Diabetes mellitus: an update

Diabetes mellitus is characterized by disturbances of carbohydrate, lipid and protein metabolism and glucose intolerance. Several factors are known to contribute to the disease, ie, obesity, immune-mediated insulin resistance, and the diabetogenic hormones glucagon, growth hormone and glucocorticoids. Recently, a number of developments have taken place in the management of human diabetes mellitus which may be applicable to dogs and cats. These include the use of diets high in soluble, non-absorbable carbohydrates which lower post-prandial increases in blood glucose. The more complex causes of instability, ie, insulin-induced hyperglycaemia, rapid metabolism of insulin and insulin resistance can be diagnosed by hospitalizing the patient and measuring blood glucose at four hour intervals for 24 hours. In human medicine, new techniques for controlling diabetes mellitus are pancreatic implants, constant infusion pumps for insulin and the use of the hormone somatostatin which suppresses glucagon secretion, but not all may be applicable to veterinary medicine.     

Diabetes mellitus in the cat: a review

About 80% of diabetic cats suffer from type 2 diabetes which is characterized by reduced insulin secretion from beta-cells and by insulin resistance. As in humans cats experienced a change in life habits and eating conditions over the last years leading to a tremendous increase in the prevalence of obesity. In both species obesity is one of the major risk factors for the development of type 2 diabetes. Treatment should be initiated immediately after diagnosis. In Zurich, therapy consists of application of an intermediate-acting insulin and dietary management. In the latter the use of diets with reduced carbohydrate content seems to be of utmost importance. We recently found that the percentage of cats with a transient course of diabetes increases from previous 25% to 50-70% when a diet with strongly reduced carbohydrate content is fed.     

Diabetes mellitus in cats.

Feline diabetes is a multifactorial disease with genetic and environmental factors, including diet, excess body weight, and physical inactivity, involved in its pathogenesis. Although type 2 diabetes is most common in cats, most cats are insulin-dependent at the time of diagnosis. If good glycemic control can be achieved early after diagnosis, a substantial proportion of diabetic cats go into clinical remission. Diabetic remission may be facilitated by using a low-carbohydrate-high-protein diet combined with a long-acting insulin, such as glargine, administered twice daily. Rather than just controlling clinical signs, these new treatment modalities make curing feline diabetes a realistic goal for practitioners.     

Diabetes mellitus in the juvenile dog: a report of four cases.

In four cases of diabetes mellitus in juvenile dogs, clinical and clinicopathologic findings were similar to those of juvenile onset diabetes mellitus in man. However, histopathologic findings varied from the usual findings in the human disease, and lack of plasma insulin was not proved in the canine cases.     

Diabetes mellitus in a domesticated Spanish mustang

An 18-year-old Spanish Mustang mare was referred for evaluation of progressive weight loss and persistent hyperglycemia. Clinicopathologic abnormalities included marked hyperglycemia and glycosuria. Serum cortisol concentration was appropriately decreased following administration of dexamethasone, indicating that the horse did not have pituitary pars intermedia dysfunction. Serum insulin and plasma C-peptide concentrations were low, suggesting that hyperglycemia was a result of decreased secretion of insulin by pancreatic beta cells. In addition, glucose concentration did not return to the baseline concentration until 5 hours after i.v. administration of a glucose bolus, suggesting that insulin secretion, insulin effect, or both were reduced. However, i.v. administration of insulin caused only a slight decrease in the plasma glucose concentration, giving the impression that the action of insulin was impaired. Within 5 hours after administration of a combination of glyburide and metformin, which is used to treat diabetes mellitus in humans, the glucose concentration was within reference limits. The horse was euthanized, and a postmortem examination was done. Immunohistochemical staining of sections of the pancreas revealed attenuation of the pancreatic islet beta-cell population, with beta cells that remained generally limited to the periphery of the islets. These findings indicate that, albeit rare, pancreatic beta-cell failure may contribute to the development of diabetes mellitus in horses.     

Diabetes mellitus affects the duration of action of vecuronium in dogs

ObjectiveTo compare the duration of action of vecuronium in diabetic dogs with a control group.Study designProspective clinical study.AnimalsForty client-owned diabetic (n = 20) and non-diabetic dogs.MethodsDogs were considered free from other concurrent disease based on clinical examination and laboratory data. After pre-anaesthetic medication with acepromazine and methadone, anaesthesia was induced with intravenous (IV) propofol and maintained with isoflurane-nitrous oxide in oxygen. Neuromuscular blockade (NMB) was achieved with vecuronium, 0.1 mg kg^?1 IV and its effects recorded by palpation (pelvic limb digital extension) and electromyography (m. tibialis cranialis) of responses (twitches; T) to repeated train-of-four (TOF) nerve stimulation. Time to onset of NMB was the period between vecuronium injection and loss of fourth twitch (T4) in the TOF pattern recorded by EMG and palpation. Duration of NMB was defined as the time from drug administration to return of T1 by palpation (T1_tactile) and EMG (T1_EMG). Times to return of T2-4 were also recorded. Time from induction of anaesthesia to vecuronium injection was recorded. Heart rate, non-invasive mean arterial pressure, body temperature, end-tidal isoflurane and end-tidal CO₂ concentrations were recorded at onset of NMB and when T1_EMG returned. Loss and return of palpable and EMG responses for diabetic and non-diabetic dogs were compared using t-tests and Mann Whitney U-tests.ResultsThere were significant (p < 0.05) differences between diabetic and non-diabetic dogs for the return of all four palpable and EMG responses. Times (mean ± SD) for return of T1_tactile were 13.2 ± 3.5 and 16.9 ± 4.2 minutes in diabetic and non-diabetic dogs respectively. There were no differences between diabetic and non-diabetic dogs in the time to onset of vecuronium with EMG or tactile monitoring.Conclusions and clinical relevanceThe duration of action of vecuronium was shorter in diabetic dogs as indicated by both tactile and EMG monitoring.     

Diabetes mellitus and bilateral cataracts in a kitten

An 18-week-old male domestic long-hair kitten was presented with a history of polyuria and polydipsia for several weeks. The general condition was unremarkable, but the kitten was considerably smaller than expected for the age and showed cataracts in both eyes. Serum glucose concentrations were persistently elevated and based on clinical findings and an elevated serum fructosamine concentration, a diagnosis of diabetes mellitus was established. Diabetes mellitus is not commonly diagnosed in young kittens, nor are cataracts recognised as a frequent feature of this disease in cats. The cataracts progressed in spite of the insulin therapy and the kitten was euthanised 10 weeks after referral. Histopathological examination of the pancreas revealed few and small islets of Langerhans compared to the examination of pancreas from a healthy kitten of the same age. Histopathological changes in the eyes included cataracts affecting both cortex and nucleus.     

Diabetes mellitus caused by pancreatitis in a bull

This paper describes a 6-year-old Simmental bull with diabetes mellitus. The animal was referred to our clinic because of severe weight loss and chronic indigestion. Clinical examination revealed markedly disturbed general condition, impaired forestomach function and polyuria. There was aciduria, glucosuria and ketonuria. The most important biochemical findings were severe hyperglycemia, markedly increased activities of hepatic enzymes and severe metabolic acidosis. Plasma concentrations of insulin, insulin-like growth factor-I, thyroxine and 3,5,3'-triiodothyronine were lower than normal, whereas those of glucagon were higher than normal. Based on these findings, a diagnosis (secondary) diabetes mellitus was made. The bull was slaughtered and histological examination revealed mixed cell pancreatitis with severe degeneration of islet cells. Immunohistochemical examination of the pancreas showed that very few insulin-, glucagon-, somatostatin- and pancreatic polypeptide, insulin-like growth factor-I and adrenomedullin-producing islet cells were present.     

Diabetes mellitus in a koala (Phascolarctos cinereus)

Objective To describe a case of diabetes mellitus in a koala (Phascolarctos cinereus).
Design A case report with controls.
Procedures We describe clinical and laboratory findings in a 6-year-old, free-living, female koala presented with traumatic injury and subsequently found to have polydipsia, hyperglycaemia and glucosuria. Over a 5 week period, serum biochemical analyses, haematological examinations, urinal-yses, measurement of serum insulin and fructosamine concentrations, necropsy, histopathological examination of a range of tissues and immunohistochemical examination of the pancreas for insulin-containing cells were done. For reference purposes, serum insulin and fructosamine concentrations were determined in four and two healthy koalas, respectively, and three healthy koalas pancreases were examined histo-logically and immunohistochemically.
Results The koala had persistent hyperglycaemia, hyperlipidaemia, hyponatraemia, hypochloraemia and glucosuria. Serum insulin concentration of the diabetic koala was only marginally smaller than that of healthy koalas, but all concentrations were smaller than reference concentrations in dogs and people. Fructosamine concentration did not allow the diabetic koala to be distinguished from healthy koalas and concentrations of all koala analytes were greater than expected for healthy dogs and people. Histopathological examination revealed extensive degeneration of pancreatic islet cells and fatty infiltration of hepatocytes. Immunoperoxidase staining revealed decreased or absent insulin in the b cells of the affected koala.
Conclusion Clinical signs, clinicopathological results and histopathological changes were consistent with diabetes mellitus. The pathogenesis of the condition could not be determined but may have been related to the administration of a parenteral corticosteroid preparation, the stress of capture or tissue damage and inflammation.     

Diabetes mellitus in a 6-month-old Charolais heifer calf

This unthrifty heifer calf was thin, weak and had a dull haircoat. Urinalysis and blood work revealed glycosuria, ketonuria, hypoproteinemia, and hyperglycemia. Euthanasia and necropsy were performed, revealing multifocal intersitial lymphocytic infiltration, an absence of islet cells, and a positive stain for bovine viral diarrhea virus in the pancreas.     

Diabetes mellitus does not affect the neuromuscular blocking action of atracurium in dogs

Objective

To compare the duration of action of atracurium in diabetic and nondiabetic dogs.