Features May 2012 Issue

Canine Diabetes: Symptoms, Diagnosis, Treatment, and Diet

Diabetes in dogs is increasingly common – but it can be controlled and quality of life maintained.

For years public health officials have reported a diabetes epidemic among America’s children and adults. At the same time, the rate of diabetes in America’s pets has more than tripled since 1970, so that today it affects about 1 in every 160 dogs. But while many human cases are caused and can be treated by diet, canine diabetes is a lifelong condition that requires careful blood sugar monitoring and daily insulin injections.

Six-year-old Penny, who developed diabetes as a puppy, receives her evening insulin shot, one of two she receives each day from owners Melba and Curtiss Lanham. “We move the injections around; we never use just one spot over and over again for the insulin injection,” says Melba.

The medical term for the illness is diabetes mellitus (mellitus is a Latin term that means “honey sweet,” reflecting the elevated sugar levels the condition produces in urine and blood). Diabetes occurs when the body is unable to produce sufficient insulin to metabolize food for energy, or when the body’s cells fail to utilize insulin properly.

The pancreas’s inability to produce insulin is known in humans as type 1 (formerly called juvenile or insulin-dependent) diabetes. This is analogous to the type that affects virtually all dogs. Dogs can also develop gestational diabetes during pregnancy.

Type 2 (formerly adult onset) diabetes, which is the result of insulin resistance often linked to diet and obesity, is the most common form of diabetes in humans. Most diabetic cats have type 2 diabetes, but there is no evidence that this form occurs in dogs.

Symptoms
The classic symptoms of diabetes are excessive thirst, increased urination, and weight loss despite normal or increased food consumption. Acute-onset blindness resulting from cataracts can also be a sign.

The diagnosis is easy to confirm with simple tests for glucose (sugar) in the blood and urine.

Other test results linked to diabetes include ketones in the urine, increased liver enzymes, hyperlipidemia (elevated cholesterol and/or triglycerides), an enlarged liver, protein in the urine, elevated white blood cells due to secondary infections, increased urine specific gravity resulting from dehydration, and low blood phosphorus levels.

Canine diabetes may be complicated or uncomplicated. Complicated cases, in which the patient is ill, not eating, or vomiting, require hospital care. Fortunately, most cases are uncomplicated and can be treated at home.

Dogs at Risk
Diabetes is one of the most common endocrine diseases affecting middle-aged and senior dogs, with 70 percent of patients older than seven at the time of diagnosis. Diabetes rarely occurs in dogs younger than one year of age, and it is more common in females and neutered males than in intact males.

Keeshonds, Pulis, Cairn Terriers, Miniature Pinschers, Poodles, Samoyeds, Australian Terriers, Schnauzers, Spitz, Fox Terriers, Bichon Frise, and Siberian Huskies may be at higher risk. Because of these breed connections, researchers speculate that the development of diabetes may have a genetic component.

Buster, a 13-year-old Maltese, was diagnosed with diabetes at age 10, after suddenly going blind. Cataract surgery completely restored his vision.

An estimated 50 percent of canine diabetes cases are likely linked to pancreatic damage caused by  autoimmune disorders. These disorders have many possible causes, including genetic predisposition and environmental factors. Many holistic veterinarians speculate that they may be linked to overstimulation of the immune system from multiple vaccinations, processed foods, and other environmental insults.

Extensive pancreatic damage resulting from chronic pancreatitis (inflammation of the pancreas) may contribute to diabetes in 30 percent of canine cases. Pancreatic disease can also cause exocrine pancreatic insufficiency, or EPI, resulting in a deficiency of digestive enzymes. When a dog develops both EPI and diabetes, the diabetes typically appears several months before symptoms of EPI. (See “Starving, Not Starved,” WDJ March 2009, for more on EPI.)

An estimated 20 percent of canine patients develop insulin resistance from other conditions, such as Cushing’s disease and acromegaly (too much growth hormone), or from the long-term use of steroid drugs, such as prednisone. (See “Too Much Cortisol,” November 2011, for more on Cushing’s disease.) In females, insulin resistance may accompany the heat cycle, or gestational diabetes may occur during pregnancy. In these cases, symptoms may disappear when the heat cycle or pregnancy ends. Diabetes may also resolve when steroids are discontinued or Cushing’s disease is treated.

Though many people assume otherside, there is actually no clear evidence that obesity causes diabetes in dogs. However, obesity can contribute to insulin resistance, making it more difficult to regulate overweight dogs with diabetes. Obesity is also a risk factor for pancreatitis, which can lead to diabetes.

Cataracts
Cataracts are a clouding of the lens of the eye. Diabetic cataracts are a leading cause of blindness in humans, and the same is true for dogs. The majority of canine patients with diabetes develop cataracts within six months of diagnosis, and 80 percent do so within 16 months. The risk of cataract development appears to increase with age regardless of blood sugar levels, so that even well controlled diabetic dogs can develop cataracts.

Surgery has saved the sight of many dogs. Cataracts treated in the early immature stage have the highest success rate and fewest surgical complications.

Hypermature cataracts create inflammation (uveitis), causing pain, eye redness, and pupil constriction. When uveitis is seen prior to surgery, the success rate for pain-free vision six months later is only 50 percent, as opposed to 95 percent for those with no pre-surgical uveitis.

Phacoemulsification to remove the lens is the preferred surgical method for diabetic dogs. After surgery, an artificial lens is installed for optimal post-operative vision. Although cataracts typically affect both eyes, treating just one can reduce costs (estimated between $1,500 to $3,000 per eye) and still restore vision.

Other potential complications from diabetes include decreased corneal sensitivity, and keratoconjunctivitis sicca (dry eye).

Complications
Concurrent disorders that can make diabetes more difficult to control include hyperadrenocorticism (Cushing’s disease), infections, hypothyroidism, renal insufficiency, liver insufficiency, cardiac insufficiency, chronic inflammation (especially pancreatitis), EPI, severe obesity, hyperlipidemia, and cancer.

Five years ago, Gryffin, then age 4, was diagnosed with diabetes and given up for adoption. Since he got on the right brand of insulin for him and his raw diet, he’s been thriving.

Diabetic nephropathy, a kidney problem, occurs in 40 percent of human patients and takes many years to develop. The percentage of canine patients with diabetic nephropathy is unknown (it’s more common in cats), but its earliest sign is hyperalbuminuria (high albumin levels in urine) followed by an increase in the urine protein-to-creatinine (UPC) ratio and hypertension (high blood pressure), which may contribute to kidney damage. Early changes may be reversed if blood sugar levels improve.

Infections – especially urinary tract infections (UTIs) – are common among dogs with diabetes because sugar in urine makes the bladder an ideal incubator for bacteria. In one study, half of the diabetic dogs tested had occult or hidden urinary tract infections that were not detected by urinalysis. The possibility of UTIs in dogs with diabetes is so great that their urine should be cultured periodically to detect infections. A long course of antibiotics (lasting six to eight weeks) can be administered if needed. Follow-up cultures and frequent retesting are recommended.

Dogs with diabetes are also susceptible to infections of the mouth and gums. Diabetic pets should have their teeth checked regularly and cleaned if necessary. Dental tartar seeds the body with bacteria, and when blood sugar levels run high, infections in important organs can take root. The kidneys and heart are particularly vulnerable. Brushing your dog’s teeth daily or at least twice a week helps to prevent and detect early signs of dental disease.

Liver (hepatic) disease is another common problem, resulting from altered fat metabolism caused by diabetes. In one survey of 221 dogs with diabetes, over 70 percent had elevated liver enzymes. Ultrasound tests and biopsies help differentiate between primary hepatic disease and secondary complications of diabetes.
Pancreatitis affects an estimated 40 percent of dogs with diabetes. See “A Pain in the Pancreas,” November 2008 for information on this disorder.

Hyperadrenocorticism, or Cushing’s disease, is another complication. In one study, 23 percent of dogs with diabetes tested positive for Cushing’s. Most canine patients with both disorders develop Cushing’s disease before the onset of diabetes. About 10 percent of dogs with Cushing’s are also diabetic.

Hypothyroidism (an underactive thyroid) may coincide with diabetes. In the study mentioned above, 9 percent of diabetic canines were hypothyroid. While the glucose intolerance caused by hypothyroidism could lead to the development of diabetes, it’s unlikely to be a major factor because the two don’t often occur together. However, thyroid hormone deficiency can result in insulin resistance, complicating glycemic control. Thyroid hormone replacement should be instituted gradually in dogs with diabetes since their insulin requirements will decrease and, without dosage adjustments, severe hypoglycemia may occur (see “Hazards of Hypoglycemia,” next page).

It makes sense to test diabetic dogs for hypothyroidism and hyperadrenocorticism, but only after their diabetes is controlled. Otherwise, the diabetes will affect test results.

Hyperlipidemia usually improves as blood sugar levels are controlled. Persistently elevated triglycerides may be linked to Cushing’s disease and can increase the risk of developing acute pancreatitis. Reducing fat in the diet can help to lower triglyceride levels. Elevated cholesterol is often linked to hypothyroidism.

Insulin resistance can be caused by hypothyroidism, Cushing’s disease, infections, pancreatitis, drug therapy (corticosteroids), obesity, acromegaly, estrus (heat cycle), and anti-insulin antibodies. Insulin resistance should be investigated in patients who need doses of 1 unit or more of insulin per pound of body weight.

Survival Statistics
With proper treatment, dogs with diabetes have survival rates very similar to those of non-diabetic dogs of the same age and gender, though their risk is greatest during the first six months of treatment, when insulin therapy is introduced and glucose levels are being regulated. Diabetic dogs are more likely to die of kidney disease, infections, or liver/pancreatic disorders than of diabetes itself. But once their condition stabilizes, diabetic dogs can lead happy, healthy lives.

Consider Buster, a 13-year-old Maltese belonging to Mary Butler in Northern California. Buster was diagnosed with diabetes three years ago after suddenly going blind due to cataracts.

Henry, a four-year veteran of diabetes, doesn’t mind his insulin injections, since they’re always followed by a treat!

“He had lens implants within a month and has had perfect vision ever since,” says Butler. “My little guy has been stable ever since his diagnosis. He has lots of energy, his coat is thick and shiny, his stools are formed and regular, and his teeth sparkle. I do brush his teeth three times a week, which I am sure helps.”

Treatment and Monitoring
Your veterinarian is your best advisor when it comes to medication. There are many different insulin products, and individual responses vary. Finding the right insulin for your dog may require experimentation.

Insulin varies in terms of onset, peak, and duration of action. Most dogs do well with intermediate-acting insulin, such as Humulin N, though some do better with long-acting insulin or mixtures that combine different types. It’s important to use only fresh insulin, switching to a new bottle every 6 to 8 weeks, and to use the correct syringe, which will vary depending on the type of insulin.

Alise Shatoff of San Diego, California, adopted her dog Gryffin five years ago at age four, when he was surrendered after developing diabetes. She feeds a commercial raw diet and says, “We have found that Gryffin does best on Humulin N.  This one works really well for dogs on a raw diet. Gryffin has been nice and stable on the Humulin N for four years now.”

Porcine (derived from pigs) and recombinant human insulin most closely resemble insulin produced by dogs, so they usually work best. Although beef insulin was successfully used before the advent of other choices, it is no longer recommended for dogs because it may result in the production of anti-insulin antibodies, leading to poor glucose control.

Diane Di Salvo of Madison, Wisconsin, whose dog, Scout, developed diabetes two years ago, notes that, “Walmart sells Humulin insulin for way less than vets and other pharmacies. It is the exact same insulin that Eli Lilly makes for all pharmacies, but it is packaged for Walmart under their ReliOn brand.”

Insulin is typically administered twice a day, immediately before or after a meal. Feeding just before giving insulin may be safer, to be sure that the dog eats, because without food the insulin’s effect would be dangerous. Assuming your dog is a chow hound, feeding her after administering insulin can be a reward for submitting to the injection.

However, most dogs don’t mind the injections, which are done with very thin needles. Carol Albert of Kensington, Maryland, has a Cardigan Welsh Corgi, Henry, who developed diabetes four years ago. “Henry gets insulin shots twice daily after meals,” says Albert. “He knows he will get a treat after the injection so he comes looking for me after he eats to get his shot.”

It is important to give insulin injections properly. One of the most common reasons for problems in achieving regulation is that the owner doesn’t inject the dog correctly. If possible, have your veterinarian observe you giving insulin to your dog. Also see the links to information on giving insulin in “Resources,” page 17.

When a dog is first diagnosed, frequent monitoring, such as every one to two weeks, may be required until the patient is stable and doing well. After that, monitoring every three to six months (veterinary exam, blood test, urinalysis, and urine culture) is recommended. 

Measuring fructosamine (glycated serum protein) is a helpful way to monitor glucose control. If it’s not possible to run glucose curves, this test would be the next best option. Blood glucose fluctuations leave a metabolic mark that lasts a week or two, and fructosamine reflects the average blood glucose over that time span. Because fructosamine looks at averages, it will not distinguish excellent control from wide swings of high to low glucose readings, but even with this limitation, fructosamine is worth including in periodic monitoring tests.

Ketones are water-soluble compounds produced as by-products when fatty acids are broken down for energy in the liver and kidneys. Dangerously high levels of ketones, called ketoacidosis, can lead to diabetic coma or death. Symptoms include nausea, lack of appetite, and lethargy. Ketoacidosis is often linked to concurrent pancreatitis, urinary tract infection, Cushing’s disease, or other types of infection or inflammation.  

Ketostix are used to detect ketones in urine and can be obtained at any pharmacy. Finding ketones occasionally is not a problem, but a positive dipstick three days in a row requires a veterinary visit.

The Right Diet
In humans and felines with type 2 diabetes, diet is a major component of the illness’s cause and treatment. Because the culprits are carbohydrates and obesity, weight loss and a high-protein, low-carb diet are sometimes all the treatment that is needed.

Scout, who developed diabetes two years ago, also suffered from urinary tract infections, a common problem in diabetic dogs.

But for dogs with type 1 diabetes, there is no single recommended diet. The most important factor is that the dog likes the food and eats it willingly. Most diabetic dogs can be well managed with an adult maintenance diet. A prescription diet is not required. If the dog has another illness, feed a diet appropriate for that illness.

Try to feed the same amount of the same type of food at the same time each day, ideally in two meals 12 hours apart. Any change in carbohydrates will affect the amount of insulin needed. Some dogs may need a snack between meals to keep glucose levels from falling too low.

Fiber and carbohydrates are controversial topics in diabetes treatment, and recommendations are changing. Only a few nutritional studies have been done on dogs with diabetes. Different dogs respond differently to varying amounts of fiber and carbohydrates, and dietary needs vary depending on whether a dog is underweight or overweight, so there is no “best diet” for this disease.

Diabetic dogs may not need a low-fat diet unless they have concurrent pancreatitis, Cushing’s disease, elevated triglycerides, elevated cholesterol, or lipemia (fatty blood). However, since the majority of diabetic dogs do have one or more of these concurrent diseases, and since pancreatitis can occur at any time (and chronic pancreatitis may cause problems before it is diagnosed), the majority of diabetic dogs will do better on a diet that is moderately low in fat. To be safe, avoid feeding high-fat diets.

The amount of protein in the diet should be normal or increased, especially for overweight dogs and for underweight dogs with muscle wasting or EPI. Protein should be increased when fat is decreased, to avoid feeding too many carbohydrates.

Understanding Carbs
Carbohydrates are responsible for the greatest changes in postprandial (after-eating) blood sugar levels. There is a strong association between the insulin dosage requirement and the carbohydrate content of the meal, regardless of carbohydrate source or type. Keeping the amount of carbohydrates in the diet steady is the best way to keep insulin needs stable.

The glycemic index measures the effects of carbohydrates in food on blood sugar levels. It estimates how much each gram of available carbohydrate (total carbohydrate minus fiber) in a food raises blood glucose level following consumption of the food, relative to consumption of glucose. Glycemic index charts that list hundreds of human foods are widely published.

Low-glycemic foods release glucose slowly and steadily, while high-glycemic foods can cause a more rapid rise in blood glucose levels. Low-glycemic foods include most fruits and vegetables, legumes, some whole grains, and fructose. Medium-glycemic foods include whole wheat products, brown rice, sweet potatoes, potatoes, sugar (sucrose), and honey. High-glycemic foods include white rice, white or wheat bread, and glucose.

Simple carbohydrates (sugars, such as corn syrup or propylene glycol, which is found in semi-moist foods) should be avoided, as they cause rapid glucose spikes.

Complex carbohydrates (starches) are digested more slowly so that the rise in glucose is spread out and there are no quick spikes. Processing can affect how quickly carbohydrates are digested.

Carbohydrates are digested faster than fats and proteins, and they have the most effect on postprandial glycemic response and insulin needs. Depending on when the insulin effect peaks, it may be important to include a certain amount of carbohydrates in meals so that the peak effect of injected insulin will coincide with the rise in glucose and not contribute to hypoglycemia.

Highly digestible diets designed for dogs with sensitive stomachs can contribute to higher blood glucose levels after eating, which is not the best thing for a diabetic dog.

The Fiber Factor
Dietary fiber or roughage is the indigestible portion of plant foods. Fiber slows gastric emptying and the digestion of carbohydrates, which also slows the release of glucose, blunting its postprandial rise (blood sugar increases less after meals). Diabetic dogs do not necessarily need more fiber than healthy dogs, and most do well with moderate amounts of fiber. Dogs with poor glycemic control may benefit from increased fiber, but some diabetic dogs do better with less.

Despite four years of diabetes, Zachary enjoyed life to age 15, thanks to holistic care and careful charting of his blood glucose levels, insulin injections, and food.

There are two types of fiber. Soluble (also called viscous) fiber ferments in the colon, creating gases. Insoluble fiber is metabolically inert, absorbing water as it moves through the digestive tract. Unlike soluble fiber, insoluble fiber does not produce intestinal gas.

Examples of soluble fiber include fructo-oligosaccharides (FOS), pectins, guar gum, lactulose, and psyllium. Most soluble fiber, with the exception of psyllium, is also fermentable. Beet pulp provides mixed soluble and insoluble, moderately fermentable fiber.

Prebiotics are fibers that are both soluble and fermentable (see “Praise for Prebiotics,” April 2012). Prebiotics feed probiotics, the beneficial bacteria that live in the digestive tract and make up an important part of the body’s immune defenses. As it ferments, soluble fiber also produces beneficial short-chain fatty acids (SCFAs).

Too much soluble fiber can cause diarrhea and gas, and can actually speed postprandial glucose absorption. Gas is most likely to develop when the fiber is first introduced or when the dose is suddenly increased. To help prevent this side effect, start with small doses and increase gradually.

Insoluble fiber, such as cellulose and bran, regulates intestinal transit time, speeding it during constipation and slowing it during diarrhea. Insoluble fiber increases stool volume, is generally well tolerated even in high doses, and may help with glucose control.

However, in large quantities, insoluble fiber can decrease the diet’s nutrient value by binding minerals. Other side effects associated with diets high in insoluble fiber include weight loss, a lack of interest in food, poor coat quality, vomiting, voluminous feces, flatulence, diarrhea, and constipation. Increased fiber is not recommended for underweight dogs, dogs who refuse to eat because of the fiber’s taste or texture, or dogs who experience adverse side effects.

It is important to provide ample fluids when adding fiber because they pull water from the body, which can lead to constipation and other problems if fluid intake is insufficient.

Examples of products that contain soluble fiber include Benefiber (wheat dextrin) and Hydrocil (psyllium). Citrucel is an example of a product that contains insoluble fiber (methylcellulose).

General Guidelines
The amount of starch in the diet is not as important as making sure it’s consistent and properly balanced with insulin. Dogs fed diets containing more starch may need more insulin or a different type of insulin than dogs fed a low-carb diet.

Limiting carbohydrates may reduce postprandial hyperglycemia (high blood sugar), but if the dog continues to have wide glucose level swings throughout the day on a low-carb diet, he might do better with more carbohydrates. If dietary protein is reduced for any reason, carbohydrates will usually increase, especially if fat is restricted. Dogs with gestational diabetes may benefit from a diet that is high in protein with restricted carbohydrates and fats, as long as their nutritional needs are met.

If a thin dog fails to gain weight once there is good glycemic control and the food intake is adequate (and not too high in fiber), concurrent EPI may be interfering with digestion. Overweight dogs who fail to lose weight once their diabetes is controlled may be getting too much insulin.

“We know that in both dogs and cats, obesity in general is a problem,” says David Bruyette, DVM, DACVIM, medical director at VCA West Lost Angeles Medical Hospital, “and obese dogs and cats tend to be resistant to the effects of insulin, so we want to have animals at an ideal body weight. If they are too heavy, they can develop insulin resistance, and if they are too thin, they can develop ketoacidosis.”

Next month we’ll review diabetes diets in detail, but for now:

-The most important factor is that your dog likes his food and eats it willingly every time.

-Most diabetic dogs can eat a typical moderate-fiber maintenance diet. They don’t need a high-fiber prescription food.

-It is fine to feed a high-protein diet, but that is not a requirement.

-The diet must be consistent, particularly in the amount of carbohydrates, and should be fed in the same quantities at the same time each day.

-Not every diabetic dog requires a low-fat diet, but because of the disease’s strong links to pancreatitis and other fat disorders, a diet moderately low in fat may be safest, even for dogs who have not been diagnosed with pancreatitis, Cushing’s disease, or hyperlipidemia.

Exercise
Exercise has a dramatic effect on blood sugar levels. In humans with type 2 diabetes, exercise reduces blood sugar so effectively that patients who walk or jog reduce their need for added insulin.

But for those with type 1 diabetes, including dogs, exercise can be both a blessing and a complication. Exercise can reduce insulin resistance in obese diabetics, but too much exercise can lead to hypoglycemia (see “Hazards of Hypoglycemia,” page 13).

Exercise should be consistent in terms of the type of activity and time of day, avoiding intermittent or unplanned strenuous exercise. One good approach is to exercise the dog for 20 to 30 minutes before the evening meal and its administration of insulin. Additional exercise can be added to the day’s activities if the insulin dose is adjusted. For example, if a strenuous hike is planned, the morning insulin might be skipped or only half of the usual insulin administered in order to avoid exercise-induced hypoglycemia.

Recommended Supplements
Some supplements may help your diabetic dog while others should be added with caution or not at all. Anything that helps lower blood glucose levels may change insulin needs.

When using human supplements, give the full human dose to large dogs, half that much to medium-sized dogs, and ¼ the adult human dose to small dogs. Tiny dogs require even smaller doses.

L-Carnitine, a conditionally essential amino acid, plays a pivotal role in fatty acid metabolism. It may help control diabetes, improve fat metabolism, maintain lean body mass, and protect muscles from catabolism during weight loss. As little as 50 mg milligrams per kilogram (2.2 pounds) of dry food may make a beneficial difference. Note that beef is a particularly good source of l‑carnitine, with about 80 mg per 3-ounce portion.

Chromium supplements are often recommended for human diabetes patients (especially those with type 2 diabetes), but don’t seem to benefit a dog’s type 1 diabetes. This supplement is recommended only for dogs with a chromium deficiency.

Zinc is an important mineral for diabetic patients, but it’s toxic to dogs if too much is given. Supplementation should be limited to a standard human or canine vitamin-mineral supplement daily.

The omega-3 fatty acids EPA and DHA may help to reduce blood lipid levels (hyperlipidemia) and inflammation as well as regulate the immune system. Human studies show, however, that too much may reduce glycemic control in some patients. EPA and DHA are found in fish, most fish oils, and some algae supplements. An appropriate dose might be 300 mg combined EPA and DHA per 20 to 30 pounds of body weight daily (or per 10 pounds of body weight for hyperlipidemia or kidney disease), preferably split between meals.

Probiotics and cranberry extract can help to prevent urinary tract infections. D-mannose works the same way as cranberry, by preventing bacteria from adhering to the bladder wall, but it is a sugar and some research has found that it may make blood sugar levels harder to control in humans with diabetes.

Digestive enzymes may be helpful for some dogs, particularly those who have had pancreatitis (dogs with EPI need prescription-strength enzymes). See “Improving Digestion,” page 22, for more about enzymes.

Some products affect blood sugar levels and so should be avoided or used with caution. Licorice can elevate blood sugar, while devil’s claw, ginger, and marshmallow can lower it. Amitraz, the active ingredient in Preventic collars, Certifect (new flea and tick control product), and Mitaban (used to treat demodex), can cause elevated blood sugar and should not be used in diabetic dogs.

Glucosamine, on the other hand, should be safe for diabetic dogs. Early research suggested it might raise blood sugar, but more recent and reliable studies refuted those findings. Monitor blood sugar levels after starting to be sure.

Treats
Between-meal treats are important, whether they’re training tools, blood sugar stabilizers, afternoon snacks, or rewards for submitting to blood tests and insulin injections.

Avoid treats that are high in carbohydrates or sugar, including all semi-moist commercial foods and treats that use propylene glycol or similar ingredients.

Dehydrated meats make excellent treats, but be sure to avoid those made in China. Chicken jerky treats (also called tenders or strips) manufactured in China have been linked to kidney failure in dogs. Check package labels carefully.

Because dried meat or poultry treats made in the U.S. can be expensive, many pet owners make their own. Simply cut meat or poultry into thin slices for drying in a food dehydrator or baking in a slow oven (250 to 300 degrees F) until they reach your dog’s preferred state of crunchiness.

Other between-meal treats that are safe for diabetic dogs include green beans – raw, cooked, canned, or frozen – or fresh, crunchy snap peas or carrot sticks; sardines or tuna packed in water; small amounts of canned pumpkin (plain, not the pie mix); freeze-dried liver; dried salmon; hard-boiled eggs; cheese (be careful of too much fat); bully sticks; dried beef tendons; chicken feet; and most low-carb treats formulated for dogs or cats.

It’s An Effort
Caring for a dog with diabetes can be time-consuming, expensive, and stressful. In fact, the initial diagnosis can be overwhelming.

According to Dr. Bruyette, “Several studies have shown that euthanasia is a common cause of death in diabetic dogs and cats mainly as a result of the owners’ concerns, real or perceived, regarding the care of pets with diabetes. It is very important that we emphasize to pet owners that while diabetes is a chronic disease, it can be well controlled with minimal disruption of their lives while maintaining their pet’s quality of life.”

Sheila Laing of Lansing, Michigan, cared for her Lab/Shepherd-mix, Zachary, for four years after he was diagnosed with diabetes at age 11. “Zachy was my soulmate and my teacher,” she says. “I am so lucky that I was able to help him lead a healthy normal life in his senior years in spite of the diabetes. People need to know that diabetes doesn’t have to be a death sentence. It can be managed!”

Coming next month: Diabetic diets in action; menu planning; and success stories.

CJ Puotinen lives in Montana. She is the author of The Encyclopedia of Natural Pet Care and other books and a frequent contributor to WDJ. Mary Straus is the owner of DogAware.com.

Comments (9)

For all of those posting about the difficulties you are having in monitoring and regulating your dog's diabetes, you are more than welcome at the forum, www.k9diabetes.com, or even to email me directly at k9diabetes@gmail.com.

I have had my own challenging diabetic dog and have been working with others online since 2003 and have gained a lot of experience along the way. Obviously I can't promise we can "fix" what is happening with your dog, but we can certainly give you an experienced opinion about how your dog's diabetes is being managed and what some of the issues and options are.

I know the place you are in - I was there myself. Most of the time, it can get better. With rare cases where the diabetes is actually a symptom of something much more sinister, diabetes can be managed well enough for it not to impact your dog's health and lifespan.

Posted by: k9diabetes | May 27, 2013 1:10 AM    Report this comment

In January 2013, we noticed our six year old lab acting not quite herself. One day I took a close look at her eyes and noticed they were cloudy. That was the beginning of many trips to different vets to diagnose Lola correctly. She was diabetic, blind and also had vestibular disease. Thank goodness we found a vet who has been a lifesaver. He has really taken the time to perform the necessary tests to check her thoroughly since she was insulin resistant from the beginning. Our vet also referred Lola to an ophthalmologist who performed successful cataract surgery on my baby girl. We have been through a lot with Lola and have paid quite a bit in doctors bills and procedures but we made the choice to help her as much as we could. It's been a huge learning curve. We recently found out she has hypothyroidism which is why she was not regulating properly. Lola's been on thyroid medication for a week and a half and we can already see an improvement in her BG readings. Prior to being diagnosed, my baby girl was happy and full of energy. I can tell she's feeling better because she's acting life her old self. For anyone who is helping their beloved pet cope with this illness, please don't give up. I know Lola is on the road to leading a normal, happy life but I couldn't have done it without my vet and his amazing team.

Posted by: Unknown | April 26, 2013 11:35 PM    Report this comment

My 12 year old jack russell ,Bailey, has recently been diagnosed with diabetes. My husband and I were just shocked as to how "out of the blue" this came his way. We feel as if we are back in the newborn days (of our children), as we are up 2-3 times in the night dealing with the frequent urination and his desperate attempts to find any source of water...including his own urine at times :( We have learned to to give him insulin twice a day and he was supposed to go in for the glucose curve today, but something else came up in his condition. We woke up to him being very lethargic and not wanting water or a snack of any kind. He was having trouble walking and my husband brought him in to the vet, only to find out that his blood sugar levels were dangerously high and that he was toxic. I was stunned, because he has been getting insulin for a few weeks and although it was not regulated to the perfect dose-it was a work in progress, we thought it was helping him to stay away from a toxic state. He now has to stay in the hospital for the next 2 days, on an IV and regulating his levels...we can't even do the glucose curve now. This has been so upsetting and draining at the same time, our poor little guy. But, he is our boy and his demeanor has been holding up very well...we will do what we can to get him healthy, he is so loved. Can anyone recommend a type of diaper for him...we have gone through the throwaway kind (useless) and the washable one with inserts...but even that one tends to fall off. Also, did your vet give you something so you can test his blood sugar? we didn't get anything...at least not yet. I hope everybody else's dogs are in their best health since diagnosis and pray for the same for my Bailey Boy...

Posted by: Tanksmomma | February 18, 2013 7:28 AM    Report this comment

Since my last dog (pomeranian)died of Diabetes, I learned that regular Vets don't know squat. My other dog (pomeranian) has Diabetes also and so I got a new Vet that is also a Nutritionist and he has helped my dog a lot. Go buy Gastriplex and give it to your dog once a day with meals. The food that helps my dog is Tripe made by Tripett (which is animal stomach lining), it stinks so bad that the dogs will love it. Inside the food I can hide his multi vitamins, B12, pre-biotics and pro-biotics, Gastriplex and Iron. I also give him Greek Yogurt once a day. Because of the gut being inflamed, your dog can not absorb nutrients. Your dog will be low on B12 and Iron. Have your dog checked on what vitamins and minerals are missing. Diabetes cause nerve damage and vitamin B12 is the best for fixing nerves (for people too). Always test your dogs blood glucose with a meter. The meter is usualy wrong because the blood clots as it slowly comes up to the surface and gives a wrong reading. I go through a lot of test strips just to be sure of the actual reading (100 test strips a week). Half unit of Insulin means that glucose levels will drop 50 points. One unit of insulin means that it will drop 100 points. If the dog is sleeping or not eating for 5 hours it will drop automatically 50 points. When you walk the dog, glucose readings will drop 50 points. If you give your dog too much insulin, cortisol will kick in to protect the dog from death and could bring up glucose readings to 800 or more. If this keeps happening, the dog will get pancreatitis, IBS, etc. You must stop the inflammation - that's the key. Even mild inflammation to the gut will make the dog insulin resistant and that will cause him/her to starve by not absorbing nutrients. You may see your dog eating a lot of grass, soil or poop - that's because they need nutrients and live enzymes. My dog eats the soil because he has an inflamed gut but after I started him on Gastriplex he stopped eating soil. It's OK if your dog eats grass and soil, it's not harmful and the dogs know what they need to heal themselves (unlike people). Buy a juicer and toss in broccoli and an apple and squirt it in his mouth. The dog must drink it right away or the live enzymes will die within 5 minutes or so. My Vet and I don't believe that dogs have Type 1 Diabetes because the symptoms are more closely related to Type 2 Diabetes (which could be controlled with the right diet). It's a battle but I will never give up. Good luck to everyone.

Posted by: Rose K. | January 30, 2013 5:31 PM    Report this comment

Great article. New solution for diabetic dogs. Helps with insulin sensitivity. It works quickly. Dia-Treaties by Vintek Nutrition. Check out the site (vinteknutrition_com), the videos, testimonials, etc. Dealing with dog diabetes just became much simpler. Veterinary tested 4+ years.

Posted by: vinteknutrition | January 20, 2013 10:48 AM    Report this comment

Our 7 1/2 year old black lab went into diabetic crisis a few days ago. We did not know she was diabetic. The vet bills are mounting (2 days at the clinic and 1 night in the hospital). She is home with us now, but doesn't seem to be responding well. We are having to liquefy her food and syringe feed her just so that we can administer insulin. I'm hoping that we can learn more and get her to start eating on her own. My greatest fear right now is that she was too far gone (in crisis) and we will have to have her put to sleep. I'm with you, Gerry... those large dark lab eyes are breaking my heart that Mom can't "fix this".

Posted by: northwestmom | January 13, 2013 8:41 PM    Report this comment

Gerry,

Our puggle, Hootch, was put in the hospital the Saturday before Christmas in diabetic crisis. We didn't even know she had diabetes, her blood sugar levels haven't been below 600 since Christmas. Her body is rejecting the insulin, thousands of dollars later we are still dealing with high blood sugar levels. Her vet said it was Cushing's that was causing the body to reject the insulin, then her thyroid was tested and we are now waiting to see if the medication she is on for the thyroid will start allowing her body to accept the insulin. Unfortunately the medication takes about 3 weeks to start working, in the mean time she's lost most of her vision due to the diabetes, she's lost a ton of wait, she's on medication to help keep her liver healthy and her blood sugar is still extremely high. I'm at a loss here..we don't know which way to go. The food cost is ridiculous, we are trying to find alternatives to her diet. I've been trying to read about various homemade dog foods and other foods that we can try that will be healthier and less expensive. I understand your frustration!! I'm right there with you. I am currently going to be seeking a second opinion of what is causing her body to reject the insulin, I'm so scared with such a high blood sugar level that more damage is being caused to her other organs. If I receive any answers I will definitely keep you informed.

I too would appreciate any assistance you may find out as well. I'm just at a loss her and I feel as if we've hit a brick wall with answers :(

Posted by: Hootchs Mom Dawn | January 12, 2013 4:53 PM    Report this comment

My sympathies Peggy. Our dog has been diagnosed as diabetic too, and isn't responding to Insulin as we would like. The American measure vs the Canadian is, I believe about 20x - ie your reading of 1000 would translate to a value we measure as 50. Our pet is in the range of 25 - 30 (500 - 600) and despite feeding her Medical Diabetic food, and twice daily injections of 12 units of Insulin, her readings are still quite high. Our insulin is the porcine type (Caninsulin)but she seems to be resistant to the treatment.

As you have found, treatment, and vet bills are high, and appear to be prohibitive. At $155 per day to do a glucose curve for her, $70 for a #15 bag of dry dog food, over $100 for a blood analysis etc. I can see where it is not possible to continue with treatments that aren't effective and unending vet bills with no postitve resolution available indefinitely.

I also would appreciate any specific advice from others who have encountered this type of problem and have resolved it. I am having a lot of difficulty facing those large dark Lab eyes trusting that I will look after her, when I can't seem to find a solution.

Thanks in advance for any assistance.

Posted by: Gerald E | January 11, 2013 1:45 AM    Report this comment

my 12lb dog was hospitalized twice for ketoacidosis. after the second bout i was told that he is not using his insulin. i was also told there is no way to know why. while in the hospital he was checked given ultrasounds, checked for infections and everything else possible. nothing was found. he is now dying. his blood sugar gets up to 1000. he is only 9 years old. even if i had the money, and i no longer have - this has been very expensive and the vets were worse than useless - i cannot just have him hospitalized every year just to keep him alive, it resolves nothing. there must be something i can do. we are now on our own. he has been on a raw food diet for about 4 years. we do everything naturally, so herbs and supplements, no tap water, etc. i am guessing that his body is simply rejecting the human insulin. i used humulin n for almost three years but just switched to humulin r since he was not using the n. but he is not using the r either. i cannot just let him die. any help would be unbelievably appreciated. thank you.

Posted by: peggyn | December 16, 2012 9:45 PM    Report this comment

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