How is diabetes mellitus treated?

This article builds on the information in the article 2 weeks ago.

Diabetes mellitus is a chronic disease of carbohydrate metabolism requiring life long management.

Type 1 diabetics (insulin dependent diabetes mellitus) must always be managed with insulin supplementation as a major component. This is because the body does not produce insulin.

Insulin is a small and fragile molecule. It must be stored in the refrigerator and handled gently. It is only available by injection. Injections are usually given twice daily, on schedule, just after meals.

The dose of insulin required for each patient varies. Initially a relatively low, book dose is given once daily to look for a response. About 7 days after starting or changing insulin therapy, a blood glucose curve is performed. This consists of collecting blood every one to two hours starting just before insulin is administered and ending 12 to 24 hours later. This allows the veterinarian to see the duration of action, the time and the value of the low blood glucose. These indicate whether the dose needs to be increased, decreased or if different insulin is needed.

Initially, several curves are usually needed to get the patient managed appropriately. Some patients are not easily regulated and quite a few curves are required initially, and then must be done very regularly.

Type 2 diabetics (non-insulin dependent diabetes mellitus) usually need insulin supplementation as part of management. Remember, I am talking about cats, not humans. Most cats presenting with diabetes mellitus have become insulin dependent by the time of diagnosis. However, a small portion of diabetic cats can be managed with only diet, exercise, weight control and oral hypoglycemic medications.

Exercise is important for all diabetics. Exercise tends to increase the cellular insulin receptors so the cells can make better use of the insulin present. Exercise also helps obese patients decrease body fat and regulate better.

All diabetics must have strict diet control. The control of carbohydrate ingestion, digestion and absorption greatly helps decrease the post meal blood sugar spike. Limiting consumption of simple sugars is the first step in this process. Simple sugars need very little digestion and are rapidly absorbed. Increasing the complexity of the carbohydrates can slow the digestion and absorption. Adding large amounts of fiber to the diet make the carbohydrates less accessible for digestion and greatly slows absorption.

In recent years, high protein/low carbohydrate foods have been developed. These foods tend to be very helpful in our carnivorous cat patients. The high levels of protein provide satiety and force the body to convert protein into blood glucose. These foods are often very helpful with control weight.

Additionally, the timing of eating is important when giving insulin injections. The risk of hypoglycemia greatly increases if a patient has not had a meal. Therefore, most veterinarians tell clients to feed their pet, make sure the pet eats, and then give the insulin injection.

While properly managed diabetes mellitus rarely causes death, it can be a common and serious complicating factor in other disease processes. Diabetics often seem to heal more slowly from injuries and infections. Cataracts and neurological problems occur. The better the management, the lower the rate of many complications.

Diabetes mellitus takes time, commitment and money to manage appropriately. Each diabetic regulates differently. Serious complications occur. Unfortunately, when management is not possible for a wide variety of reasons, euthanasia often becomes the best option. Poor regulation of diabetes only causes the pet to suffer.

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