Align-ju STUDENT cats , a low-carbohydrate and high-protein diet is ideal [ 1 ] . Dogs may be given carrots , peas and sweetcorn by their owners as treats , but owners should be advised that some vegetables are relatively high in sugar .
Royal Canin diabetic foods for dogs and cats help to reduce net energy supply and support the maintenance of muscle mass . They have a reduced level of starch to help limit post-prandial blood glucose , and contain cereals with a low glycaemic index and selected fibres to help in the management of post-prandial blood glucose [ 11 ] . The Royal Canin diabetic diet is recommended for patients with DM and a body condition score ( BCS ) ≤6 / 9 , or for animals with DM and a BCS ≥7 / 9 until glycaemic control has been achieved [ 11 ] . It is not recommended during growth , gestation and lactation [ 11 ] .
Hill ' s Prescription diet w / d has high L-carnitine levels to help patients to metabolise fat and maintain lean muscle [ 12 ] , as well as high levels of fibre to support blood glucose levels . Optimum levels of soluble and insoluble fibre in w / d for cats help to promote healthy digestion [ 12 ] and w / d has also been formulated to promote a urinary environment that reduces the risk of development of struvite and calcium oxalate crystals [ 12 ] .
Complications of poorly controlled DM
If DM is left untreated , fats are broken down to provide energy , which leads to a build-up of ketones [ 1 ] . An excessive build-up of this waste product can lead to DKA . Clinical signs of DKA include polyuria , polydipsia , lethargy , weakness , vomiting , increased respiratory rate , decreased appetite , unexplained weight loss , dehydration , an unkempt coat and , in some cases , sweet-smelling breath [ 13 ] . Ketones will be present in the patient ' s urine and bloodstream , and electrolyte abnormalities will occur . DKA can be fatal if not treated promptly .
Hypoglycaemia is another possible complication of DM . It is commonly associated with an insulin overdose . Clinical signs are lethargy , ataxia , weakness , behavioural changes , muscle twitching and severe seizures . Immediate treatment includes rubbing honey into the gums and administering intravenous dextrose as directed by the VS . Fluid therapy is given to rehydrate the patient and to correct acidosis and electrolyte imbalances [ 1 ] . Short-acting soluble insulin is given intravenously or intramuscularly to lower blood glucose slowly [ 1 ] . Blood glucose , electrolytes and phosphate need to be monitored frequently and treatment adjusted as directed by the VS [ 1 ] .
If left untreated , hypoglycaemia can be fatal . Clients should be advised to call the veterinary practice immediately if their pet displays signs of hypoglycaemia , and if they have any honey to hand , they should rub honey into the patient ' s gums before travelling to the practice , if instructed to do so by their practice .
Hyperglycaemia is where the blood glucose level is abnormally high , as a result of an underdose of insulin or poor control of DM due to underlying conditions . Hyperglycaemia can also be due to overdosing with insulin due to a compensatory mechanism called Somogyi overswing ( Figure 1 ) [ 1 ] . If a patient presents with high blood glucose or urine glucose prior to the administration of the morning dose of insulin , it is advisable to perform a serial blood glucose curve or other diagnostic tests as instructed by the VS [ 1 ] . A patient with undiagnosed DM may present to the practice with the clinical signs mentioned above and a high blood glucose level .
Figure 1 . Somogyi overswing [ 1 ] .
Insulin overdose
Hypoglycaemia
Release of glucagon and stress hormones
Glucagon facilitates release of glucose from the liver
Hyperglycaemia
The initial DM consultation
VNs cannot diagnose DM themselves but , once the VS has diagnosed DM , a VN can explain the condition to the client , demonstrate how to administer insulin ( see guide on page 52 ) and explain the importance of diet and lifestyle management . Clients can be signposted to websites and leaflets for further information and offered a follow-up call to check how they and the patient are getting on at home .
Effective consultations can have a positive effect on clients and help to strengthen their relationship with the practice . Communication is vital in the long-term management of DM , and it is essential that the client is involved in creating a home-care plan for their pet .
Volume 38 ( 5 ) • October 2023
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