Changes

==Description==

==Description==

The clinical syndrome described by the term '''diabetes mellitus''' results from intolerance to glucose.  It is a chronic disease caused by an absolute or relative deficiency of insulin and, although all body systems are ultimately affected, it is primarily a disorder of carbohydrate metabolism.

The clinical syndrome described by the term '''diabetes mellitus''' results from intolerance to glucose.  It is a chronic disease caused by an absolute or relative deficiency of insulin and, although all body systems are ultimately affected, it is primarily a disorder of carbohydrate metabolism.  The approximate incidence of the disease is 13 cases/10,000 dogs years at risk<ref name="one">Fall T, Hamlin HH, Hedhammar A, Kämpe O, Egenvall A. '''Diabetes mellitus in a population of 180,000 insured dogs: incidence, survival, and breed distribution.''' ''J Vet Intern Med. 2007 Nov-Dec;21(6):1209-16.''</ref>.

===Aetiology===

===Aetiology===

==Signalment==

==Signalment==

Diabetes mellitus is most common in mature dogs and it is twice as common in females than in males.  Miniature Poodles, Dachshunds and terriers may suffer from degenerative changes and type 1 disease.

Diabetes mellitus is most common in mature dogs and it is twice as common in females than in males.  Miniature Poodles, Dachshunds and terriers may suffer from degenerative changes and type 1 disease.  Non-insulin dependent diabetes mellitus is paticularly common in obese indoor cats with low physical activity <ref>Slingerland LI, Fazilova VV, Plantinga EA, Kooistra HS, Beynen AC. '''Indoor confinement and physical inactivity rather than the proportion of dry food are risk factors in the development of feline type 2 diabetes mellitus.''' ''Vet J. 2009 Feb;179(2):247-53. Epub 2007 Oct 26.''</ref>.

==Diagnosis==

==Diagnosis==

===Diagnostic Imaging===

===Diagnostic Imaging===

Radiographs or ultrasonography of the bladder may reveal evidence of cystitis, such as a thickened bladder wall and presence of (struvite) cystoliths.  Animals with diabetes mellitus, due to the high glucose concentration in their urine, may have bacterial fermentation within the bladder resulting in the formation of gas bubbles in a disease called '''emphysematous cystitis'''.  The gas can be detected by either imaging modality.

Radiographs or ultrasonography of the bladder may reveal evidence of cystitis, such as a thickened bladder wall and presence of (struvite) cystoliths.  Animals with diabetes mellitus, due to the high glucose concentration in their urine, may have bacterial fermentation within the bladder resulting in the formation of gas bubbles in a disease called '''emphysematous cystitis'''<ref>Peli A, Fruganti A, Bettini G, Aste G, Boari A. '''Emphysematous cystitis in two glycosuric dogs.''' ''Vet Res Commun. 2003 Sep;27 Suppl 1:419-23.''</ref>.  The gas can be detected by either imaging modality.

===Pathology===

===Pathology===

===Management===

===Management===

The non-ketotic diabetic animal can be managed as an outpatient and a great deal of the monitoring and treatment of the disease will then devolve upon the owner.  In dogs, almost all cases of diabetes mellitus are insulin-dependent and insulin is therefore a necessary part of the management regime.  Since many cats suffer from non-insulin dependent diabetes mellitus, they can often be managed with a change in diet and oral hypoglycaemic drugs.

The non-ketotic diabetic animal can be managed as an outpatient and a great deal of the monitoring and treatment of the disease will then devolve upon the owner.  In dogs, almost all cases of diabetes mellitus are insulin-dependent and insulin is therefore a necessary part of the management regime.  Since many cats suffer from non-insulin dependent diabetes mellitus, they can often be managed with a change in diet and oral hypoglycaemic drugs.

====Insulin====

====Insulin====

The diet fed to diabetic animals should be '''consistent''' and, at least initially, it should have a good caloric density to allow animals to regain weight.  If the animal is obese at presentation, a programme of controlled weight loss should be instituted so that insulin resistance is also minimised.  The diet should be '''low in simple carbohydrates''' which may induce the secretion of glucagon and other hormones antagonistic to insulin.  A '''constant feeding schedule''' should be maintained, with the animal usually being fed twice per day at the same times.

The diet fed to diabetic animals should be '''consistent''' and, at least initially, it should have a good caloric density to allow animals to regain weight.  If the animal is obese at presentation, a programme of controlled weight loss should be instituted so that insulin resistance is also minimised.  The diet should be '''low in simple carbohydrates''' which may induce the secretion of glucagon and other hormones antagonistic to insulin.  A '''constant feeding schedule''' should be maintained, with the animal usually being fed twice per day at the same times.

It has been shown that a higher dietary '''fibre''' content may achieve better stabilisation in cases of diabetes mellitus because this substrate forms a viscous gel in the intestine that slows the absorption of glucose.  This effect is greatest with soluble fibre but soluble/insoluble fibre mixes are often suitable.

It has been shown that a higher dietary '''fibre''' content can help to achieve better stabilisation in cases of diabetes mellitus because this substrate forms a viscous gel in the intestine that slows the absorption of glucose<ref>Graham PA, Maskell E, Rawlings JM, Nash AS, Markwell PJ. '''Influence of a high fibre diet on glycaemic control and quality of life in dogs with diabetes mellitus.''' ''J Small Anim Pract. 2002 Feb;43(2):67-73.''</ref>.  This effect is greatest with soluble fibre but soluble/insoluble fibre mixes are often suitable.

=====Cats=====

=====Cats=====

Similarly to dogs, the diet should be consistent and not contain a large proportion of simple carbohydrates.  In cats with suspected non-insulin dependent diabetes mellitus, obesity should be corrected as a priority to reduce insulin resistance.  Emaciated cats should be fed a diet with high caloric density.

Similarly to dogs, the diet should be consistent and not contain a large proportion of simple carbohydrates.  In cats with suspected non-insulin dependent diabetes mellitus, obesity should be corrected as a priority to reduce insulin resistance.  Emaciated cats should be fed a diet with high caloric density.

Recently, diets with '''high protein content''' have become popular in the management of diabetes mellitus in cats.  These diets are used because their carbohydrate content can be reduced accordingly and because cats do not develop high peaks in post-prandial blood glucose concentration when they are fed on high protein diets.  It is not clear whether supplementation of dietary fibre has any beneficial effect in cats.

Recently, diets with '''high protein content''' have become popular in the management of diabetes mellitus in cats.  These diets are used because their carbohydrate content can be reduced accordingly and because cats do not develop high peaks in post-prandial blood glucose concentration when they are fed on high protein diets.  It is not clear whether supplementation of dietary fibre has any beneficial effect in cats<ref>Mori A, Sako T, Lee P, Nishimaki Y, Fukuta H, Mizutani H, Honjo T, Arai T. '''Comparison of three commercially available prescription diet regimens on short-term post-prandial serum glucose and insulin concentrations in healthy cats.''' ''Vet Res Commun. 2009 Oct;33(7):669-80. Epub 2009 Mar 26.''</ref>.

====Hypoglycaemic Drugs====

====Hypoglycaemic Drugs====

====Investigation of Instability====

====Investigation of Instability====

 

==Prognosis==

==Prognosis==

==References==

==References==

 

[[Category:Liver_-_Degenerative_Pathology]][[Category:Cat]][[Category:Dog]]

[[Category:Liver_-_Degenerative_Pathology]][[Category:Cat]][[Category:Dog]]

[[Category:To_Do_-_James]]

[[Category:To_Do_-_James]]