Diabetes mellitus in animals. Diabetes mellitus in cats: how it manifests itself, what to do, how to treat it, what to feed

Diabetes as a metabolic disorder. Diabetes mellitus is a painful condition of persistently high levels of glucose in the blood. Most people with diabetes are: tame rats; hand mice; cats (approximately 0.2%); dogs (about 0.5%) animals. There was no gender or breed predilection for diabetes mellitus. The disease spreads very quickly; just 15 years ago, diabetes mellitus in animals was rare. Nowadays, castrati and non-sterilized female cats usually get sick. Diabetes develops over several years; Typically, signs of the disease are found in animals aged 6 years and older. Recently, cases of diabetes in kittens older than six months have become more frequent.

Main signs of diabetes

The onset of symptoms of diabetes mellitus is extended over time. Animals drink a lot and urinate frequently. The skin becomes dry. Cats' gait changes: animals rely on their feet. Characterized by prolonged diarrhea. Animals smell like rotten apples or sauerkraut. Animals with diabetes begin to eat a lot. At the same time, they gain unusually large amounts of weight or lose weight quickly in a matter of weeks.

Causes and course of diabetes mellitus

The transmission of type 2 diabetes mellitus by inheritance has been established. In some cases, one of the animal's parents had type 1 diabetes, and the offspring had type 2 diabetes, and vice versa. The main cause of diabetes is inhibition and subsequent destruction of pancreatic cells that produce insulin. In the development of type 3 diabetes, insulin plays little role. Amylin (sometimes called amoline) secreted by pancreatic cells is involved in the use of glucose by cells. The mechanism of action of amylin is unknown, but a connection has been established between low amylin activity and the occurrence of type 3 diabetes.

The main reasons for the inhibition and destruction of pancreatic cells are:

• genetic predisposition;
• autoimmune disorders;
• hormonal abnormalities;
• transmission of viral diseases in severe form;
• individual increase in sensitivity to a number of drugs;
• severe inflammation of the pancreas (pancreatitis).

Genetic predisposition well expressed in rats and mice. In cats and dogs, the inheritance of the disease is complex and is associated with many other signs. Diabetes mellitus mainly manifests itself when crossing animals that have relatives from the second to the sixth generation. Animals with such connections are used in breeding to obtain groups that enhance certain qualities of the breed (lines). The result is often autoimmune disorders.

Diabetes mellitus is a metabolic disorder in which cells are unable to metabolize glucose

Diabetes mellitus is a metabolic disorder in which cells are unable to metabolize glucose. It is believed that the main role in the development of diabetes is played by the pancreatic hormone insulin, which is responsible for the transport of glucose from the blood to the tissues. Depending on the effect of this hormone on the disease, there are: insulin-dependent, or type 1 diabetes; non-insulin dependent, or type 2 diabetes; impaired resistance (tolerance) to various carbohydrates and glucose, or type 3 diabetes. The differences in the symptoms of these types of diabetes mellitus are insignificant, the principles of treatment are the same.

Autoimmune disorders

The body’s defenses are “considered enemies” of cells own body. Disorders are not only genetic in nature. Some viruses, such as the causative agents of distemper and infectious canine hepatitis, are genetically similar to pancreatic cells.

Cell destruction is slow in most cases. However, the process stops only with the complete destruction of cells that are mistakenly perceived as an infection.

Hormonal abnormalities lead to inhibition of the pancreatic cells responsible for the production of insulin and amylin. The production of these hormones is influenced by the pituitary gland, pineal gland, thyroid and sex glands, and adrenal glands.

Carrying severe viral diseases depletes the body's strength. In addition, viruses invade gland cells. In an exhausted body, a malfunction occurs: the immune system begins to perceive healthy cells as damaged. In other words, an autoimmune disorder begins.

Increased individual sensitivity to a number of medications causes disruption of the adrenal glands and thyroid gland. First of all, drugs based on hormones, such as hydrocortisone and prednisolone, are dangerous. A similar effect is exerted by iodine-based medications (5% iodine solution, saveiodim, etc.) with long-term (more than 10 days) use and an increase in individual sensitivity.

Methods for restoring the pancreas in diabetes mellitus have not been developed

Severe inflammation of the pancreas (pancreatitis) has a dual effect. On the one hand, inflammation depletes the body. In addition, the pancreas has different types of cells. Some produce digestive enzymes. Others produce hormones - insulin and amylin. With pancreatitis, the cells that produce digestive enzymes are destroyed. The released enzymes digest the cells that create the hormone.

In addition, the diet of wild dogs and cats contains much less carbohydrates than the diet of domestic predators. However, the significance of excess carbohydrates in food for the development of diabetes mellitus has not been studied.

As a result of these reasons, the functioning of the pancreas is irreparably impaired. The functioning of pancreatic cells is gradually disrupted. The load on the surviving cells increases. At first, the body compensates for the increase in blood glucose levels, but over time, the release of hormones decreases.

Glucose is actively excreted in the urine and deposited in the nervous tissue and kidneys. Excretion in urine results in the removal of large amounts of water from the body. Deposition of glucose in the kidneys leads to low-grade inflammation and cell death.

The deposition of glucose in nerve cells slows down and later stops the conduction of impulses. The animal's gait and reaction to what is happening around is disrupted.

Large amounts of glucose in the blood slowly destroy blood vessels. The functioning of red blood cells and other blood elements gradually deteriorates. Small foci of necrosis appear in the organs.

Treatment

Methods for restoring the pancreas in diabetes mellitus have not been developed. Israeli specialists with the help genetic engineering obtained intestinal bacteria capable of producing insulin and amylin. However, there is no information about the regular use of such bacteria in animals. The lack of hormones in diabetes is compensated for by injections. There are long-acting (for example, Lantus), medium-acting (Protafan) and short-acting (Monodar) insulin preparations. The use of insulin-based medications remains the only way to maintain life with diabetes.

Additionally, concomitant diseases are treated. So, when signs of kidney inflammation (nephritis) appear, antibiotics are prescribed to suppress the infection.

Herbal preparations that improve excretory function are also used, for example, " healthy kidneys". Additionally appointed ascorbic acid, rutin, cocarboxylase. In case of defeat nervous system use B vitamins, Cavinton and similar medications. The animal’s diet must be adjusted. It is highly advisable to provide exclusively dry food for animals with diabetes.

If your pet begins to eat more or less than usual, or loses or gains weight, contact your veterinarian immediately. Only a competent specialist can make a diagnosis and prescribe the correct treatment.

Cats, male cats and kittens may suffer from various diseases, many of which are not difficult to treat at the veterinarian, but there are also some for which there is practically no cure. Diabetes can be cured, but you need to understand that it cannot be treated without a veterinarian, as complications are possible. different breeds cats, cats and kittens, which can lead to disastrous consequences.

This article is for informational purposes, because accurate diagnosis and only a veterinarian can give a prognosis for treatment after examining the pet, but it will not be superfluous to learn about how they are treated and what needs to be done in such situations in order to prepare for what awaits you in the future.

How does diabetes mellitus manifest itself in cats? Symptoms

Cats are more likely to suffer from diabetes than cats. Symptoms of this disease in animals are:
- obesity or sudden weight loss of a previously quite well-fed cat;
- increased thirst;
- increased volume of urination;
- the smell of acetone coming from the mouth;
- general weakness, apathy, deterioration of the skin and coat.

If you ignore these signs of diabetes and do not start treating the disease, the animal will die.

Diabetes mellitus in a cat: causes, signs, consequences, unpleasant odor, prognosis

The main reason for the development of diabetes mellitus in cats is various pathophysiological changes in the body. Pancreatitis, disruptions in the pancreas, intense secretion of somatotropic hormone in the mammary glands - these and other endocrine disorders provoke the onset of diabetes.

The main clinical signs of diabetes mellitus in animals, as in humans, are increased thirst, copious discharge urine, weight loss (in some cases, on the contrary, obesity) and bad smell from mouth. But this does not mean that diabetes in cats can be cured by using human medications.

Sugar-lowering tablets for humans are in many cases contraindicated for cats!

Sick animals are usually prescribed insulin therapy. However, before you start injecting insulin, you need to make sure that there is no insulin resistance.

If a cat's diabetes mellitus is in an advanced state, the prognosis will be disappointing - the animal is doomed.

Diabetes mellitus in a cat: tests, diagnosis, blood sugar levels

Diabetes mellitus in a cat can only be detected by conducting clinical tests of the animal’s urine and blood for glucose content. In healthy cats, the sugar norm is 5-7 mmol per liter.

At home, the level of glucose in the blood can be measured using a “human” glucometer, and in the urine - with special strips Uriglyuk or Glucofan.

Blood for analysis is taken from the vessels located at the tips ears animals, and the easiest way to collect urine is to teach the cat to use a toilet tray with a grid (without filler).

How to treat diabetes in cats, treatment with tablets, folk remedies, recommendations

When treating diabetes mellitus in cats, a specialist may prescribe sugar-lowering tablets - Glipizide, Acarbose, Metformin. Veterinarians also recommend changing the diet of sick animals, limiting them in carbohydrates and enriching their food with proteins.

In folk medicine, for the treatment of diabetes mellitus in cats, cooled decoctions from asparagus rhizomes or linden color, which are given to animals instead of water to drink during the week.

Diabetes mellitus in cats, what to feed, nutrition and diet, feeding and care

A cat with diabetes will need to be cared for until the end of its allotted life. The animal will constantly need drug treatment and dieting.

Special low-carbohydrate foods have been developed for diabetic cats, but it is better if the necessary diet is prescribed by the attending physician, since in each specific case the nutrition of a sick animal can vary quite dramatically. The number and time of feedings is also agreed with the veterinarian, as it should be related to the time of insulin injections and its dose.

Remission of diabetes mellitus in an old cat

Unfortunately, it is not always possible to achieve remission of diabetes mellitus in an old cat. Positive results are achieved under the conditions of insulin therapy as early as possible, strict adherence to a high-protein diet and timely treatment of other chronic ailments that can worsen the health of a diabetic cat.

Diabetes mellitus in a cat, treatment without insulin, complications

When treating diabetes mellitus in cats, insulin can be replaced with drugs that lower sugar. Glipizide, metformin, vanadium, acarbose or troglitazone are usually prescribed, but some veterinarians consider the tablets ineffective, arguing that remission can only be achieved with insulin. No matter how, diabetic In any case, the animal must receive adequate dietary nutrition.

To avoid unforeseen complications of the disease, the owner of the animal must constantly monitor the health of his pet and regularly perform lab tests for the presence of glucose in his urine and blood.

Sterilizing an animal and fighting its excess weight helps reduce the risk of diabetes progression, but a universal recipe or a method suitable for everyone, despite a number of promising studies, has not been found. Complications of diabetes are fatal.

Diabetes mellitus in cats treatment sugar does not decrease

In most cases, insulin is used to treat diabetes mellitus in cats. If the glucose content in the animal’s urine and blood does not decrease after a course of insulin therapy, then there is a high probability of an incorrectly chosen dosage of this drug. The optimal option for cats is considered to be glucose at a level of 6-16 mmol/l.

Diabetes in cats: how often can blood be drawn?

The owner of a cat with diabetes needs to constantly monitor the level of glucose in the animal's blood. Control measurements and blood sampling are carried out every 7-14 days, judging by the condition of the sick animal. Glucose concentration tests are taken three times a day - before the insulin injection, 6 hours after the injection and before the evening injection.

Some pet owners have the opinion that diabetes is an exclusively “human” disease, and our little brothers are not familiar with this disease.

This opinion is fundamentally wrong: all mammals, including representatives of the cat family, suffer from diabetes.

Diabetes mellitus is a disease that is a direct consequence of disturbances in the functioning of the pancreas and its inflammation.

This organ consists of several types of cellular structures, the functions and purposes of which are different.

The former are responsible for the production of digestive enzymes, and the latter synthesize the hormone that controls blood sugar levels - insulin.

Due to inflammation of the pancreas, these cells completely or partially stop working, producing insufficient insulin to neutralize sugars.

Diabetes in cats symptoms: signs of diabetes in cats may be vague due to the specific reaction of the body. The disease is asymptomatic for some time, after which clinical signs often appear quickly and colorfully.

Often the presence of this disease in a pet is indicated by:

1. General malaise, changes in behavior and taste preferences. Complete or partial refusal of food in the initial stages.
2. Strong thirst, the pet drinks a lot and actively.
3. Frequent urination as a consequence of thirst.
4. The pet suddenly gains or loses weight.
5. In the later stages, disturbances in the functioning of the nervous system, muscle twitching, and convulsions are observed.
6. Laboratory findings: increased blood glucose.
7. Laboratory findings: glucosuria (excretion of large amounts of sugar in the urine).

The causes of this disease have not been fully elucidated.

There are many theories according to which the following are considered a predisposing factor to the onset of the disease:

1. Hereditary or genetic predisposition.
2. Overweight.
3. Application hormonal drugs for the treatment of certain diseases.
4. Pancreatitis.
5. Rarely - pre-estrus period or pregnancy.
6. Hormonal imbalances, excess or deficiency of certain hormones.
7. Incorrect, unbalanced feeding.

All animals are at risk. Mostly old cats, as well as pets over 5 years of age, are affected. Kittens and young representatives of the cat family rarely get sick, only in the case of hereditary transmission of the disease.

Diagnosis of diabetes mellitus is simple: to confirm the diagnosis, blood is taken for analysis and a conclusion is made based on the presence of glucose in it.

Diabetes insipidus is rare in cats. It is manifested by a complex of congenital anomalies, an underdeveloped pituitary gland or its tumor.

Clinical symptoms are often similar to regular diabetes, the production of insulin and antidiuretic hormone completely or partially stops, the body suffers due to high level blood sugar.

Treatment: drugs and medications

For the treatment of diabetes mellitus it is used exclusively intravenous administration insulin in a dosage determined by the attending veterinarian.

At first, several visits are made to the clinic to adjust the dosage in accordance with laboratory and clinical diagnostic data.

In the future, when the functioning of the pancreas normalizes, the dose of insulin is reduced.

Vitamin preparations are also prescribed.

Without insulin, treatment is considered incomplete and in 80% of cases there is no improvement, and all the prerequisites for death appear.

How to treat diabetes in cats should be determined solely by the employee. veterinary clinic. Self-medication can be detrimental to your pet’s health and cause disturbances in the functioning of the body’s organs and systems.

Treatment of diabetes mellitus in cats with folk remedies at home does not give a positive result.

Nutrition for diabetes

So, what to feed your pet? As maintenance therapy, sick animals are prescribed a special diet prepared by a veterinary nutritionist.

It should not contain food that is difficult to digest, hot spices, or other substances that irritate the digestive system.

The diet should include fermented milk products without sugar with a low percentage of liquid.

Also, sick animals are often switched to feeding premium food.

Some of them (Hill's, Proplan, Royal Canin, Purina) have specially formulated product lines for diabetic cats.

It is better to choose food for cats with diabetes by carefully studying its composition.

How long do diabetic cats live?

The life expectancy of sick pets is determined solely by the quality and quantity of treatment prescribed, as well as the specific individual and species characteristics of the cat’s body.

In the absence of treatment, sick animals die 15-30 days after the clear manifestation of symptoms and clinical signs.

This applies primarily to the symptomatic manifestation of the disease, expressed by damage to the nervous system and convulsions.

More "calm" and hidden forms This disease can be asymptomatic for 2 to 5 years, without showing obvious symptoms.

To prevent the development of this form of diabetes mellitus or detect it early stages, you must visit at least once a year veterinarian to take blood for analysis.

This allows us to identify not only diabetes, but also a whole complex serious illnesses internal organs, which are difficult to treat in the later, final stages.

It should be remembered that this disease is not a death sentence. Insulin injections into correct dosage prolong the life of the pet without affecting the overall duration. Cats with diabetes can live, like all healthy animals, 10 to 14 years.

Remember! If the animal exhibits general malaise, which is expressed by refusal to feed, depression, refusal to play, decreased motor mobility, cloudy eyes, you should immediately consult a veterinarian.

Even if your animal is simply unwell, without any specific reason, a visit to a specialist will not be superfluous.

Related Posts

therapist, endocrinologist,
Neurologist, DVM, BSc

Diabetes dogs, cats and humans have a lot in common. However, the mechanism that leads to the development of diabetes and its manifestations often differ significantly depending on the animal species. And therefore, approaches to treatment are also not the same in everything.

Therefore, we cannot blindly transfer everything we know about diabetes in humans to dogs. For example, it is incorrect to divide diabetes in dogs into type 1 and type 2 diabetes, as is common in humans. In addition, many drugs that work well in humans work poorly or not at all in animals. There are other differences too. So, we will only talk about dogs.

What happens normally

All cells in our body require glucose (“sugar”) as their main source of energy. Glucose enters the body through the intestines from food or from internal reserves (liver glycogen, muscles, etc.). From the intestines or from internal reserves, glucose is carried to places of consumption by the blood. However, for most cells, it is not enough for the blood to bring them glucose; it is also necessary for a hormone called insulin to transmit the corresponding signal to the cell, and the cell is able to perceive this signal. This hormone is produced in the body in the so-called islets of Langerhanz in the pancreas.

So, after eating, glucose from the intestines enters the blood and its level in the blood increases. The pancreas senses this increase and releases insulin into the blood. The cells of the body perceive the insulin signal and transfer glucose from the blood into the cytoplasm (inside the cells). The level of glucose in the blood drops, the cells feel “full”, and the pancreas stops releasing insulin into the blood.

What happens with diabetes

In diabetes, one or both of the following occurs:

• the pancreas loses its ability to produce enough insulin
• body cells lose the ability to perceive the insulin signal

In both cases, the cells “do not understand” that there is already enough glucose in the blood and do not transport it inside. As a result, blood glucose levels remain high while cells starve. Hence, one of the symptoms of diabetes is high blood glucose.

Normally, the kidneys do not pass glucose from the blood into the urine. However, when blood glucose levels rise above a certain limit, the kidneys cannot cope and glucose begins to be excreted in the urine. Thus, another symptom of diabetes mellitus appears - high glucose in the urine.

When there is a lot of glucose in the urine, it then “pulls” water from the blood. As a result, the volume of urine increases and the animal begins to urinate a lot. Water is removed from the body, the body becomes dehydrated, the animal feels thirsty and begins to drink more. Hence two other symptoms of diabetes: polyuria and polydipsia (excessive drinking and urination).

Since cells cannot bring glucose in, this situation is essentially starvation for the body. It includes compensation mechanisms: the animal becomes hungry and begins to eat more than usual (although this is not beneficial, since glucose remains in the blood and then leaves in the urine), and internal energy reserves are also mobilized. When glycogen stores in the liver and muscles are no longer sufficient, the body begins to use protein and fat reserves. Due to protein breakdown, muscle mass decreases. This is how another symptom of diabetes appears - increased appetite along with weight loss.

With the massive breakdown of fats in the body, many ketone bodies are formed. Ketone bodies can also be found in urine. One of the ketone bodies is acetone, so animals that are seriously ill with diabetes may smell acetone in their breath. In addition, the acidity of the blood increases (pH decreases). This situation is called diabetic ketoacidosis and is critical. Without intensive treatment, it can lead to death in a matter of days, or even hours.

High blood sugar has a detrimental effect on many systems: due to damage to nerve fibers, weakness of the hind limbs and a plantigrade gait appear, and diabetic cataracts occur (the lens of the eye becomes cloudy; it is rare in cats). The presence of sugar in the urine creates excellent conditions for the growth of bacteria, so cystitis is also a common complication of diabetes.

Who has diabetes

It most often appears in cats between 9 and 11 years of age. Neutered cats are more likely to get sick.

What is the reason

In dogs, the main cause is hereditary predisposition.

Without delving into the mechanism of development of diabetes, we can say that in most cases it is impossible to establish the exact cause of its occurrence. However, there are factors that predispose to diabetes and, together, can lead to it.

These factors are:

• overweight
• treatment with hormonal drugs
• pancreatitis
• the period of the first 1-2 months after estrus or pregnancy
• other hormonal disorders.

How to make a diagnosis

To make a definitive diagnosis of diabetes, it is not enough to detect any one of the above-mentioned signs, since for each of them there can be many other causes besides diabetes. For example, polyuria and polydipsia can be caused by chronic renal failure, blood glucose can rise simply from stress, cataracts can simply be “senile”, and increased appetite along with weight loss can be caused by worms. For this reason, if you or your doctor suspects an animal has diabetes mellitus, it is often necessary to carry out a whole range of examinations, which are necessary both in order to make an accurate diagnosis and in order to detect related problems and complications. These examinations may include: blood tests (general, biochemical, acid-base balance, serial glucose measurements, hormone tests), urine tests, assessment of the amount of fluid intake and urine output, x-rays, ultrasound, ECG.

So, we know that our animal has diabetes mellitus, that is, the body’s cells do not take glucose from the blood inside. In most cases, to overcome the lack of insulin or low sensitivity to it, it is necessary to introduce insulin from outside.

It is impossible to predict in advance exactly how much insulin will be needed for any given animal. However, based on the weight of the animal and previous experience, you can start with a certain dose, and then adjust the amount and frequency of insulin administration in accordance with the body’s reaction. For the most accurate and quick dosage selection the best way is to plot a glucose curve. To do this, blood glucose is measured every 1-2 hours after insulin administration for 8-24 hours. Thus, you can find out at what interval after administration insulin begins to act, at what period its action peaks, how long and how strongly it acts.

The next step is to select the optimal time to feed the animal. Depending on the type of insulin used (short, intermediate or long acting), on the type of food and on individual characteristics The animal may be recommended to be fed simultaneously with the administration of insulin, some time after the administration, fractional and frequent feeding in small portions, or providing constant access to food.

Further observation is carried out by the owner with regular monitoring by the attending physician. The animal's condition may change, insulin sensitivity may increase or decrease, and concomitant diseases may appear. For this reason, it is necessary to periodically come for follow-up examinations and carry out laboratory research and sometimes repeat the glucose curve.

It is necessary for the doctor or assistant to explain in detail and show the owner how to store, how to draw and how to administer insulin.

It is important to remember that the effects of too much blood glucose affect the body gradually, while a drop in blood glucose below normal levels (hypoglycemia) can be fatal very quickly. Therefore, when using insulin, the goal is not to bring glucose to a normal level, but to keep it slightly above the upper limit of normal. This way we will be sure that we will not get hypoglycemia.

For the same reason, it is not as scary to “under-dose” insulin as to overdose it. Therefore, if you injected insulin, but were not sure that you were in the right place (for example, you felt that the fur became wet at the injection site), or you don’t know whether someone at home injected insulin before you, never do not re-inject insulin. It is better to miss an injection once than to inject twice by mistake.

Since there are often some difficulties with purchasing insulin in pharmacies, it is recommended to always have one spare sealed package of insulin at home. It is usually recommended to throw away an opened package of insulin after 1.5-2 months, even if it is not completely used up.

Feeding

Usually, immediately after a meal, glucose in the blood increases very strongly, and the body of a diabetic animal cannot cope with such a load. Therefore, the point of feeding for diabetes is to ensure that the flow of glucose from food into the blood is as slow as possible. This is usually achieved by selecting special sources of dietary fiber in the right proportion. In addition, the food must contain a limited amount of calories and a sufficient amount of protein. The best solution is to feed special medicinal feeds. If for any reason this is not possible, you should discuss other options with your doctor. As we mentioned above, the frequency and time of feeding are selected individually.

As for the amount of food consumed per day, it is very important to feed the animal in such quantities that it remains thin. Obesity reduces the sensitivity of cells to insulin, which means it worsens diabetes.

When to sound the alarm

If the animal develops weakness, unsteady gait, trembling, loss of consciousness, convulsions, it is necessary to offer the animal to eat (if it is conscious), and if it refuses food, spread honey, sugar syrup or glucose solution on the oral mucosa (tongue, gums). and contact your doctor immediately.

If your blood or urine glucose levels rise above what they were before, you should contact your doctor within 1-2 days.

If the blood glucose level drops below 3 mmol/liter, it is necessary to offer the animal to eat (if it is conscious), and if it refuses food, spread honey, sugar syrup or glucose solution on the oral mucosa (tongue, gums) and immediately contact doctor.

If your urine glucose level drops to zero and/or ketones appear in your urine, you should check your blood glucose levels.

Diabetic ketoacidosis

Diabetic ketoacidosis is a critical condition that usually appears after an animal has had diabetes for a long time. However, in some cases, diabetes can lead to ketoacidosis in a matter of days. As mentioned above, in this state the body mobilizes large amounts of fat as an energy source. The liver forms ketone bodies from these fats, one of which is acetone. This leads to acidification of the blood and can lead to death within a short time.

Symptoms of diabetic ketoacidosis are: smell of acetone from the breath, lethargy, refusal to eat, vomiting, diarrhea, rapid breathing, low temperature, coma.

If one or more of these symptoms occur, you should contact your doctor immediately.

Treatment of animals in a state of diabetic ketoacidosis consists primarily of the use of insulin and intensive care. In such cases, insulin is used not so much to lower blood glucose levels as to stop the production of ketone bodies in the liver. For this purpose, short-acting types of insulin are used; the drug is administered very often (every 1-2 hours) and under strict control of blood glucose levels. Droppers are needed in order to restore water, acid-base and electrolyte balance in the body, in order to quickly remove ketone bodies from the body, and also to prevent blood glucose from falling below normal due to the administration of insulin in large quantities. doses

Problem cases

If the patient cannot be stabilized for a long time, the reason may be the following:

• incorrect dialing and/or administration of insulin
• ineffective insulin (expiration date has expired or storage conditions have not been met)
• accelerated insulin metabolism (rapid elimination from the body)
• Somogyi effect (too high a dose of insulin can lead first to a sharp drop and then to a strong and prolonged rise in glucose levels)
• simultaneous use of other drugs (especially hormones)
• changes in internal hormonal levels (sexual cycle in bitches, hyper- and hypo-adrenocorticism, acromegaly, etc.)
• concomitant infections (in particular, cystitis, periodontal disease, dermatitis) and other diseases
• obesity (see above)
• true insulin resistance
• excess fats in the blood
• antibodies against insulin.

What can you do besides insulin?

In most cases, no drug can replace insulin in the treatment of canine diabetes. However, there are a number of measures that can, if not eliminate, then at least significantly reduce the need for insulin in animals. For female dogs, such an event is, first of all, sterilization (removal of the uterus and ovaries). If diabetes appears during the first two months after estrus or pregnancy, then sometimes spaying or simply ending this period completely relieves the animal of the symptoms of diabetes. However, the predisposition to diabetes remains, and it can reappear at any time.

Another important point regarding obese animals is reducing body weight to normal. It is also important to increase physical activity animals (walk longer and play with dogs).

You should switch to feeding special medicinal foods (Hill's w/d, Royal Canin Diabetic, etc.).

Use of oral hypoglycemic agents

Glipizide(as well as glyburide and glibenclamide) – enhances the production of insulin by the pancreas. This drug is not effective in treating canine diabetes. Metformin - increases tissue sensitivity to insulin, and also reduces the release of glucose from the body's internal reserves and the synthesis of glucose in the body.

Metformin, could possibly help animals that retain some ability to produce insulin, but side effects (lethargy, loss of appetite, vomiting) limit its use. At this stage, additional research is required to draw conclusions about the feasibility of its use.

Vanadium is an element that is present everywhere. It probably has insulin-like properties and is virtually free of side effects, but is nonetheless ineffective on its own. Vanadium was studied in the form of dipicolinate. This form is not available for purchase. Vanadium sulfate is sold as a vitamin supplement, but its effectiveness is unknown.

Chromium– in the form of picolinate, enhances the effect of insulin in healthy dogs. However, this effect was not observed in dogs with diabetes.

Acarbose– inhibits digestive enzymes responsible for the breakdown of starches (the main sources of glucose in the intestines). As a result, glucose enters the intestines more gradually and more even glucose levels are maintained in the blood. The drug is expensive and has side effects (diarrhea, weight loss), so it is used in dogs only if insulin alone is not enough to control hyperglycemia.

Troglitazone– increases tissue sensitivity to insulin

Authors): ON THE. Ignatenko, Ph.D., member of the European Society of Dermatology, member of the European Society of Endocrinology, Kiev, Ukraine / N. Ignatenko, Member of ESVD, ESVE, Kiev, Ukraine
Magazine: №5 - 2014

UDC 616.379-008.64:636.8.045

Keywords: diabetes mellitus in cats, remission of diabetes mellitus, hyperglycemia, hypoglycemia, insulin therapy, diet, exercise

Key words: diabetes mellitus in cats, remission of diabetes mellitus, hyperglycemia, hypoglycemia, insulin, diet, exercise

annotation

Diabetes mellitus in cats is a common endocrine disorder. Difficulty perceiving a severe endocrine disorder leads to common mistakes in home therapy of diabetic cats. Five short steps allow you to consistently understand the issues of etiology, clinical manifestations, diagnostics, at important points in the treatment and prognosis of diabetes mellitus, and also facilitate the path to achieving remission, which is the most desirable goal of therapy in diabetic cats.

Diabetes in cats is a common endocrine disorder. The complexity of perception of severe endocrine disorder resulting in frequent errors in home therapy diabetic cats. Five short stages allow consistently deal with issues of etiology, clinical manifestations, diagnosis, therapy and the important points of the forecast of diabetes. And also make it an easier way to achieve remission, which is the most desirable goal in cats with diabetes.

Diabetes mellitus in cats is a disease that is characterized by a relative or absolute deficiency of insulin and leads to the development of persistent hyperglycemia. It is generally accepted that diabetes mellitus is primarily a problem for old elderly cats, since cats under one year of age are 50 times less likely to develop diabetes mellitus than cats over 10 years of age. Males are more likely than cats to suffer from this disease, but, nevertheless, in the routine practice of a veterinarian, it is becoming more common (if earlier foreign statistics spoke of one case of the disease per 1000 cats, then the modern one indicates that diabetes mellitus may occur in one in 200 cats admitted). Therefore, we can encounter this disease in any age group of any gender and breed and must be prepared to recognize it by its characteristic clinical signs.

1. Clinical picture (What's going on with my cat?)

The clinical signs of diabetes mellitus, unlike many endocrine pathologies, are quite characteristic, and we can also count them on the fingers of one hand:

Polydipsia;

Polyuria;

Polyphagia;

Fluctuations in weight;

In more rare cases with long-term diabetes mellitus, peripheral neuropathy manifests itself in a strange plantigrade gait. Cataracts, which are common in diabetic dogs, are not common in diabetic cats. However, it should be remembered that such clinical signs can be observed not only in diabetes mellitus, so it is necessary to carry out a differential diagnosis of disturbing symptoms. We discussed it in detail in No. 4 of the VetPharma-2013 magazine, so I would just like to remind you about hyperthyroidism and chronic renal failure, which are no less rare findings in older cats.

The development of diabetes mellitus in cats is associated with two mechanisms:

1. violation functional state beta cells of the pancreas, as a result of which the synthesis and release of insulin and aniline is disrupted;

2. the occurrence of insulin resistance, which leads to impaired utilization nutrients in tissues sensitive to it. The consequence of these factors is the accumulation of amyloid in the islets of Langerhans; a similar mechanism for the development of type II diabetes mellitus has been described in humans. Just as in humans, one can distinguish between conditionally insulin-dependent, or type I diabetes mellitus, and non-insulin-dependent, or type II diabetes mellitus. As well as transient diabetes mellitus, which can occur against the background of another disease, such as pancreatitis, and go away with effective treatment. Most cats have type II diabetes, but insulin therapy will be a mandatory component of treatment, which we will discuss later.

2. Reasons(Why is my pet sick?)

There is no one absolute factor that could be called the root cause of diabetes in cats, but it will be easy for owners to name the “top five” among the contributing factors:

Availability overweight;

Pancreatitis;

Drug therapy using progestogens and glucocorticoids;

Concomitant diseases: hyperlipidemia, liver diseases, cardiovascular diseases, chronic renal failure, infectious pathology, etc.;

Competitive endocrine disorders (hyperthyroidism, acromegaly).

The importance of genetic predisposition to diabetes mellitus in cats remains controversial. The latter plays a key role in the development of type I diabetes mellitus in humans, but its significance has not been proven in cats.

3. Diagnostics(How can I be sure that my four-legged family member has diabetes?)

Diabetes mellitus is a rare endocrine pathology, the diagnosis of which is not difficult: for this we only need the triad:

Characteristic clinical signs;

Hyperglycemia ( higher level blood glucose);

Glucosuria (appearance of glucose in the urine).

However, in cats, unlike dogs and people, stress hyperglycemia may occur due to blood collection or other diseases; glucose levels, while normal up to 6.2 mmol/L, can increase to 20 mmol/L. If stress hyperglycemia is so high, then glucose may also appear in the urine (which is unusual for humans and dogs), since with glucose above 10-13 mmol/L in the blood, it will pass through the renal barrier and appear in the urine. Therefore, sometimes, in addition to the listed three components, which in most cases are sufficient, sometimes two more may be needed: determination of glycosylated hemoglobin and fructosamine.

Glycosylated hemoglobin and fructosamine are formed as a result of irreversible nonspecific binding of glucose by amino acid residues. The level of their concentration in the blood is directly proportional to the average concentration of glucose in the blood over a certain period of time, and their content is determined general level recycling of the corresponding proteins, which is shorter for whey proteins than for hemoglobin.

Fructosamine is a complex of glycosylated whey proteins, the concentration of which can be determined using a colorimetric assay, which serves as a marker reflecting the average glucose concentration of cats over the past 10-14 days. Glycosylated hemoglobin is a product of the interaction of hemoglobin and glucose, its concentration is determined using chromatography - the concentration in the blood reflects the average level of glucose in the blood over 60-70 days in cats, in contrast to dogs and people, in whom it is considered to reflect the level of glucose over 110 -120 days. Anemia (Ht< 35), гипопротеинемия будут приводить к занижению этих показателей, а хранение проб крови при комнатной температуре – к завышению. Об этом необходимо помнить при интерпретации показателей. Стоит обратить внимание на то, что показатели гликозилированного гемоглобина у кошек значительно ниже, чем у людей (Table 1). The cause of lower glycosylated hemoglobin in cats is unknown. It is believed that this is a consequence of the shorter lifespan of red blood cells in cats, different permeability of red blood cell membranes to glucose, or differences in the amino acid composition of hemoglobin in animals of both species, as well as people, which determine the number of glucose binding sites.

4. Therapy(How to cope with diabetes?)

Once the diagnosis has been made, it is very important to explain to the owner of a diabetic cat that the success of therapy will depend solely on the joint efforts of the doctor and owner, and to strive to achieve maximum mutual understanding. By formulating the goals and objectives that we expect to achieve when starting therapy in diabetic cats, we want not only to eliminate the symptoms of diabetes mellitus, avoid ketoacidosis, as well as other complications and late consequences of diabetes mellitus, but also to achieve remission.

Remission is a decrease in insulin requirements associated with improved function of the remaining beta cells. Partial clinical remission is a significant reduction in the insulin dose (less than 0.4 U/kg per day). Complete clinical remission – no need for exogenous insulin administration. It is assumed that the damaged pancreas in cats, like the liver, is capable of regeneration within 8-12 weeks. Hyperglycemia temporarily suppresses insulin secretion + amyloid deposition leads to the destruction of beta cells. By starting insulin therapy, we remove the factor of the toxic effect of glucose, allowing the pancreas to regenerate. Euglycemia, achieved through insulin therapy + a low-carbohydrate diet 24 hours a day, promotes the regeneration of the pancreas, but tissue resistance to insulin remains for some time. Continuation of therapy leads to a decrease in oxidative stress, a decrease in insulin resistance and a decrease in insulin dosage. Long-term euglycemia leads to recovery of the pancreas. There are high chances of achieving remission in cats with newly diagnosed diabetes mellitus if therapy is quickly started, as long as residual secretion of beta cells is preserved and amyloid deposits in the pancreas are not critical.

The most important components of treating diabetes mellitus in cats in order to achieve remission are:

Insulin therapy started as early as possible;

Intensive monitoring of glucose levels during dose selection;

High protein diet;

Physical exercise;

Stabilization of other chronic diseases leading to deterioration in the health of diabetic cats.

I would like to dwell on each of these points in a little more detail.

Many cat owners, having heard that their pet has type II diabetes mellitus, try to draw an analogy with people, asking not to prescribe insulin to their animal, fearing that in this way they will suppress the secretion of their own insulin, and simply demand glucose-lowering tablets. But they do not understand the mechanism of action of these drugs, often thinking that this is a different form of release, the so-called insulin tablets. Therefore, at the first appointment it is very important to explain to the owner that hypoglycemic drugs all 5 groups that are used in humans (sulfonylureas, thiazolidinediones, meglitinides, biguanides and alpha-glucosidase inhibitors) cannot improve the functioning of the pancreas; on the contrary, sooner or later they will lead to its complete depletion. While properly selected insulin can help the pancreas recover, if the process is still reversible.

The best drugs for the treatment of diabetes mellitus in cats are analogues of long-acting insulin: Lantus, which is recognized as the first choice insulin for diabetic cats, and Levemir, on its use for cats there are fewer published ones yet clinical trials, but the results are also encouraging. Therefore, if the duration of action of Lantus is too short, or there are contrainsular diseases, then it is necessary to try the use of Levemir. Dosing of lantus starts with 0.5 units per kg of body weight of a cat, but not more than 2 units during the first administration. You should start using Levemir in lower dosages: from 0.1-0.2 units per kg.

Insulins are not antibiotics, and their duration of action varies individually: there are patients for whom the drug works for 12 hours, and for those for whom it works for 18-24 hours. Less common are cats in which insulin analogues work for 8 hours, and in this case it is necessary to either inject insulin every 8 hours or choose insulin that will work longer. Less effective with a shorter duration of action in cats are NPH insulins with an intermediate duration of action or mixed insulins, which combine insulin of a short and medium duration of action. With these insulins it is much more difficult to achieve a stable course of diabetes mellitus, and therefore achieve remission.

It is very difficult for the owner of a newly diagnosed diabetic patient to assimilate such large amounts of information at one time, so he needs constant support from the medical staff until he learns to independently grasp the patterns of insulin administration frequency and dosage.

A simpler and more preferable option, at first glance, would be to leave a newly diagnosed diabetic cat in the clinic to determine the dose of insulin and the duration of its action. However, cats in the clinic are under a lot of stress, which can increase stress glycemia, and many of them do not want to eat in the clinic, which also makes dose adjustment difficult. Therefore, if the cat feels clinically well, its appetite is preserved, and there are no clinical and laboratory signs of ketoacidosis or impending hyperosmolar coma, then it is better to adjust the dose of insulin at home.

Before the owner of a diabetic cat picks up a syringe on his own, you must be sure that the owner knows which one he needs. insulin syringe, and later, when purchasing at a pharmacy, he will choose the right one. Long-acting insulin analogues, such as Lantus and Levemir, are available in syringe pens, 1 step in them is 1 unit, and this is very convenient for dosing, except in cases where the insulin dose is 1.5-2.5, etc. d. Unit In this case, it will be more useful to use insulin syringes with 0.5 or 0.3 U U100 (1 ml - 100 units of active action).

It is also worth remembering that there are different places for injecting insulin in cats, and the skin in the withers area is thicker than the skin in the inguinal fold area. It is important to warn the owner and ask him to practice, under the supervision of a doctor, collecting insulin on his own (this will minimize the likelihood of an insulin overdose) and injecting it (it is important to teach how to inject subcutaneously and not intradermally, since in this case there will be inadequate resorption of insulin, and not intramuscularly, otherwise insulin will be work like short-acting insulin).

After the manipulation (measuring glucose or administering insulin), it is worth rewarding the animal for its good behavior ( Photo 5-9).

However, when leaving the appointment, the owner must first learn, under the supervision of a specialist, and then independently measure glucose levels. The optimal sites for collection from cats are the ears and paw pads. The latter, however, cannot be called an ideal place for taking blood due to the potential threat of infection in those cats that scoop in the toilet. It is necessary that owners independently in the clinic master simple procedures for drawing blood, observing some small subtleties (warming the ear, applying a drop of Vaseline oil first, using only special lancets for drawing blood, as well as squeezing out a drop with a volume of at least 5 μl to completely fill the capillary test strips), they can easily monitor glucose levels at home and, based on the results, select the dose and time of administration.

It is important to warn the owner that it is necessary to place a cotton pad between the ear and his own finger so as not to pierce his finger, and to press the lancet tightly to the ear.

A drop of blood has been received, now you need to bring a glucometer with a test strip to it to get the result ( Photo 10-14).

For the first week, so that the owner feels more confident, you can draw insulin into syringes in the clinic, and the owner of the house will only inject it, then the likelihood of an error will be lower. It is very important that when starting insulin therapy, the owner understands that 1 unit and 0.1 ml are not synonymous words! And insulin dosage is never carried out in ml, only in units of active action! When we begin intensive monitoring of a diabetic cat, we aim to restore his pancreas and achieve remission, meaning that as the beta cells recover, the need for exogenous administration will decrease and the insulin dose will need to be lowered. The goal is to achieve indicators of 6-10 (up to 12) in diabetic cats. Because of this, owners may experience episodes of hypoglycemia and must be able to recognize and respond appropriately to them. If the pet owner does not confuse the insulin dose and if the cat eats adequately, then episodes of severe hypoglycemia when using long-acting insulin analogues are rare. But an important message: if a diabetic cat behaves inappropriately: it is too active or, on the contrary, passive, it has an increased appetite or impaired reaction, it staggers or does not respond to stimuli, the first thing is to measure sugar and make sure that the animal does not have hypoglycemia . If the glucose level drops below 4 mmol/l, then it is necessary to urgently feed the animal and repeat the glucose measurement after 30 minutes. If the glucose level is below 3 mmol/l, and the cat has clinical signs of hypoglycemia, then it should immediately lubricate the gums with honey or glucose syrup (while the animal is swallowing) and bring it to the clinic as soon as possible. If a cat has no clinical signs of hypoglycemia, and a medical glucose meter shows less than 2 mmol/l, then this may be due to the fact that humans and animals have different glucose distributions. In humans, the glucose content of red blood cells is 42%, while 58% of glucose is in plasma.

In cats (fewer red blood cells, which are small in size), the glucose content in red blood cells is about 7%, and 93% of glucose is in the blood plasma, so a medical glucometer shows a lower value than it actually is. If the cat doesn't have clinical symptoms hypoglycemia, and the veterinary glucometer shows a glucose level of less than 2 mmol, it is important to ensure that the capillary of the test strip is completely filled with blood. Incomplete filling of the capillary due to a small drop may lead to an underestimation of the result. In this case, the glucose measurement should be repeated.

If the same dose of insulin begins to work longer over time and reduces glucose levels below 4 mmol/l, then this is one of the signs of approaching remission. It is important not to miss it and to constantly reduce the dose and increase the interval. If glucose is measured only once a day before insulin administration, then there is a possibility of missing an episode of post-hypoglycemic hyperglycemia and increasing the dose when it needs to be reduced. In this case, a chronic increase in dose can lead to the development of insulin resistance - Somogyi syndrome. Characteristic clinical signs of Somogyi syndrome are persistent hyperglycemia with indicators of uncompensated diabetes mellitus against the background of insulin therapy, persistent polydipsia, polyuria, polyphagia and lack of weight loss, and sometimes further weight gain. It is very important to identify this condition promptly (by serially measuring glucose levels every 4 hours) and select the correct dose of insulin.

Cats are obligate carnivores, therefore, for a stable course of diabetes mellitus and achieving remission, it is important to choose a high-protein diet for the animal, in which the protein content will be at least 45%. It is preferable to use wet food. Since most diabetic cats suffer from excess weight, the diet should be aimed at reducing and preventing it. The content of arginine, which increases the secretion of endogenous insulin, is an additional advantage in the direction of high-protein nutrition.

Studies conducted to study the effects of high-protein diets on kidney function have shown that they do not worsen kidney function. renal function(urea, creatinine, phosphorus) in cats and does not worsen the condition of patients with initial stage chronic renal failure. But it cannot be used in patients with already severe renal failure. It is advisable to feed cats with diabetes twice a day, along with insulin or after its administration. However, there are animals, for example in old age, which are very difficult to retrain to switch to a different type of food. In this case, it is worth trying to give the main portions of food with insulin, and leave a smaller amount of the daily ration for snacks. It is very important not to overfeed a diabetic cat, which is very difficult at the very beginning, with severe symptoms of polyphagia. But excess weight is a factor that not only contributes to the development of diabetes, but also provokes insulin resistance, so it is very important for owners of cats suffering from diabetes to convey the message about the need to reduce excess weight in their pets.

“What to do if insulin doesn’t work?” owners often ask. The most important reason for the ineffective action of insulin is the owner of the animal, so first of all it is necessary to check the accuracy of the dose, the correct administration and storage conditions of the insulin. If everything is done correctly, then try to change the dose. If a cat receives more than 2 units per kg of lantus or levemir, and glucose levels remain high, then we are talking about insulin resistance and should try to find out its causes. From endocrine disorders antagonistic diseases can primarily be hyperthyroidism and acromegaly; hyperadrenocorticism is very rare in cats. But even such routine diseases as asymptomatic chronic cystitis can cause insulin resistance, so at the stage of the first clinical studies it is important to create the most complete overall picture of the health of a cat suffering from diabetes.

In addition to the correct dose selection of long-acting insulin analogues and high-protein nutrition, it is very important to get the cat moving. Physical activity is also a necessary point in increasing tissue sensitivity to insulin. Therefore, it is important to discuss with the owners all the possibilities of how to make the cat move more: you can put food little by little in different parts of the kitchen, buy toys in which you can pour food inside, and the cat will require physical effort in order to get it, from running after a laser pointer to catching virtual fish on a tablet - all means are good.

5. Forecast(How long will my pet live after he gets diabetes?)

The prognosis for any diabetic animal is unpredictable. Much depends on the owner (degree of affection, willingness to devote time to treating and monitoring the pet), the presence and severity of concomitant disease. According to statistics from foreign authors, 50% of cats diagnosed with diabetes mellitus die within 12-17 months after diagnosis (including aggravating diseases). Nelson writes: "... in cats surviving the first 6 months after diagnosis of diabetes mellitus, good quality life is preserved for more than 5 years, despite the disease...”

The owner must remember that weight loss helps to lengthen life expectancy. Modern sources are more optimistic about the life expectancy of diabetic cats: the median is 516 days. And, in my opinion, these indicators will improve as intensive home monitoring and therapy with long-acting insulin analogues improve. Early initiation of insulin therapy helps achieve remission in 70-80% of cats with newly diagnosed diabetes mellitus. The prognosis is worsened by chronic renal failure, as well as previous ketoacidotic or hyperosolar coma. But more about this in the next issues of the magazine.

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