Diabetes Mellitus is classified as DM. It is a common disease in the canine. The lack of insulin in the animal body leads to the inability to use the sugar in the body. The ability of the animal is obtained through the digestion of its own fat. At this time, ketone bodies are produced, and a large number of ketone bodies will acidify the body and cause acidosis. Diabetic animals are unable to use glucose in the blood, and the use of fat leads to fat accumulation in the liver, which gradually leads to liver damage, such as fatty liver disease. This case of DM had a symptom of consistency anemia, which is considered to be liver disease leading to the oxidation of the red blood cells. Also， anemia is due to other inflammation in the body. At the same time, because of the animal’s long-term anorexia, the intake of hematopoietic nutrients is insufficient will also aggravate anemia; Anemia is more pronounced after treatment with fluids during dehydration.
Keywords: Canine, DM, anemia, diagnosis, treatment
Name: XIAO GUI ZI
Sex: Female (not-castrated)
Age: 7 years old
Body weight: 8.5 kg
History: Complete vaccination and deworming, infection disease when she was young, performed polydipsia and diuresis two years ago
The owner fed her at home these years and found she appeared to drink and urinate more than usual two years ago. She would eat humanity’s food, such as chicken, rice, and pork, in usual.No contact with other animals and humans. Three months ago, the patient’s eyesight started to get nasty, which was not found when checked in the hospital. Three days ago, the patient began to lose appetite and was weak. The owner found it in low spirits and vomited after eating a sweet potato. So decided to take her to the hospital. Vaccinate records is completed, and deworming is this year.
Body weight 8.5 kg, temperature 38.7℃，respiratory rate was 44/min, heart rate: 110 beats/min—a little abnormal murmurs in heart beating. Mouth mucosa was mild yellow, capillary refill time（CRT）<2s, the patient was fat, and the body condition score（BCS）was 3/9, which can touch the ribs in palpation. The affected person becomes offered an incredibly miserable situation—dry coat and nose. Abdominal palpation was found nothing obvious abnormal. There were moderate dental calculus and gingivitis in an oral exam. The surface hair of the skin becomes the day. The dehydration was evaluated at 5%. In palpation, the rate of the femoral artery changed identically to the heart price. The lymph gland on the surface skin was normal.
Complete Blood Count (CBC) examination
Interpretation: There was a mild increase in the OTHER%. Red blood cell count and HCT indicate a possibility of dehydration that may have a low liquid volume, combined with the performance of the patient, but they were still in the reference range.
Idexx Catalyst biochemistry CHEM17
Interpretation: There was an obvious increase in ALT, and CREA, which is a cue for cell injury and dehydration.No obvious abnormalities in other biochemical indicators.
The result of the CRP testing
Interpretation:The result of CRP was normal.
The result of the blood gas analysis
Interpretation:The result of CRP was normal.
Picture 1 stomach
Picture 2 duodenum
Picture 3 ovary
Picture 4 gall bladder
Picture 5 cornua uteri
Picture 6 pancreas
Interpretation:Gastric effusion; Duodenal intestinal effusion; Gallbladder full, a small amount of cholestasis; Bilateral ovary enlargement; Endometrium echo is uneven; The echo of pancreatic parenchyma was more diffuse.
The diagnosis methods for Canine diabetes mellitus usually used in veterinary clinics consist of the physical examination findings or history, laboratory examination such as complete blood count, cytology, biochemistry panel, urinalysis, urine culture, fructosamine measurement, A1C test(more used commonly to monitor diabetes mellitus in people), thyroid assays, pancreatic lipase immunoreactivity, ACTH stimulation test, abdominal ultrasound imaging, dexamethasone suppression tests, blood pressure measurement.
Some clinical signs are common, such as polyuria, polydipsia, polyphagia, weight loss, dehydration, lethargy, muscle wasting, poor hair coat, and even eye symptom like cataract formation.
（1）Neutral protamine hagedorn（NPH） 0.25u/kg s.c q12hrs
（2）Maropitan 1mg/kg s.c q24hrs
（3）Amoxicillin clavulanic acid 25mg/kg p.o q12hrs
（4）Lactated Ringer’s liquid + KCL liquid get 10mL/h/kg
（5）Dietary of high-fiber food
（6）SHENGMINGYUAN（polyethylene glycol bovine hemoglobin conjugate）5mL i.v q24hrs
Infusion with liquid to correct dehydration and acidosis; antiemesis to control gastrointestinal symptoms, antibiotics to control inflammation; Add potassium and magnesium ions; Use insulin infusion therapy to manage blood sugar; Blood gas and blood sugar are monitored daily. No vomiting was observed the next day, and feeding began. On the third day of review, indicators improved, reducing the amount of fluid; On the fourth day, transient blood glucose was installed, and insulin injection was used to manage blood glucose. Their mental appetite recovered after a week in the hospital. Blood sugar occasionally rises.
The rechecking results showed that most indicators had improved. Among them, blood routine showed the anemia continued, considering infusion during hospitalization, which led to diluting red blood cells. The elevating white blood cell numbers may be the result of persistent uterine diseases such as progesterone; ALKP continued to increase, primarily due to liver, bone, and steroid effects. Kidney, intestinal tract, and placental products are rare, whether to consider the presence of false pregnancy in animals.
In consideration of the increasing age of the animal, the owner did not make a further diagnosis and was discharged from the hospital to recuperate at home. He took oral medicine for a week, injected insulin at home twice a day, 2U each time, monitored blood sugar, and took metronidazole and zonal orally to control infection and inflammation. Take a nourishing oral solution to replenish blood. Two weeks later, the prognosis was good, the dog’s spirit and appetite were typical, and the body weight increased by 0.1 kg. Regularly rechecking is needed.
Definition and signalment
Diabetes mellitus (DM) is a common endocrine disease characterized by absolute or relative insulin deficiency in cats and dogs. There are three types of diabetes:
1) Type I: Insulin-dependent diabetes mellitus (IDDM): insufficient insulin secretion leads to an absolute lack of insulin and relies on external insulin supplementation. Type I diabetes, the most common form in dogs, may be caused by autoimmune destruction of the beta cells of the pancreas that secrete insulin.
2) Type II: none insulin-dependent diabetes mellitus(NIDDM) is characterized by beta cell dysfunction, which leads to impaired insulin secretion, and peripheral insulin resistance. Insulin production may be normal or increased; However, insulin is not enough to prevent high blood sugar. Abnormal insulin secretion combined with insulin resistance leads to stable re-regulation of blood glucose levels at higher concentrations. Type 2 diabetes is sometimes reversible, meaning the disease can go into remission. Type 2 diabetes occurs in cats, not dogs.
3) Type III: gestational hormone-induced diabetes, which occurs when insulin resistance is associated with high concentrations of progesterone or other prediabetic hormones (such as cortisol, adrenaline, growth hormone, and glucagon). Both cats and dogs are reported to have Type III diabetes.
Physiology of pathology
The role of insulin: The existence of insulin is mainly in the liver, muscle, and fat cells. Its primary function is to promote the storage of glucose to be glycogen, amino acids to be protein, and fatty acids to be overweight. Insulin also promotes glycogen synthesis and gluconeogenesis, reducing liver enzymes that convert amino acids into glucose. Insulin promotes lipid synthesis and inhibits lipid degradation. Insulin promotes positive nitrogen balance by stimulating protein synthesis and inhibiting protein degradation.
The effects of insulin deficiency: In the case of absolute or relative insulin deficiency, the flow of glucose into the liver, muscle, and adipose tissue is reduced. The liver also produces more glucose through increased gluconeogenesis and glycogen breakdown, which leads to high blood sugar. Once the kidney’s ability to reabsorb glucose is exceeded, glucose is lost through the urine, resulting in osmotic diuresis. When insulin is deficient, protein synthesis decreases, and protein catabolism increases. These effects can lead to loss of muscle mass and negative nitrogen balance, a lipid metabolism disorder. The Increasing non-esterified fatty acids are transported to the liver, leading to hepatic steatosis and hyperlipidemia. The increase in ketone bodies eventually leads to ketoacidosis.
The cause of Immune-mediated disease: Diabetes is considered to be a multi-factorial disease. In most dogs, it is believed that the immune-mediated process leads to the destruction of insulin-secreting pancreatic beta cells, resulting in absolute insulin deficiency. Various beta-cell antibodies have been found in people with type 1 diabetes; However, no large-scale anti-cellular antibody studies have been conducted in dogs. One report found anti-beta cell antibodies in 9 out of 23 newly diagnosed diabetic dogs. Another report found the anti-beta cell antibody GAD65 in 4 out of 30(13%) newly diagnosed diabetic dogs. In contrast, about 85 percent of newly diagnosed type 1 diabetes patients have antibodies to GAD65.Pancreatitis.Chronic pancreatitis leads to the progressive destruction of insulin-secreting cells, as well as glucagon-secreting cells. Chronic pancreatitis is secondary to about 30% of canine cases. Lipemia, a high-fat diet, and obesity are associated with the origin of pancreatitis and may contribute to the development of diabetes.
Genetics also plays a role in canine diabetes mellitus. Some breeds of dogs have a genetic predisposition, while others have a lower risk of diabetes. Breed susceptibility varies geographically and may be related to genetic influences. The specific genetic determinants of canine diabetes are not well defined. Associations between diabetes risk and single nucleotide polymorphisms were found in the insulin gene region of the Jack Russell terrier and Cocker Spaniel and cytotoxic t lymphocyte-associated protein 4 in several breeds. A pattern of polygenic inheritance has been found in American Eskimo dogs. The genetic determinants of dogs may be related to the canine leukocyte antigen (DLA) gene encoding major histocompatibility complex Class II (MHC-II). MHC-II is responsible for presenting antigens to T lymphocytes. In theory, MHC genes benefit the positive selection of anti-pancreatic t cells in high-risk patients.
Exposure to elevated levels of progesterone during pregnancy can lead to glucose intolerance and gestational diabetes in dogs. Exposure to excessive amounts of other diabetes hormones (growth hormone, cortisol) can also lead to diabetes. Hyperadrenocorticosis is a common diagnosis in diabetic dogs. In a study of 35 dogs with multiple endocrine disorders, 20/35(57.1%) had both diabetes and hyperadrenocorticism activity. Another study of 221 dogs with diabetes reported that 51 (23%) also had hyperadrenocorticism training. Streptozotocin use can cause diabetes in dogs. While obesity may indirectly influence the development of diabetes, no direct link has been found between the two.
Except for the brief periods of type III diabetes (such as pregnancy), diabetes in dogs does not go into remission, and treatment is usually life-long. In a study of 439 dogs, the median survival time (MST) after diagnosis was 17.3 months. In another study of 860 dogs, MST was two years (excluding patients who died within a day of diagnosis). Another study of 68 dogs reported an MST of 964 days. However, many diabetic dogs are euthanized because owners are frustrated with the cost of treatment and the time commitment of managing the disease. Therefore, educating the owners; Setting reasonable expectations; Constant communication is essential. In some cases, it may be helpful to use a quality-of-life questionnaire.