Diabetes mellitus is a disease in which endocrine pancreatic beta cells stop producing insulin or can no longer produce in sufficient quantities for the body's needs. This condition is usually divided into two types, depending on the origin of the condition: type 1 diabetes, sometimes called "adolescent diabetes", caused by destruction of pancreatic beta cells. This condition is also referred to as insulin-dependent diabetes, which means exogenous insulin injections should replace insulin the pancreas is no longer capable of producing for the body's needs. Dogs can have insulin-dependent diabetes, or Type 1; the study found no type 2 diabetes in dogs. Therefore, there is no possibility that permanently damaged pancreatic beta cells can be reactivated to cause possible remission with some cases of diabetic cat, where the main type of diabetes is Type 2. There is another less common form of diabetes. , diabetes insipidus, which is an inadequate condition of hormones or antidiuretic resistance.
This most common form of diabetes affects about 0.34% of dogs. These conditions can be treated and do not need to shorten the lifespan of animals or impair quality of life. If left untreated, this condition can cause cataracts, increase leg weakness (neuropathy), malnutrition, ketoacidosis, dehydration, and death. Diabetes mainly affects dogs of middle age and older, but there are cases of adolescents. Typical diabetic dog patients are middle age, female, and overweight at diagnosis.
The number of dogs diagnosed with diabetes mellitus has tripled in thirty years. At a survival rate of nearly the same time, only 50% survived the first 60 days after diagnosis and continued to be successfully treated at home. Currently, diabetic dogs receiving care have the same age of expectation as non-diabetic dogs of the same age and gender.
Video Diabetes in dogs
Classification and causes
Currently, there is no international standard classification of diabetes in dogs. Commonly used terms are:
- Diabetes lacks insulin or primary diabetes, which refers to the destruction of pancreatic beta cells and their inability to produce insulin.
- Diabetes insulin resistance or secondary diabetes, which describes resistance to insulin caused by other medical conditions or by hormonal drugs.
While the occurrence of beta cell damage is known, all the processes behind it are not. Primary Diabetic Canine mirror Diabetes type 1 human in the inability to produce insulin and the need for exogenous replacement, but the target of dog canine autoantibodies has not been identified. Breeds and care studies have been able to provide some evidence of genetic connections. Research has provided evidence that dog diabetes has a seasonal relationship unlike in human type 1 diabetes, and the "lifestyle" factor, with pancreatitis being the obvious cause. This evidence suggests that the disease in dogs has several environmental and food factors involved.
Secondary diabetes can be caused by the use of steroid medications, estrus hormones, acromegaly, (vomiting can overcome diabetes), pregnancy, or other medical conditions such as Cushing's disease. In such cases, it is possible to treat major medical problems and return the animal to non-diabetic status. Returning to a non-diabetic status depends on the amount of damage the pancreatic insulin-producing beta cells produce.
This is rare, but it is possible for a pancreatitis attack to activate the endocrine part of the organs back into being able to produce insulin once again in the dog. There is the possibility of acute temporary pancreatitis, or temporary diabetes, most likely due to damage to endocrine beta cells. Insulin resistance that can follow a pancreatitis attack may take place for some time afterwards. Pancreatitis can damage the endocrine pancreas to the point where diabetes is permanent.
Genetic susceptibility to certain breeds
The list of risk factors for dog diabetes was taken from a genetic breed study published in 2007. Their "neutral risk" category should be interpreted as insufficient evidence that genetically breeding dogs exhibit high, moderate, or low risk for disease. All risk information is based solely on genetic factors found.
Gene therapy
In February 2013, scientists managed to cure type 1 diabetes in dogs using pioneering gene therapy.
Maps Diabetes in dogs
Pathogenesis
The body uses glucose for energy. Without insulin, glucose can not enter the cell where it will be used for this purpose and other anabolic ("build"), such as glycogen synthesis, protein, and fatty acids. Insulin also actively prevents the damage or catabolism of glycogen and fat. The absence of sufficient insulin causes this dashed process to be accelerated; it is the mechanism behind fat metabolism, not glucose and the appearance of ketones.
Since the glucose that normally enters the cell can not do without insulin, it begins to accumulate in the blood where it can be seen as hyperglycemia or high blood glucose levels. Tubular tubules are usually able to reabsorb glucose, but they can not handle and process the amount of glucose that is served. At this point, called the renal threshold, excess glucose spills onto the urine (glycosuria), where it can be seen in a urine glucose test. This is polyuria, or frequent urination, which causes polydipsia, or excessive water consumption, through the osmotic process. Despite the excess glucose, lack of insulin makes it impossible to enter the cell. As a result, they can not receive food from their normal glucose source. The body starts using fat for this purpose, causing weight loss; the process is similar to hunger.
Symptoms
The main symptoms that occur in almost all dogs with diabetes mellitus are:
- excessive water consumption, known as polydipsia,
- frequent and/or excessive urination, known as polyuria, often requires the dog to be allowed to urinate outside at night,
- The appetite is greater than the average, known as polyphagia,
- weight loss.
Sometimes, the first sign of diabetes that the owner may notice is that their dog has become blind (due to cataract formation in the eye), or has vomiting, anorexia, lethargy and weakness (due to ketoacidosis).
Management
Early diagnosis and interventive treatment can reduce the incidence of complications such as cataracts and neuropathy. Because dogs are dependent on insulin, oral medications are not effective for them. They should be placed on insulin replacement therapy. Approved oral diabetes drugs can help Type 2 diabetics because they work in one of three ways: by inducing the pancreas to produce more insulin, by allowing the body to more effectively use the insulin it produces, or by slowing glucose uptake. levels of the digestive tract. Unapproved "natural" drugs make similar claims for their products. All of this is based on the premise of having an endocrine pancreas with beta cells capable of producing insulin. Those with type 1 diabetes or insulin-dependent diabetes, have permanently damaged beta cells, which can not produce insulin. This is the reason why there is no insulin replacement therapy that can be considered as a real and effective treatment. Canine diabetes means insulin dependence; insulin therapy should be continued for life.
The goal is to regulate blood glucose of pets using insulin and some possible diet and daily routine changes. The process may take several weeks or months. This is basically the same as in human type 1 diabetes. The goal is to keep the value of blood glucose within an acceptable range. The generally recommended dosing method is the "low and slow start" as indicated for diabetics.
During the initial process of regulation and periodically thereafter, the effectiveness of insulin doses in controlling blood glucose needs to be evaluated. This is done with a series of blood glucose tests called curves. Blood samples were taken and tested at intervals of one to two hours over a 12 or 24 hour period. The results are generally transferred to graphic form for easier interpretation. They are compared with feeding and insulin injection time for assessment. The curve provides information about the action of insulin in animals. This is used to determine the adjustment of the insulin dose, determine the lowest and highest blood glucose levels, find the duration of insulin and, in the case of advanced hyperglycemia, whether the cause is insufficient insulin dose or Somogyi rebound, where blood glucose levels initially reach hypoglycemic levels and are brought to which is hyperglycemic by the body's counterregulatory hormone. The curve also provides evidence of insulin resistance that may be caused by a drug other than insulin or by a disorder other than diabetes that further testing may help identify.
Other diagnostic tests to determine the level of diabetes control are the fructosamine blood test and glycosylated hemoglobin (GHb) which can be useful especially if stress can be a factor. While anxiety or stress can affect the results of blood or urine glucose testing, these two tests measure glycated proteins, which are unaffected by them. Fructosamine testing provides information on blood glucose control for an approximate period of 2-4 weeks, while a GHb test measures a period of 2- to 4 months. Each of these tests has its own limitations and deficiencies and is not intended as a substitute for testing and blood glucose curves, but should be used to supplement the information obtained from it. Although the HbA1c test is a common diagnosis for diabetes in humans, recently A1C tests are available for cats and dogs. This product calls A1CARE and is available from Baycom Diagnostics.
Diabetic pets are considered to be regulated when their blood glucose levels remain within the acceptable range on a regular basis. The acceptable rate for dogs is between 5 and 10 mmol/L or 90 to 180 mg/dL. This range is wider for diabetic animals than for non-diabetics, because insulin injections can not replicate the accuracy of the working pancreas.
Insulin therapy
A common form of this treatment is intermediate insulin-mediated insulin with a food and insulin regimen every 12 hours, with insulin injections after meals. The most commonly used intermediate workplace isolates are NPH, also referred to as isophane, or Caninsulin, also known as Vetsulin, insulin Lente pig. While normal diabetic routine is fed with insulin injections after meals, dogs that do not follow this pattern can still achieve satisfactory regulation. Most dogs do not require a basal insulin/bolus injection; treatment protocols regarding consistency in calorie diets and compositions along with prescribed feeding and injectable times are generally well suited for selected intermediate-acting insulin.
With lantus and insulin zinc protamine (PZI) that are unreliable in dogs, they are rarely used to treat dog diabetes. Insulin bovine has been used as a treatment for some dogs, especially in the UK. Pfizer Animal Health stopped all three of its cow insulin insuvet types by the end of 2010 and advised patients to be diverted to Caninsulin. The original owner of the insulin brand, Schering-Plow Animal Health, contracted Wockhardt UK to produce it. Wockhardt UK has been producing cow and pork insulin for the human pharmaceutical market for some time.
Diet
Most of the diabetic recipes are commercially available high in fiber, complex carbohydrates, and have proven therapeutic results. The main concern is getting or keeping an animal feed, because the use of insulin amounts determined depends on eating a full meal. When no food is eaten, there is still a need for a basal insulin dose, which supplies the body's needs without taking food into consideration. Eating partial food means a reduction in the dose of insulin. Basal and reduced dosage insulin information should be part of the physician-client's initial discussion in terms of need.
It is possible to regulate diabetes without dietary changes. If the animal will not eat the prescribed food, there is no dog's best interest to impose it; the additional amount of insulin needed for a non-prescription diet is being given generally between 2-4%. Half-humid foods should be avoided because they tend to contain lots of sugar. Because dogs with diabetes are prone to pancreatitis and hyperlipidemia, feeding low-fat foods may help limit or avoid these complications. Non-prescription foods with a "fixed formula" would be appropriate because of the consistency of preparation. Formula foods still contain the right amount of their ingredients so the batch or lot is not much different if at all. Food "Open formula" contains the ingredients indicated on the label but the amount may vary, but they must meet the guarantee analysis on the package. These changes may have an effect on the control of diabetes. Food recipes are a fixed formula, while most of which are not prescribed are open formulas unless the manufacturer states otherwise.
Glucometer and urine test strip
The use of cheap glucometers and home blood glucose testing can help avoid dangerous insulin overdose and can provide a better picture of how well these conditions are managed.
A 2003 study of new dog diabetic caregivers to test home blood glucose found that 85% of them did well in testing and continued in the long run. Using only one blood glucose reading as the reason for the increased dose of insulin should be avoided; while the results may be higher than desired, further information, such as the lowest blood glucose readings or nadir, should be available to prevent the possibility of hypoglycemia.
The urine strip is not recommended for use as a single factor for insulin adjustment because it is not accurate enough. Urine glucose testing strips have negative results until the renal threshold of 10 mmol/L or 180 mg/dL is achieved or exceeded for a certain period of time. The range of negative reading values ​​is wide enough to include normal or near normal blood glucose levels without the danger of hypoglycemia (euglycemia) against low blood glucose values ​​(hypoglycemia) where treatment is needed. Because urine is usually stored in the bladder for several hours, urine test results are not an accurate measurement of glucose levels in the bloodstream at the time of testing.
Glucometers made for humans are generally accurate using canines and cat blood except when reading lower ranges of blood glucose (& lt; 80 mg/dL), (& lt; 4.44 mmol/L). At this point the difference in the size of red blood cells versus human animals can create inaccurate readings. Glucometer for humans was successfully used with pets long before the animal-oriented yards were produced. A 2009 study directly compared the readings of both types of glucometers with that of a chemical analyzer. Both glucometer readings fit perfectly with the analyzer, but the differences were not clinically significant when compared with the results of the analysis. All glucometer readings need to be compared with the same sample laboratory values ​​to determine the accuracy.
Disease complications
Keton - ketoacidosis
The urine or blood ketone, as detected by the urine strip or blood ketone test gauge, may indicate the onset of diabetic ketoacidosis (DKA), a dangerous and often fatal high condition caused by high glucose levels (hyperglycemia) and low insulin levels combined. with certain other systemic pressures. DKA can be arrested if caught quickly.
Ketones are produced by the liver as part of fat metabolism and are not usually found in sufficient quantities to be measured in either urine or non-diabetic blood or people with well-controlled diabetes. The body usually uses glucose as its fuel and is able to do so with sufficient levels of insulin. When glucose is not available as an energy source because of untreated or poorly treated diabetes or some other unrelated medical condition, it begins to use fat for energy instead. The result of a body that switches to using fat as a glucose substitute for energy means measurable ketone production when testing urine or blood for them.
More serious ketone problems than "trace or a little" range require immediate medical attention; they can not be treated at home. Veterinary treatment for ketosis/ketoacidosis may involve intravenous (IV) fluids to fight dehydration, if necessary, to replace lost electrolytes, short intravenous or intramuscular short acting insulin to lower blood glucose levels, and measure glucose or force feeding, to bring metabolism re-use glucose rather than fat as a source of energy.
When testing urine for ketones, samples should be as fresh as possible. Ketones evaporate quickly, so there is an opportunity to get false negative test results if testing older urine. The bottle of urine testing strips has instructions and color charts to illustrate how the color on the strip will change given the level of ketone or glucose in urine over 15 (ketone-Ketostix) or 30 (glucose-Ketodiastix) seconds. Reading colors at time intervals is important because the colors will continue to darken and later readings will be the wrong result. Time with a second clock or watch rather than counting more accurately.
Currently, there is only one glucometer available for home use that tests blood for ketones using a special strip for that purpose - Xott Abbott Precision. This meter is known as Precision, Optium, or Xceed outside the US. A blood ketone test strip is very expensive; prices start around US $ 50 for ten strips. Most likely a good urine-strip test that tests only for ketones or that test both glucose and ketones in urine will be used. The table above is a guide when ketones may be present.
Nonketotic hyperosmolar syndrome
Nonketotic hyperosmolar syndrome (also known as hyperosmolar hyperglycemic syndrome) is a rare but very serious complication of untreated dog diabetes, which is a medical emergency. It shares symptoms of extreme hyperglycemia, dehydration, and lethargy with ketoacidosis; because there is some insulin in the system, the body does not start switching to using fat as its energy source and no ketone production. There is not enough insulin available for the body for proper glucose absorption, but there is enough to prevent the formation of ketones. The dehydration problem in NHS is more profound than in diabetic ketoacidosis. Seizures and coma may occur. Treatment is similar to ketoacidosis, with the exception being that the NHS requires that blood glucose and rehidration levels be normalized at a slower rate than for DKA; cerebral edema may occur if treatment progresses too quickly.
Dehydration
Loss of body fluids is measured in two main ways - sensible and insensitive. Sensible is defined as the ability to be measured in several ways; vomiting, urination and bowel movements are all considered as reasonable losses because they have the ability to be measured. An example of an unreasonable loss is to breathe because when there is some fluid loss, it is impossible to measure their number. Under conditions such as fever, it is possible to measure the amount of fluid loss from it with a formula that increases by 7% for every degree above normal body temperature, so it will be classified as a reasonable loss.
Examination of the gums and skin of pets can show dehydration; Gums become tacky and dry and skin does not return fast when pinched in case of dehydration. When the skin on the back is removed, the dehydrated animal does not fall back into place quickly. Serious dehydration (loss of 10-12% of body fluids) means the retractable skin remains there and does not return to its place. At this point, animals may experience shock; Dehydration 12% or more is an immediate medical emergency. Hypovolemic shock is a life-threatening medical condition in which the heart can not pump enough blood to the body, due to fluid loss.
Dehydration can change the way subcutaneous insulin is absorbed, so hyperglycemia or hypoglycemia may occur; dehydration may also result in incorrect negative or false positive urine test results. Hyperglycemia means more risk for dehydration.
Treatment Complications
Hypoglycemia
Hypoglycemia, or low blood glucose, can occur even with caution, as the need for insulin may change without warning. Some common reasons for hypoglycemia include increased or unplanned exercise, illness, or drug interactions, in which other drugs potentiate the effects of insulin. Vomiting and diarrhea episodes may lead to hypoglycemia reactions, due to dehydration or just too many cases of insulin and inadequately digested foods properly. Symptoms of hypoglycemia need to be taken seriously and treated promptly. Because serious hypoglycemia can be fatal, it is better to treat suspected incidents rather than fail to respond quickly to signs of actual hypoglycemia. Dr. Audrey Cook addressed this issue in his article on diabetes mellitus in 2007: "Lethal hypoglycemia: no hyperglycemia • The owners should clearly understand that too much insulin kills, and that they should call the veterinarian or halve the dose if they have concerns about wellbeing or pet appetite Tell the owner to immediately offer food if the pet is weak or acting strange. "
Clinical Sign
Some common symptoms are:
- depression or lethargy
- confusion or dizziness
- shaking
- weakness
- ataxia (loss of coordination or balance)
- loss of excretion or bladder control (sudden home accidents)
- vomiting, and then lose consciousness and possible seizures
The success of home care from the incidence of hypoglycemia depends on the ability to recognize symptoms early and respond quickly with treatment. Trying to make swallowing an unhealthy animal or bird can cause choking food or fluids. There is also the possibility that the ingredients could be sucked (enter the lungs instead of being swallowed). Seizures or loss of consciousness due to low blood glucose levels is a medical emergency.
Treatment
Food should be offered at the first signs of possible hypoglycemia. If the animal rejects it, the sugar solution (corn syrup, honey, pancake syrup, etc.) should be poured on the finger and rubbed on the gums or under the tongue (sublingually). The solution should be applied in this way to prevent the possibility of that aspiration. Intervet suggests a tablespoon of sugar solution rubbed into the gums, regardless of the size of the dog. Another hypoglycemia formula is 1 gram of glucose per kilogram (2.2 lb) of animal body weight. Because sugar acts quickly, the response should be seen in a minute or two.
Honey, syrup, or sugar, as simple carbohydrates, act quickly and will make blood glucose rise, but the increase will not last long, because they are broken down quickly by the body. Feeding something that contains complex carbohydrates when a pet can eat will ensure the incidence of other hypoglycemia does not overtake the rapid rise in blood glucose levels from a 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 eating. Snacks should be fed and animals taken for medical evaluation to determine whether further treatment is needed. Treatment of a serious hypoglycemia episode is similar to that of a diabetic: using a glucose or glucagon infusion, depending on the severity.
References
External links
- Veterinary & amp; Emergency Critical Care Society Search for emergency facilities around the world
- Blood glucose converter: mg/dL to mmol/L, mmol/L for mg/dL Children With Diabetes
- Pound to Kilograms/Kilogram to Pounds online Converter Go to Toronto
- Dogs and Diabetes - Signs, Treatment, Complexity
- Recipes approved by veterinarians for diabetic dog food
Source of the article : Wikipedia
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