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A Review on Diagnosis and Management of Diabetes Mellitus in Dogs

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A Review on Diagnosis and Management of Diabetes Mellitus in Dogs Int.J.Curr.Microbiol.App.Sci (2019) 8(6): 10-16 International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 8 Number 06 (2019) Journal homepage: http://www.ijcmas.com Review Article https://doi.org/10.20546/ijcmas.2019.806.002 A Review on Diagnosis and Management of Diabetes Mellitus in Dogs Shabnam Sidhu* and Swaran Singh Randhawa Department of Veterinary Medicine, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India *Corresponding author ABSTRACT Diabetes mellitus (DM) is one of the most common endocrinopathies observed in dogs. The main clinical manifestations are polydipsia, polyuria, polyphagia, weight loss and K e yw or ds glucosuria. The etiology of diabetes mellitus is similar in dogs, cats and humans and is Diabetes mellitus, probably multifactorial (genetic, immune and environmental factors). Diabetes mellitus is Dogs, Pancreas, described to be deficiency or absolute lack of insulin secretion is divided into two types: Fructosamine, insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus Glycated (NIDDM). Various breed susceptibilities have been reported. Conventionally diagnosis of hemoglobin canine DM was based on persistent fasting hyperglycemia and glucosuria. However, nowadays serum fructosamine, glycated hemoglobin (GHb) and glycated albumin (GA) Article Info measurements are used to complement blood glucose concentration for the diagnosis and Accepted: treatment response monitoring of DM. Traditionally, management of DM is achieved by 04 May 2019 insulin administration, diet, regular exercise and oral hypoglycemic drugs. Alternate Available Online: therapies like use of encapsulated islet, gene therapy etc. are being evaluated for its clinical 10 June 2019 application in the efficient management of DM. This review will briefly summarize our current knowledge about the diagnosis and management of diabetes in dogs. Introduction dogs, cats and humans (Nelson and Reusch, 2014). The etiology of diabetes mellitus in Diabetes mellitus is one of the most common dogs is probably multifactorial. Factors endocrinopathies observed in middle to old contributing to the development of diabetes aged dogs, characterized mainly by mellitus are genetic, immune and hyperglycemia, glycosuria and weight loss, environmental factors. resulting from absolute or relative deficiency of insulin (Audrey, 2012). Pathologically, it is Genetic factors influence susceptibility, a multiple organ affecting disorder in which specific genes and inheritance patterns. the body has chronic carbohydrate, protein Environmental factors playing role could be and fat metabolism failure, specifically in the obesity, diet, exposure toxicants or drugs. insulin responsive organs. The etiology of Immune-mediated destruction of islet cells diabetes mellitus development is similar in and destruction of islet cells secondary to 10 Int.J.Curr.Microbiol.App.Sci (2019) 8(6): 10-16 pancreatitis may play a role in establishing Pancreas and its endocrine hormone pathogenesis (Guptill et al., 2003). production Pathophysiologically, diabetes mellitus is Pancreas is a small dual functional gland described to be deficiency or absolute lack of located in the abdominal cavity near to small insulin secretion by the beta cells of the intestine, having both exocrine and endocrine pancreas or decreased number of insulin functions. The exocrine part secretes digestive receptors (Wubie and Getaneh, 2015). enzyme containing pancreatic fluid that help to further break down the carbohydrate, On the basis of degree of beta-cell insulin proteins and lipids or fats. Endocrine function production failure, diabetes mellitus is of the pancreas is performed by islets of divided into two types: insulin dependent Langerhans. The islets comprise of four type diabetes mellitus (IDDM) and non-insulin of cells; alpha cell that secrete hormone dependent diabetes mellitus (NIDDM). Type glucagon, the beta cells which release insulin, 1 diabetes (IDDM) is more common in dogs delta cells that secrete somatostatin and as compared to type 2 diabetes mellitus gamma cells responsible for pancreatic (Feldman and Stephen, 2005). polypeptide ( Aiello and Mays, 2005). Insulin produced by beta cells of pancreas, plays a Understanding on susceptibility of dogs to central role in regulation of carbohydrate, diabetes as an effect of breed, age and sex has protein and fat metabolism in the body. It been reported by many researchers causes absorption of glucose from blood by worldwide. Breeds like Poodles, Keeshounds, the cells of liver, skeletal muscles and fat Alaskan Malamutes, Miniature Schnauzers, tissue. In the liver and skeletal muscles, Cairn Terrier and English Springer Spaniels glucose is stored as glycogen and in are reported to be under high risk for adipocytes it is stored as triglycerides spontaneous development of diabetes (Cunningham, 2002). mellitus, However, German Shepherd, Cocker Spaniels, Collies and Boxers breeds are Classification of diabetes mellitus considered to be in the low risk group (Guptillet al., 2003; Catchpole et al., 2013). The classification of diabetes mellitus in dogs Almost all breeds of dogs are susceptible, and cats has more or less followed the scheme however mixed and large breed dogs are more used in human medicine, although the susceptible to the disease (Feldman and etiopathogenic mechanisms may not be Nelson, 2004). completely identical. Diabetes has been broadly classified into TYPE I and TYPE II Although DM is a non-curable disease but its based on the degree of beta cell injury successful management requires ongoing (Nelson and Reusch, 2014). veterinary treatment and a long-term commitment by the owners (Aptekmann and Catchpole et al., (2008) classified two forms Schwartz, 2011). The first choices for of canine DM; insulin deficiency diabetes treatment of diabetes mellitus include oral (IDD) with absolute insulin deficiency and hypoglycemic drugs, exogenous insulin insulin resistance diabetes (IRD) with relative injection, dietary supplements and exercise, insulin deficiency. β cell loss in pancreas however if the disease is severe fluid and associated with uncontrolled hyperglycaemia bicarbonate therapy are also recommended can lead to the complication of IRD and its (Feldman and Stephen, 2005). progression to secondary IDD. 11 Int.J.Curr.Microbiol.App.Sci (2019) 8(6): 10-16 Type I diabetes mellitus (insulin dependent GDM affects middle aged bitches in the latter diabetes mellitus) is characterized by half of gestation with a breed disposition in destruction of βcells of the pancreas and Nordic Spitz. It has been reported that GDM complete loss of insulin secretion, manifested resolves within days to weeks after whelping. by permanent hypoinsulinemia, essentially no GDM is most often attributed to reduced increase in endogenous serum insulin levels. insulin sensitivity in healthy bitches after 1 This type occurs most commonly in dogs, to month of gestation and increased levels of certain extent also in cats. In this type of progesterone (Fall et al., 2008). Overt diabetes loss ofβ cells is irreversible so diabetes during diestrus in bitches may be due chances of developing diabetic ketoacidosis is to higher levels of progesterone causing higher as compared to type II diabetes glucose intolerance (Kim et al., 2012). (Feldman and Stephen, 2005). The etiology of Juvenile diabetes, a form of insulin dependent type I diabetes in dogs is multifactorial. diabetes mellitus has also been reported in Genetic predispositions have been suggested canines with particular prevalence in golden by familial associations, pedigree analysis of retrievers, German shepherd and keeshonds Keeshonds, and genomic studies aimed at (Kang et al., 2008). identification of susceptibility (Guptill et al., 2003). A number of genes associated with Clinical manifestations diabetes susceptibility in humans have been linked with high risk of diabetes in dogs. The most common clinical manifestations of Genes associated with diabetes in dogs are diabetes mellitus are polydipsia, polyuria, major histocompatibility complex class II polyphagia, weight loss and glucosuria. genes [dog leukocyte antigen (DLA)], with Untreated or improperly managed diabetes, similar haplotypes and genotypes identified in may lead to change in the acidity of blood the breeds most susceptible for diabetes (diabetic ketoacidosis) with dehydration, (Catchpole et al., 2013). vomiting, depression, coma and ultimately death (Feldman and Nelson, 2004). Other Type II (non-insulin dependent diabetes clinical signs can be weight loss, bilateral mellitus) is less common in dogs and more cataracts and weakness (Bruyette, 2013). common in cats. Principle pathological Canine diabetes mellitus is a disorder with alteration in type II diabetes is impaired several pathological mechanisms and insulin secretion by β cells, insulin resistance complication of abnormal metabolism in insulin responsive tissue and acceleration complications. Poluuria and polydipsia occurs of hepatic glucose. The ability of beta cells to due to abnormal carbohydrate metabolism and secrete insulin is present, however, the responsible for cataract formation in diabetic secretory response to stimulation is delayed dogs. Hyperlipidemia, ketone production and and the amount of insulin secretion in hepatic changes are primarily due to altered abnormal (Feldman and Stephen, 2005). fat metabolism. Cataracts start to develop within 5-6 months course of diabetes and In addition to the two
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