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  • Dr. Carsen, DVM
    UTI Cushings disease overactive adrenal glands pancreatitis cancer and hypothyroidism Common underlying diseases in the DKA cat include pancreatitis cholangiohepatitis inflammation infection of the liver and bile ducts inflammatory bowel disease hepatic lipidosis chronic kidney failure infections and cancer As I wrote in my June 2006 column animals with DM have large amounts of glucose in their blood streams but due to an absolute deficiency of insulin or factors which make it impossible for the insulin which is present to do its job insulin resistance the glucose is unable to get into the cells where it is needed as fuel The animal s body thinks it is starving and starts to break down its own body tissue DKA dog include urinary tract infection UTI Cushings disease overactive adrenal glands pancreatitis cancer and hypothyroidism Common underlying diseases in the DKA cat include pancreatitis cholangiohepatitis inflammation infection of the liver and bile ducts inflammatory bowel disease hepatic lipidosis chronic kidney failure infections and cancer As I wrote in my June 2006 column animals with DM have large amounts of glucose in their blood streams but due to an absolute deficiency of insulin or factors which make it impossible for the insulin which is present to do its job insulin resistance the glucose is unable to get into the cells where it is needed as fuel The animal s body thinks it is starving and starts to break down its own body tissues to supply more fuel If this starving in the midst of plenty condition goes on for a long enough time DKA results A DKA dog or cat is dehydrated often severely The dehydration is caused in part by what s called osmotic diuresis the kidneys get rid of the excess blood glucose as the glucose is excreted it pulls with it water as well as the electrolytes sodium Na potassium K calcium Ca phosphorus P and magnesium Mg Also as the DKA develops the DKA animal feels sicker and sicker drinking and eating less in addition he usually starts to vomit and have diarrhea Thus there is excess water and electrolytes going out and less than usual water and electrolytes coming in The second major factor in DKA is a condition of excess acidity in the body As the body s proteins fats and carbohydrates are broken down in an attempt to correct starvation chemicals called ketone bodies KBs are formed KBs are strong acids and as their numbers build up eventually a potentially life threatening condition called metabolic acidosis comes about As the body attempts to get rid of the ketones in the urine they pull even more water and electrolytes out of the body thus contributing to a worsening vicious cycle The signs of decreased appetite vomiting and diarrhea acetone breath smells like nail polish remover weight loss weakness and sometimes seizures or coma obviously will alert you to the fact that your animal is very sick and needs to see her veterinarian If the DKA is caught

    Original URL path: http://www.themetaarts.com/2006november/drcarson.html (2016-02-13)
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  • Dr. Carsen, DVM
    day for your diabetic dog your veterinarian will tell you to feed her on a schedule if your dog is being given insulin only once a day you will be told to feed her half the determined amount of food at the time of the injection and the other half 8 10 hours later If your dog is being given insulin twice daily then you will feed her half the determined amount with each injection as close to 12 hours apart as is feasible for you Since cats tend to be nibblers they can be given the recommended amount of food all at once they will finish it off through eating multiple small meals during the day It is always best to hold off on giving your animal his insulin injection s until you re sure he s going to eat the food you ve just given him If he doesn t eat the food or eats only part you will be told to skip the injection for the former or reduce the dose for the latter It is rare for the initial dose of insulin to be the one that ends up being the ideal final one for your dog or cat but you still should see some signs of improvement when your animal first goes on insulin your animal s previous ravenous appetite and extreme thirst should begin to decrease he should urinate smaller amounts of urine and he should begin to gain back at least some of the weight he had lost A potential problem which could develop with insulin treatment for your diabetic animal is blood sugar which is too low hypoglycemia This is more likely to happen when your animal is first put on insulin when if his dose is increased or if your animal exercises a lot more than normal Hypoglycemia can cause problems some very serious ranging from mild muscle twitching to weakness wobbliness to loss of consciousness or a seizure Your veterinarian will recommend that you always keep handy a supply of either honey or karo syrup If you see any of these symptoms he ll tell you to give your animal the honey karo syrup this will give her body a rapidly absorbed source of sugar which will start to bring her BG back up to a more normal level Even if your animal is unconscious you can rub small amounts of the honey or karo syrup into her gums and it ll be absorbed that way If she can swallow you can give her multiple small doses but don t give her so much at one time that she chokes Also if your animal is seizuring wait until she stops to give her the honey karo syrup you could be badly bitten if you attempt to do so during a seizure and or she could inhale some of the honey karo syrup into her lungs Unless your animal s BG is extremely low the honey karo syrup should bring her

    Original URL path: http://www.themetaarts.com/2006october/drcarson.html (2016-02-13)
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  • Dr. Carsen, DVM
    your dog or cat s diabetes is diagnosed as Type I or Insulin Dependent Diabetes Mellitus IDDM In my May 2006 column I wrote that almost all diabetic dogs and a large percentage of diabetic cats have IDDM What is involved in this insulin treatment for your diabetic cat or dog There is no one size fits all treatment regimen when it comes to treating IDDM with insulin Each diabetic cat or dog needs a program suited to his her particular needs Those needs also will probably change with time In this and next month s columns I m going to try and outline the main points of insulin treatment for a cat or dog with uncomplicated IDDM See November s column for the treatment of complicated IDDM First of all insulin is given by injection Many if not all people with newly diagnosed diabetic cats or dogs are apprehensive with the idea of giving injections to their animal The overwhelming majority of people overcome this initial apprehension In fact after a while they don t even think twice about giving a shot Aiding this process is the fact that insulin does not sting when injected the amount given is very small and the needles are very fine thus causing minimal discomfort When you cat dog is first diagnosed with IDDM your veterinarian will want to hospitalize her for 2 3 days As I explained above every animal s insulin treatment regimen needs to be individualized so it takes a while to decide what dose and type of insulin will be best for your animal and how frequently it needs to be given I ll stop here to say that there are quite a few different types of insulin They differ according to the source of the insulin human animal beef and or pork and synthetic length of action short also called Regular insulin intermediate and long acting insulin preparations and concentration most are either 40 units ml U 40 or 100 units ml U 100 Also the syringes used to deliver the insulin are not the syringes used for drugs vaccines etc there are special insulin syringes made only for giving insulin Furthermore there are different insulin syringes used for delivering U 40 insulin U 40 syringes vs U 100 insulin U 100 syringes If the wrong syringe is used the dosage will not be correct and this can cause very serious problems When your veterinarian hospitalizes your animal to start insulin treatment she will give probably him either an intermediate acting insulin usually used for dogs or a long acting insulin usually used for cats The short acting or Regular insulin is occasionally used at the very beginning to rapidly reduce a very high blood glucose BG in an uncomplicated diabetic but it is most often used in the initial treatment of complicated diabetes see November s column There are guidelines for the start up dose of insulin for dogs and for cats However it is rare that

    Original URL path: http://www.themetaarts.com/2006september/drcarson.html (2016-02-13)
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  • Dr. Carsen, DVM
    Diabetes Mellitus Non Insulin Treatment by Kathleen M Carson D V M What is the treatment for Diabetes mellitus DM Since DM is such a complex disease the treatment plan is often complex too In this month s column I ll discuss non insulin treatments A Attention to a diabetic dog or cat s diet is crucial in the control of the disease 1 Reducing obesity is very important in diabetic animals obesity can cause insulin resistance 2 It is ideal that the blood glucose BG stays as even as possible One of the ways of doing this is by offering several small meals per day However with our busy lives this isn t always possible so other means have been developed to bring this about One of the ways of accomplishing both these ideals is through a diet high in fiber and complex carbohydrates and low in calories The higher fiber content slows the passage of the food through the digestive tract and complex carbohydrates are broken down slowly into the simpler sugars Slower passage through the GI tract and the slower conversion of complex carbohydrates to the simple sugar glucose keep the BG at a more even level in the hours after a meal This is contrasted to a diet which is higher in the simple sugars in a human diet this would include such things as a candy bar or a piece of cake which brings about a sudden rise of the BG followed by an equally precipitous drop in BG Examples of diets high in fiber and complex carbohydrates and lower in calories are Hill s r d and w d A special diet which has been developed for the feline diabetic is one which is high in protein and low in carbohydrates CHOs This mimics a cat s natural diet in the wild cats are carnivores ie meat eaters this diet is naturally high in protein On the other hand dogs are omnivores in the wild they eat more of a varied diet A cat s body is made to derive its energy sources from protein This is a slower process than deriving them from CHOs so their BG tends to be more even in the hours after a meal If a cats is fed a high level of CHOs in addition to protein then he can end up with a BG level which is chronically higher than normal hyperglycemia This puts stress on his pancreas to produce more and more insulin Eventually pancreatic exhaustion can come about and the cat can become diabetic Returning their diet to a more normal high protein low CHO diet takes away the extra stress on a cat s pancreas On this more natural diet some diabetic cats lose their need for insulin altogether or they need a much lower dose Examples of feline high protein low CHO diets are Hill s m d and Purina s DM B Exercise is another very important consideration in a diabetic dog

    Original URL path: http://www.themetaarts.com/2006august/drcarson.html (2016-02-13)
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  • Dr. Carsen, DVM
    a young cat with chronic sinusitis She had been born with a large cleft palate hole in the roof of her mouth Every time she ate she got food up into her nasal cavities and sinuses To make matters worse as a young kitten she had contracted a nasty upper respiratory viral infection further damaging these areas Eventually she underwent a series of surgeries which closed the hole in her palate This wasn t the answer to all her problems however Because of the previous chronic insult of food and infection to her nasal cavities sinuses she had developed a chronic purulent nasal discharge and severe upper respiratory congestion These signs would temporarily respond to topical and oral antibiotics and decongestants but the symptoms would recur at shorter and shorter intervals after the medications were stopped By the time she came to see me at about two years of age she had to be on almost continuous antibiotics and even then there was still some degree of congestion and discharge After a few acupuncture treatments we began to notice improvements she was breathing easier and the discharge was less In fact my clients informed me that they d learned to wear old clothes when they brought her in for treatments for on the way home it seemed that her sinuses just opened up and drained and since she couldn t blow her nose into a hanky their clothes served that purpose As the weeks went by we slowly weaned her off the medications When I last heard from these clients she d been off antibiotics altogether for months Constipation can be a very frustrating condition to treat Cats seem to be more often affected by this condition though dogs can have it too It is not just an uncomfortable condition to have in its later stages it can kill the appetite cause vomiting and lead to serious debility While some patients respond quickly to just dietary changes increased dietary fiber others also require subcutaneous fluids lubricants stool softeners and or drugs to stimulate bowel motility Even with all these medical treatments some patients still require periodic cleaning out under anesthesia If all else fails surgery to remove much of the large intestine may be necessary Now these patients can also be helped by acupuncture herbs and other alternative complementary treatments As with so many other conditions response depends on the severity chronicity of the problem If there is only mild constipation the alternative treatments alone may be sufficient to get the bowels moving again However since most animals aren t presented until their condition is pretty far along this gentler approach often needs to be combined with one or more conventional treatments In these latter cases combining acupuncture and other complementary care with a more conventional approach often allows us to use lower dosages fewer drugs and to avoid surgery At the other end of the gastro intestinal G I spectrum alternative treatments also can be very helpful in controlling

    Original URL path: http://www.themetaarts.com/2006july/drcarson.html (2016-02-13)
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  • Dr. Carsen, DVM
    insulin but the insulin is unable to do its job insulin resistance Type II DM aka Non Insulin Dependent Diabetes Mellitus or NIDDM Insulin s most crucial role in your animal s body is to promote the transfer of glucose from the blood into the body s cells where it is used for energy If there is not enough insulin or if there is insulin resistance then the glucose is unable to pass into your animal s cells The glucose just builds up in your animal s bloodstream The old saying starving in the midst of plenty is literally true in a diabetic animal Since the glucose isn t getting into your animal s cells his body starts breaking down his own tissues for more fuel just as if he were eating nothing at all Thus one of the premiere signs of DM is A ravenous appetite accompanied by progressive weight loss A second hallmark symptom of DM comes about because of the extremely high blood glucose BG which can t get into his body s cells from his bloodstream When the blood gets filtered through his kidneys his kidneys dump the excess glucose into the urine The excess glucose pulls water with it greatly increasing the volume of urine passed This is called osmotic diuresis With the loss of so much water through his kidneys your animal s body signals his brain to make him thirsty Thus the second foremost sign of DM is Excessive urination and excessive thirst The third common sign of DM comes about because your animal s body is starved for energy Weakness and lethargy A sign commonly found in diabetic dogs but rarely in diabetic cats is Cataracts especially ones which develop rapidly The cataracts come about this way the excess glucose is metabolized to two other sugars fructose and sorbitol Unlike glucose these sugars are not freely diffusible across the lens The buildup of these sugars in the lens causes the lens to pull in extra water This process results in swelling and rupture of the lens fibers with resultant cataract formation Diabetic animals are also more prone to infections since the diabetes interferes with their bodies normal defense mechanisms Thus diabetic animals commonly have Infections of the urinary tract skin and respiratory tract There are other signs associated with DM these generally aren t as common as the ones mentioned above and almost always occur in diabetic cats Weakness in the hind legs What s known as a plantigrade stance ie the cat walks on his hocks the backward facing joint above his hind foot This condition is called diabetic neuropathy caused by damage to nerves from lack of glucose in his nerve cells There are other symptoms which are associated with a potentially life threatening complication of DM called diabetic ketoacidosis or DKA DKA is a complex condition and I will write about it in another column Take your dog or cat right to your veterinarian if you see the above

    Original URL path: http://www.themetaarts.com/2006june/drcarson.html (2016-02-13)
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  • Dr. Carsen, DVM
    pancreatitis see columns for February March and April 2006 If you remember from my February 2006 column the pancreas has two major parts 1 the exocrine part which produces digestive enzymes and 2 the endocrine part which produces the hormone insulin Insulin is made in groups of special pancreatic cells called beta cells The beta cells are clustered together in scattered areas throughout the pancreas the clusters of beta cells are called the Islets of Langerhans When your animal eats a meal the food is swallowed goes down his esophagus and enters his stomach After it s been worked on in his stomach it enters his small intestines The entry of the food into his intestines stimulates his pancreas to release insulin into his bloodstream As the food is broken down in your animal s small intestine the broken down ingredients of the food enter her circulating bloodstream from her intestines One of these ingredients is glucose a simple sugar Glucose is used by her body s millions of cells for energy What insulin does is promote the transfer of glucose from the blood into her cells If there is no insulin the glucose is unable to enter her cells Your animal s digested food also contains amino acids the broken down components of protein and fatty acids the broken down products of fat After these are absorbed from her intestines into her bloodstream insulin also allows the cells of your animal s body to take in these amino acids and fatty acids Lastly insulin helps your animal s body to store the glucose amino acids and fatty acids which her body doesn t need immediately The insulin stimulates liver and muscle cells to convert the excess glucose into a substance called glycogen which is then stored in those liver and muscle cells It stimulates your animal s fat cells to make and store fat from any excess fatty acids and stimulates liver and muscle cells to make and store protein from excess amino acids Diabetes mellitus has two common types in Type I DM the pancreas doesn t produce enough insulin Patients with Type I DM need insulin injections it is also called Insulin Dependent Diabetes Mellitus or IDDM In Type II DM the insulin is present but is prevented from doing its job the latter is called insulin resistance Insulin resistance comes about when your animal s body s cells don t have enough insulin receptors or the insulin receptors don t work properly Without functioning insulin receptors even if insulin is present in the blood it can t help glucose to get into the cells Patients with Type II DM usually don t need insulin injections dietary changes and oral hypoglycemic drugs like glipizide which stimulates the pancreas to produce more insulin are usually sufficient to keep the disease under control Occasionally these patients need low doses of insulin Type II DM is also referred to as Non Insulin Dependent Diabetes Mellitus of NIDDM Some Type II

    Original URL path: http://www.themetaarts.com/2006may/drcarson.html (2016-02-13)
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  • Dr. Carsen, DVM
    pancreas I described chronic pancreatitis as a condition in which there has been a lowgrade subclinical without symptoms pancreatitis over an extended period of time Slowly normal pancreatic tissue is destroyed and is replaced with scar tissue When enough of the pancreas is destroyed the remaining pancreatic tissue can t produce enough of the pancreas digestive enzymes to digest the food the animal eats This is called Exocrine Pancreatic Insufficiency or EPI and it results in chronic diarrhea The treatment of chronic pancreatitis EPI consists of adding digestive enzymes to the patient s food usually for the rest of the animal s life In most cases this treatment alone is sufficient However if the EPI is complicated by bacterial overgrowth in the intestines inflammatory bowel disease IBD and or cobalamin vitamin B12 insufficiency then additional treatments are called for antibiotics for bacterial overgrowth an anti inflammatory drug for IBD and cobalamin supplementation for B12 insufficiency Usually these latter 3 treatments are needed for a short time only The treatment for acute pancreatitis is more complex for one often is dealing with a very sick patient Generally speaking the treatments consist of supportive care and pain control The extent of the former depends on the extent and severity of the disease Hospitalization with high volumes of IV intravenous fluids is necessary in most cases because of the dehydration from vomiting especially and in many cases shock Electrolytes are given with the fluids to counteract the electrolyte deficiencies imbalances which result from vomiting diarrhea and not eating Dextrose is added for caloric needs B vitamins are also often added to the IV fluids If shock is severe plasma transfusions may be necessary Anti pain and anti vomiting drugs are also essential Antibiotics are given when secondary infection is present If the pancreatitis is complicated by diseases of other organs tissues like the kidneys liver intestines heart lungs and or blood cells then these conditions must be addressed as well Dogs with pancreatitis are kept NPO nihil per os or nothing by mouth for several days This is in part to prevent more vomiting but more importantly it is because food even the sight smell of it causes the pancreas to start secreting more enzymes which is the very last thing wanted or needed in a patient with pancreatitis Even drugs need to be given parenterally other than by mouth because the presence of the pill capsule in the mouth may also stimulate enzyme secretion as well as possibly triggering more vomiting After 2 3 days of no vomiting small amounts of water can be given If this is kept down then small amounts of a bland diet high in carbohydrates and very low in protein and fat is given every few hours If vomiting still does not return then the volume of the food can gradually be increased and the frequency decreased If it does return then the dog must again be kept NPO until the vomiting has stopped for 2 3

    Original URL path: http://www.themetaarts.com/2006april/drcarson.html (2016-02-13)
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