With November being National Pet Diabetes Month, veterinarians have an excellent opportunity to educate their clients about this growing epidemic. Pet owners should be familiar with the signs and symptoms of the disease, have an understanding of the disease process, and know about treatment options. By keeping pet owners actively involved in the care of their pets, veterinarians gain an ally in the battle against diabetes. The classic symptoms of diabetes are increased thirst, increased appetite and increased urination. In addition to the textbook symptoms of polydipsia, polyphagia, and polyuria, pets with diabetes may become lethargic, lose weight, have a dull coat, and in dogs, develop cataracts. Pet owners should be familiar with the signs and symptoms of diabetes so they can promptly seek veterinary care if these develop. Diabetes mellitus develops when the body is unable to regulate the amount of sugar in the bloodstream. In Type 1 diabetes (insulin-dependent diabetes mellitus or IDDM), the body is unable to produce the hormone insulin. Insulin is released into the bloodstream when sugar levels are high and directs cells to remove sugar from the bloodstream and into cells to be stored or used for energy. Type 2 diabetes, sometimes called insulin resistance or non-insulin-dependent diabetes mellitus (NIDDM), develops when the body becomes less responsive to the effects of insulin. Regardless of the cause, both forms of diabetes result in chronically elevated levels of sugar in the blood that damage capillaries and result in a number of different medical issues like nerve damage, kidney failure and even death. Risk Factors Diabetes mellitus is a multifactorial disease influenced by both inherited and environmental factors. Genetic predispositions seem to be an important risk factor, and in dogs, certain breeds, like Keeshonden and Samoyeds, are more likely to develop diabetes. Age is another important risk factor, and though diabetes can affect animals of any age, it is more common in middle-aged and older animals, especially neutered males. Of all the risk factors, obesity is the most concerning, especially since the prevalence of obesity is increasing. In the U.S., it is estimated that 45 percent of dogs and 58 percent of cats are overweight—that’s more than half of the cats in the U.S. Diabetes is manageable. With the right medications, diet and weight loss, diabetes can be controlled. The goal of treatment is to prevent hyperglycemia and provide stable blood sugar levels. Insulin is the primary treatment for both dogs and cats. Several different types of insulin are available with different durations of action. Only two have been approved by the FDA for use in animals: Vetsulin (porcine insulin zinc suspension), an intermediate-acting insulin approved for use in dogs and cats, and Prozinc (protamine zinc recombinant human insulin), a long-acting insulin approved for use in cats. Otherwise, veterinarians have relied on the off-label use of insulin FDA-approved for use in humans. Options Limited Recently, the treatment options became even more limited. In late 2009, Intervet/Schering Plough reported problems with the stability of Vetsulin, which could have caused unpredictable glucose levels, and it began distributing the product only through a Critical Needs Program. On Feb. 7 of this year Intervet/Schering Plough announced that it was halting that program due to problems with product contamination. Since Vetsulin became unavailable, most veterinarians are now using Prozinc or Lantus (insulin glargine) to treat diabetic cats. Because cats metabolize insulin rapidly, most experts recommend using one of these two long-acting insulins. However, only Prozinc is FDA-approved for use in cats. In dogs, there are currently no FDA-approved insulins available, so veterinarians have been forced to use off-label one of many insulins that are FDA-approved for use in humans. In addition to medications, diet and weight loss are just as important when it comes to treating diabetes in pets. In dogs with uncomplicated diabetes, a high-fiber, high-carbohydrate and low-fat diet is preferred, whereas in cats, a high-protein and low-carbohydrate diet is recommended. Recent nutritional studies show that switching to a low-carbohydrate and high-protein canned food diet is the most effective dietary routine for most diabetic cats. Weight loss is also important because obesity is a common cause of insulin resistance. Fatty tissue releases factors that impair the effects of insulin. To promote weight loss, pet owners should be encouraged to exercise their pets in addition to changing their diet. While most people know how to get their dogs to exercise, many have no idea how to get their cats off the couch. Provide your clients with helpful handouts about how to encourage active play and exercise for both dogs and cats. Also provide informational material that addresses other important topics such as how to give insulin injections, how to monitor blood glucose at home, how to deal with hypoglycemia, how to keep a diabetic home journal, and a listing of support groups and online informational resources. Education Benefits All Being proactive and educating your clients about diabetes benefits everyone—it empowers the pet owner, improves the quality of life for her pets, and promotes client loyalty. Having some background knowledge about diabetes also better prepares pet owners to cope with a newly diagnosed diabetic pet. Although it can feel overwhelming at first, well-informed pet owners at least know that diabetes can be managed. Pet owners of newly diagnosed diabetic pets need additional support from their veterinarian to ensure that their pets get the care that they need. In summary, while diabetes is an increasingly common problem in pets, the prevalence of this disease represents a tremendous opportunity to educate clients, provide an invaluable service to at-risk animals and build client loyalty. For more detailed information about caring for your diabetic patients, consult the American Animal Hospital Association Diabetes Management Guidelines for Dogs and Cats. In addition, Boehringer Ingelheim Vetmedica, the maker of ProZinc, provides a wide variety of educational material about feline diabetes for veterinarians and clients, including instructional videos, a “Home Care Diary” and other useful information at www.prozinc.us. This Education Series article was underwritten by Boehringer Ingelheim Vetmedica Inc. of St. Joseph, Mo.
