferred into graph form for easier interpretation. They are compared against the feeding and insulin injection times for judgment. [56] The curve provides information regarding the action of the insulin in the animal. It is used to determine insulin dose adjustments, determine lowest and highest blood glucose levels, discover insulin duration and, in the case of continued hyperglycemia, whether the cause is insufficient insulin dose or Somogyi rebound, where blood glucose levels initially reach hypoglycemic levels and are brought to hyperglycemic ones by the body's counterregulatory hormones. [31] [32] Curves also provide evidence of insulin resistance which may be caused by medications other than insulin or by disorders other than diabetes which further testing can help identify. [57] [58] [59]

Other diagnostic tests to determine the level of diabetic control are fructosamine and glycated hemoglobin (GHb) blood tests which can be useful especially if stress may be a factor. [60] While anxiety or stress may influence the results of blood or urine glucose tests, both of these tests measure glycated proteins, which are not affected by them. Fructosamine testing provides information about blood glucose control for an approximate 2- to 4-week period, while GHb tests measure a 2- to 4-month period. Each of these tests has its own limitations and drawbacks and neither are intended to be replacements for blood glucose testing and curves, but are to be used to supplement the information gained from them. [52] [60] [61] [62] While HbA1c tests are a common diagnostic for diabetes in humans, only recently has an A1C test become available for cats and dogs. The product is called A1CARE and is available from Baycom Diagnostics. [63]

The diabetic pet is considered regulated when its blood glucose levels remain within an acceptable range on a regular basis. Acceptable levels for dogs are between 5 and 10 mmol/L or 90 to 180 mg/dL. [64] [65] The range is wider for diabetic animals than non-diabetics, because insulin injections cannot replicate the accuracy of a working pancreas. [66]

Insulin therapy

The general form of this treatment is an intermediate-acting basal insulin with a regimen of food and insulin every 12 hours, with the insulin injection following the meal. [52] [67] [68] The most commonly used intermediate-acting insulins are NPH, also referred to as isophane, [69] [70] or Caninsulin, also known as Vetsulin, a porcine Lente insulin. [71] [72] [73] While the normal diabetes routine is timed feedings with insulin shots following the meals, dogs unwilling to adhere to this pattern can still attain satisfactory regulation. [74] Most dogs do not require basal/bolus insulin injections; treatment protocol regarding consistency in the diet's calories and composition along with the established feeding and injection times is generally a suitable match for the chosen intermediate-acting insulin. [75] [76]

With Lantus and protamine zinc insulin (PZI) [77] being unreliable in dogs, they are rarely used to treat canine diabetes. [30] [52] [78] [79] Bovine insulin has been used as treatment for some dogs, particularly in the UK. [80] [81] Pfizer Animal Health discontinued of all three types of its veterinary Insuvet bovine insulins in late 2010 and suggested patients be transitioned to Caninsulin. [82] [83] The original owner of the insulin brand, Schering-Plough Animal Health, contracted Wockhardt UK to produce them. [84] [85] Wockhardt UK has produced both bovine and porcine insulins for the human pharmaceutical market for some time. [86] [87] [88]

Diet

Most of the commercially available prescription diabetes foods are high in fiber, complex carbohydrates, and have proven therapeutic results. [52] [74] One primary concern is getting or keeping the animal eating, as use of the prescribed amount of insulin is dependent on eating full meals. [74] [89] [90] When no meal is eaten, there is still a need for a basal dosage of insulin, which supplies the body's needs without taking food into consideration. [42] [59] Eating a partial meal means a reduction in insulin dose. Basal and reduced insulin dose information should be part of initial doctor–client diabetes discussions in case of need. [52] [67]

It is possible to regulate diabetes without any diet change. [52] [91] If the animal will not eat a prescribed diet, it is not in the dog's best interest to insist on it; the amount of additional insulin required because a non-prescription diet is being fed is generally between 2–4%. [74] Semi moist foods should be avoided as they tend to contain a lot of sugars. [30] [52] [92] Since dogs with diabetes are prone to pancreatitis and hyperlipidemia, feeding a low-fat food may help limit or avoid these complications. [64] [34] A non-prescription food with a "fixed formula" would be suitable because of the consistency of its preparation. Fixed formula foods contain precise amounts of their ingredients so batches or lots do not vary much if at all. "Open formula" foods contain the ingredients shown on the label but the amount of them can vary, however they must meet the guaranteed analysis on the package. [93] These changes may have an effect on the control of diabetes. [94] Prescription foods are fixed formulas, while most non-prescription ones are open formula unless the manufacturer states otherwise. [93]

Glucometers and urine test strips

The use of an inexpensive glucometer and blood glucose testing at home can help avoid dangerous insulin overdoses and can provide a better picture of how well the condition is managed. [58] [67]

Ketodiastix color chart for interpreting test results. This test measures both ketones and glucose in urine. Ketodiastix.jpg
Ketodiastix color chart for interpreting test results. This test measures both ketones and glucose in urine.

A 2003 study of canine diabetes caregivers who were new to testing blood glucose at home found 85% of them were able to both succeed at testing and to continue it on a long-term basis. [95] [96] Using only one blood glucose reading as the reason for an insulin dose increase is to be avoided; while the results may be higher than desired, further information, such as the lowest blood glucose reading or nadir, should be available to prevent possible hypoglycemia. [56] [97]

Urine strips are not recommended to be used as the sole factor for insulin adjustments as they are not accurate enough. [98] [99] Urine glucose testing strips have a negative result until the renal threshold of 10 mmol/L or 180 mg/dL is reached or exceededfor a period of time. [100] [101] The range of negative reading values is quite wide-covering normal or close to normal blood glucose values with no danger of hypoglycemia (euglycemia) to low blood glucose values (hypoglycemia) where treatment would be necessary. [56] Because urine is normally retained in the bladder for a number of hours, the results of urine testing are not an accurate measurement of the levels of glucose in the bloodstream at the time of testing. [102]

Glucometers made for humans are generally accurate using canine and feline blood except when reading lower ranges of blood glucose (<80 mg/dL), (<4.44 mmol/L). It is at this point where the size difference in human vs animal red blood cells can create inaccurate readings. [74] [103] Glucometers for humans were successfully used with pets long before animal-oriented meters were produced. [104] A 2009 study directly compared readings from both types of glucometers to those of a chemistry analyzer. Neither glucometer's readings exactly matched those of the analyzer, but the differences of both were not clinically significant when compared to analyzer results. [105] All glucometer readings need to be compared to same sample laboratory values to determine accuracy. [56]

Continuous glucose monitoring

Some veterinarians are using continuous monitoring as part of the dog's treatment plan (2019). Sensors intended for humans, e.g. Abbot labs Freestyle Libre, can be applied and provide direct measurement of glucose levels eliminating the need for daily urine or blood checks.


Disease complications

Ketones – ketoacidosis

Ketone monitoring needed:
High blood sugar
over 14 mmol/L or 250 mg/dL
Dehydration
skin does not snap back into place quickly
after being gently pinched; gums are tacky or dry [106] [107]
Not eating for over 12 hours
Vomiting Lethargy
Infection or illness [108] High stress levels
Breath smells like acetone (nail-polish remover) or fruit. [109]

Ketones in the urine or blood, as detected by urine strips or a blood ketone testing meter, may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by high glucose levels (hyperglycemia) and low insulin levels combined with certain other systemic stresses. [110] [111] DKA can be arrested if caught quickly.

Ketones are produced by the liver as part of fat metabolism and are normally not found in sufficient quantity to be measured in the urine or blood of non-diabetics or well-controlled diabetics. [74] The body normally uses glucose as its fuel and is able to do so with sufficient insulin levels. When glucose is not available as an energy source because of untreated or poorly treated diabetes and some other unrelated medical conditions, it begins to use fat for energy instead. The result of the body turning to using fat instead of glucose for energy means ketone production that is measurable when testing either urine or blood for them. [112] [113] [114]

Ketone problems that are more serious than the "trace or slight" range need immediate medical attention; they cannot be treated at home. [115] Veterinary care for ketosis/ketoacidosis can involve intravenous (IV) fluids to counter dehydration, [74] [116] when necessary, to replace depleted electrolytes, [117] [118] [119] [120] intravenous or intramuscular [34] short-acting insulin to lower blood glucose levels, [121] [122] and measured amounts of glucose or force feeding, to bring the metabolism back to using glucose instead of fat as its source of energy. [34] [44] [123]

Ketostix color chart for interpreting test results. This test measures only ketones in urine. Ketostix chart.jpg
Ketostix color chart for interpreting test results. This test measures only ketones in urine.

When testing urine for ketones, the sample needs to be as fresh as possible. Ketones evaporate quickly, so there is a chance of getting a false negative test result if testing older urine. [124] The urine testing strip bottle has instructions and color charts to illustrate how the color on the strip will change given the level of ketones or glucose in the urine over 15 (ketones–Ketostix) or 30 (glucose–Ketodiastix) seconds. [125] Reading the colors at those time intervals is important because the colors will continue to darken and a later reading will be an incorrect result. [111] Timing with a clock or watch second hand instead of counting is more accurate. [126]

At present, there is only one glucometer available for home use that tests blood for ketones using special strips for that purpose–Abbott's Precision Xtra. [127] [128] This meter is known as Precision, Optium, or Xceed outside of the US. [129] [130] The blood ketone test strips are very expensive; prices start at about US$50 for ten strips. [131] It is most likely urine test strips–either ones that test only for ketones or ones that test for both glucose and ketones in urine would be used. The table above is a guide to when ketones may be present.

Nonketotic hyperosmolar syndrome

Nonketotic hyperosmolar syndrome (also known as hyperglycemic hyperosmolar syndrome) is a rare but extremely serious complication of untreated canine diabetes, which is a medical emergency. It shares the symptoms of extreme hyperglycemia, dehydration, and lethargy with ketoacidosis; because there is some insulin in the system, the body does not begin to turn to using fat as its energy source and there is no ketone production. [116] There is not sufficient insulin available to the body for proper uptake of glucose, but there is enough to prevent ketone formation. The problem of dehydration in NHS is more profound than in diabetic ketoacidosis. [132] Seizures and coma are possible. [133] Treatment is similar to that of ketoacidosis, with the exceptions being that NHS requires that the blood glucose levels and rehydration be normalized at a slower rate than for DKA; cerebral edema is possible if the treatment progresses too rapidly. [116]

Dehydration

Clinical Signs of Dehydration [134]
Based on percentage of body weight, not percentage of fluid loss
< 5% (mild)not detectable
5–6% (moderate)slight loss of skin elasticity
6–8% (moderate)
definite loss of skin elasticityslight prolongation of capillary refill
slight sinking of eyes into orbit slight dryness of oral mucous membranes
10–12% (marked)–emergency
tented skin stands in place
prolonged capillary refilleyes sunken in orbits
dry mucous membranespossible signs of shock
12–15% signs of hypovolemic shock, death–emergency [135]

Body fluid loss is measured in two major ways–sensible and insensible. Sensible is defined as being able to be measured in some way; vomiting, urination and defecation are all considered to be sensible losses as they have the ability to be measured. An insensible loss example is breathing because while there are some fluid losses, it is not possible to measure the amount of them. [134] With a condition like fever, it is possible to measure the amount of fluid losses from it with a formula that increases by 7% for each degree of above normal body temperature, so it would be classed as a sensible loss. [136]

A check of the pet's gums and skin can indicate dehydration; gums become tacky and dry and skin does not snap back quickly when pinched if dehydration is present. [106] [107] [134] When the skin at the back is lifted, a dehydrated animal's does not fall back into place quickly. Serious dehydration (loss of 10–12% of body fluids) means the pulled up skin stays there and does not go back into place. At this point, the animal may go into shock; dehydration of 12% or more is an immediate medical emergency. [136] Hypovolemic shock is a life-threatening medical condition in which the heart is unable to pump sufficient blood to the body, due to loss of fluids. [135]

Dehydration can change the way subcutaneous insulin is absorbed, so either hyperglycemia or hypoglycemia are possible; dehydration can also cause false negative or positive urine ketone test results. [137] [138] Hyperglycemia means more of a risk for dehydration. [139]

Treatment complications

Hypoglycemia

Hypoglycemia, or low blood glucose, can happen even with care, since insulin requirements can change without warning. Some common reasons for hypoglycemia include increased or unplanned exercise, illness, or medication interactions, where another medication potentiates the effects of the insulin. [140] [141] Vomiting and diarrhea episodes can bring on a hypoglycemia reaction, due to dehydration or simply a case of too much insulin and not enough properly digested food. [142] [143] Symptoms of hypoglycemia need to be taken seriously and addressed promptly. Since serious hypoglycemia can be fatal, it is better to treat a suspected incident than to fail to respond quickly to the signs of actual hypoglycemia. [144] [145] [146] Dr. Audrey Cook addressed the issue in her 2007 article on diabetes mellitus: "Hypoglycemia is deadly; hyperglycemia is not. Owners must clearly understand that too much insulin can kill, and that 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 is weak or is behaving strangely." [52] [89] [147]

Clinical Signs

Some common symptoms are: [140] [142] [146]

  • depression or lethargy
  • confusion or dizziness
  • trembling [75]
  • weakness [141]
  • ataxia (loss of coordination or balance)
  • loss of excretory or bladder control (sudden house accident)
  • vomiting, and then loss of consciousness and possible seizures [148]

Successful home treatment of a hypoglycemia event depends on being able to recognize the symptoms early and responding quickly with treatment. [141] Trying to make a seizing or unconscious animal swallow can cause choking on the food or liquid. There is also a chance that the materials could be aspirated (enter the lungs instead of being swallowed). [140] [149] Seizures or loss of consciousness because of low blood glucose levels are medical emergencies. [140] [150]

Treatment

Food should be offered at the first signs of possible hypoglycemia. If the animal refuses it, a sugar solution (corn syrup, honey, pancake syrup, etc.) should be poured on the finger and rubbed on its gums or under the tongue (sublingually). The solution must be applied this way to prevent possible aspiration of it. [140] [143] [151] Intervet suggests one tablespoon of a sugar solution rubbed onto the gums, regardless of the size of the dog. [140] Another hypoglycemia formula is 1 gram of glucose for every kilogram (2.2 lb) of the animal's body weight. [142] [152] Since sugar acts quickly, a response should be seen within a minute or two. [140]

Honey, syrup, or sugar, as simple carbohydrates, [153] act rapidly and will make the blood glucose rise, but the rise will not last very long, as they are broken down quickly by the body. [154] Feeding something containing complex carbohydrates [155] [156] when the pet is able to eat will make sure another hypoglycemia event does not overtake the rapid rise in blood glucose levels from the sugar solution. Complex carbohydrates take longer to be broken down by the body, so they do not raise blood glucose levels until some time after being eaten. [52] [152] [157] A small meal should be fed and the animal taken for medical evaluation to determine if further treatment is needed. [140] [141] [142] Treatment of a serious hypoglycemia episode is similar to that of diabetic humans: using glucose or glucagon infusions, depending on severity. [11] [35] [158] A part from the medicinal way, lifestyle management of the dog can also be considered when preventing a diabetes attack on the dog. [159] Physical exercising activities such as homeopathy2, walking and swimming of the dog are suggested under behavioral management in treating diabetes because it results in tissue preservation. Dietary management in food service is also essential in preventing diabetes attack. A dietary management may include low fat content foods, complex carbohydrates that aid in slowing down glucose absorption, protein and fiber.

Related Research Articles

<span class="mw-page-title-main">Hypoglycemia</span> Health condition

Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose below 70 mg/dL (3.9 mmol/L), symptoms associated with hypoglycemia, and resolution of symptoms when blood sugar returns to normal. Hypoglycemia may result in headache, tiredness, clumsiness, trouble talking, confusion, fast heart rate, sweating, shakiness, nervousness, hunger, loss of consciousness, seizures, or death. Symptoms typically come on quickly.

The following is a glossary of diabetes which explains terms connected with diabetes.

<span class="mw-page-title-main">Diabetic ketoacidosis</span> Medical condition

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. A person's breath may develop a specific "fruity" smell. The onset of symptoms is usually rapid. People without a previous diagnosis of diabetes may develop DKA as the first obvious symptom.

<span class="mw-page-title-main">Ketone bodies</span> Chemicals produced during fat metabolism

Ketone bodies are water-soluble molecules or compounds that contain the ketone groups produced from fatty acids by the liver (ketogenesis). Ketone bodies are readily transported into tissues outside the liver, where they are converted into acetyl-CoA —which then enters the citric acid cycle and is oxidized for energy. These liver-derived ketone groups include acetoacetic acid (acetoacetate), beta-hydroxybutyrate, and acetone, a spontaneous breakdown product of acetoacetate.

<span class="mw-page-title-main">Glucose tolerance test</span> Medical test of how quickly glucose is cleared from the blood

The glucose tolerance test is a medical test in which glucose is given and blood samples taken afterward to determine how quickly it is cleared from the blood. The test is usually used to test for diabetes, insulin resistance, impaired beta cell function, and sometimes reactive hypoglycemia and acromegaly, or rarer disorders of carbohydrate metabolism. In the most commonly performed version of the test, an oral glucose tolerance test (OGTT), a standard dose of glucose is ingested by mouth and blood levels are checked two hours later. Many variations of the GTT have been devised over the years for various purposes, with different standard doses of glucose, different routes of administration, different intervals and durations of sampling, and various substances measured in addition to blood glucose.

<span class="mw-page-title-main">Hyperglycemia</span> Too much blood sugar, usually because of diabetes

Hyperglycemia is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/L (200 mg/dL), but symptoms may not start to become noticeable until even higher values such as 13.9–16.7 mmol/L (~250–300 mg/dL). A subject with a consistent fasting blood glucose range between ~5.6 and ~7 mmol/L is considered slightly hyperglycemic, and above 7 mmol/L is generally held to have diabetes. For diabetics, glucose levels that are considered to be too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. On average, however, chronic levels above 10–12 mmol/L (180–216 mg/dL) can produce noticeable organ damage over time.

<span class="mw-page-title-main">Ketosis</span> Using body fats as fuel instead of carbohydrates

Ketosis is a metabolic state characterized by elevated levels of ketone bodies in the blood or urine. Physiological ketosis is a normal response to low glucose availability, such as low-carbohydrate diets or fasting, that provides an additional energy source for the brain in the form of ketones. In physiological ketosis, ketones in the blood are elevated above baseline levels, but the body's acid–base homeostasis is maintained. This contrasts with ketoacidosis, an uncontrolled production of ketones that occurs in pathologic states and causes a metabolic acidosis, which is a medical emergency. Ketoacidosis is most commonly the result of complete insulin deficiency in type 1 diabetes or late-stage type 2 diabetes. Ketone levels can be measured in blood, urine or breath and are generally between 0.5 and 3.0 millimolar (mM) in physiological ketosis, while ketoacidosis may cause blood concentrations greater than 10 mM.

<span class="mw-page-title-main">Diabetic coma</span> Medical condition

Diabetic coma is a life-threatening but reversible form of coma found in people with diabetes mellitus.

<span class="mw-page-title-main">Blood sugar level</span> Concentration of glucose present in the blood (Glycaemia)

The blood sugar level, blood sugar concentration, blood glucose level, or glycemia is the measure of glucose concentrated in the blood. The body tightly regulates blood glucose levels as a part of metabolic homeostasis.

<span class="mw-page-title-main">Ketoacidosis</span> Medical condition

Ketoacidosis is a metabolic state caused by uncontrolled production of ketone bodies that cause a metabolic acidosis. While ketosis refers to any elevation of blood ketones, ketoacidosis is a specific pathologic condition that results in changes in blood pH and requires medical attention. The most common cause of ketoacidosis is diabetic ketoacidosis but can also be caused by alcohol, medications, toxins, and rarely, starvation.

Diabetes is a chronic disease in cats whereby either insufficient insulin response or insulin resistance leads to persistently high blood glucose concentrations. Diabetes affects up to 1 in 230 cats, and may be becoming increasingly common. Diabetes is less common in cats than in dogs. The condition is treatable, and if treated properly the cat can experience a normal life expectancy. In cats with type 2 diabetes, prompt effective treatment may lead to diabetic remission, in which the cat no longer needs injected insulin. Untreated, the condition leads to increasingly weak legs in cats and eventually to malnutrition, ketoacidosis and/or dehydration, and death.

<span class="mw-page-title-main">Type 1 diabetes</span> Form of diabetes mellitus

Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when cells that make insulin are destroyed by the immune system. Insulin is a hormone required for the cells to use blood sugar for energy and it helps regulate glucose levels in the bloodstream. Before treatment this results in high blood sugar levels in the body. The common symptoms of this elevated blood sugar are frequent urination, increased thirst, increased hunger, weight loss, and other serious complications. Additional symptoms may include blurry vision, tiredness, and slow wound healing. Symptoms typically develop over a short period of time, often a matter of weeks if not months.

The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentrations of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity-onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.

<span class="mw-page-title-main">Ketonuria</span> Medical condition

Ketonuria is a medical condition in which ketone bodies are present in the urine.

Chronic Somogyi rebound is a contested explanation of phenomena of elevated blood sugars experienced by diabetics in the morning. Also called the Somogyi effect and posthypoglycemic hyperglycemia, it is a rebounding high blood sugar that is a response to low blood sugar. When managing the blood glucose level with insulin injections, this effect is counter-intuitive to people who experience high blood sugar in the morning as a result of an overabundance of insulin at night.

Hypoadrenocorticism in dogs, or, as it is known in people, Addison's disease, is an endocrine system disorder that occurs when the adrenal glands fail to produce enough hormones for normal function. The adrenal glands secrete glucocorticoids such as cortisol and mineralocorticoids such as aldosterone; when proper amounts of these are not produced, the metabolic and electrolyte balance is upset. Mineralocorticoids control the amount of potassium, sodium, and water in the body. Hypoadrenocorticism is fatal if left untreated.

Complications of diabetes are secondary diseases that are a result of elevated blood glucose levels that occur in diabetic patients. These complications can be divided into two types: acute and chronic. Acute complications are complications that develop rapidly and can be exemplified as diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), lactic acidosis (LA), and hypoglycemia. Chronic complications develop over time and are generally classified in two categories: microvascular and macrovascular. Microvascular complications include neuropathy, nephropathy, and retinopathy; while cardiovascular disease, stroke, and peripheral vascular disease are included in the macrovascular complications.

Empagliflozin, sold under the brand name Jardiance, among others, is an antidiabetic medication used to improve glucose control in people with type 2 diabetes. It is not recommended for type 1 diabetes. It is taken by mouth.

<span class="mw-page-title-main">Diabetes</span> Group of endocrine diseases characterized by high blood sugar levels

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects. Classic symptoms include thirst, polyuria, weight loss, and blurred vision. If left untreated, the disease can lead to various health complications, including disorders of the cardiovascular system, eye, kidney, and nerves. Untreated or poorly treated diabetes accounts for approximately 1.5 million deaths every year.

Mladen Vranic, MD, DSc, O.C., O.Ont, FRSC, FRCP(C), FCAHS, Canadian Medical Hall of Fame[CMHF] April 3, 1930 – June 18, 2019, was a Croatian-born diabetes researcher, best known for his work in tracer methodology, exercise and stress in diabetes, the metabolic effects of hormonal interactions, glucagon physiology, extrapancreatic glucagon, the role of the direct and indirect metabolic effects of insulin and the prevention of hypoglycemia. Vranic was recognized by a number of national and international awards for his research contributions, mentoring and administration including the Orders of Canada (Officer) and Ontario.

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  143. 1 2 Cat-Dog-Diabetes. "Hypoglycaemia". Intervet (UK). Retrieved 17 April 2010.
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  145. ↑ "Hypoglycemia" (PDF). Novo Nordisk. Archived from the original on July 6, 2011. Retrieved 17 April 2010.{{cite web}}: CS1 maint: unfit URL (link) (PDF)
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  148. ↑ "Seizures". Washington State University College of Veterinary Medicine. Archived from the original on April 4, 2011. Retrieved 17 April 2010.{{cite web}}: CS1 maint: unfit URL (link)
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  150. ↑ Thomas, WB. "Hypoglycemia". University of Tennessee College of Veterinary Medicine. Retrieved 17 April 2010.
  151. ↑ "Photo illustrating how to rub sugar solution on an animal's gums". Drs. Foster & Smith Pet Education. Retrieved 17 April 2010.
  152. 1 2 Caninsulin. "Hypoglycemia". Intervet. Retrieved 17 April 2010.
  153. ↑ "Carbs Information-simple carbohydrates". Carbs Information. Retrieved 17 April 2010.
  154. ↑ "Hypoglycemia in Dogs". BD Diabetes. Retrieved 17 April 2010.
  155. ↑ "Complex Carbohydrates". Weight Loss for All. Retrieved 17 April 2010.
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  157. ↑ "Hypoglycemia" (PDF). Yorkshire Diabetes. Archived from the original on March 4, 2012. Retrieved 17 April 2010.{{cite web}}: CS1 maint: unfit URL (link) (PDF)
  158. ↑ Sheafor, Sarah (2000). "Glucagon Infusions". SouthPaws. Archived from the original on June 9, 2008. Retrieved 17 November 2010.{{cite web}}: CS1 maint: unfit URL (link)
  159. ↑ Behrend, Ellen; Holford, Amy; Lathan, Patty; Rucinsky, Renee; Schulman, Rhonda (January 2018). "2018 AAHA Diabetes Management Guidelines for Dogs and Cats" (PDF). Journal of the American Animal Hospital Association . 54 (1): 1–21. doi:10.5326/jaaha-ms-6822. ISSN   0587-2871. PMID   29314873. S2CID   43327430.
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