Welcome to April's Case of the Month! Sorry it's a little late, but it is tax season! Anyhow, here's a purely medical case.

A LITTLE TOO SWEET

HISTORY

Monster was a middle-aged Labrador Retriever who had been a patient of ours for several years for routine care. One day he came to us because he'd been urinating more frequently than usual for about 2 weeks, and had begun to have some accidents in the house. His owners weren't aware of any other problems.

PHYSICAL FINDINGS

Monster's examination was pretty unremarkable. His weight was about what it had always been, and he showed no outward signs of any problems. A few things we think of immediately when we have problems involving excess urination include urinary tract infections, kidney failure, and diabetes. The first thing we did was examine a urine sample from Monster.

URINALYSIS RESULTS

We evaluate several things when we look at a urine sample. We evaluate pH, several chemical components of the urine, and view a microscopic sample to learn about cells, crystals, and bacteria that might be present:

What Monster's urinalysis pointed to was diabetes. Normally there should be no glucose (sugar) in the urine. The only way any glucose would be present was if the blood level was abnormally high.

A troubling feature of Monster's urinalysis was the presence of ketones, which are an abnormal breakdown product of metabolism associated with a buildup of acid (acidosis) in the system. Large amounts of ketones can lead to severe problems including coma and death.

We analyzed a blood sample to determine Monster's glucose level and to evaluate him for involvement of any of his other internal organs. All of his blood values were normal except the following:

Test				Results		Normal Range		Indicator
								LOW   NORMAL   HIGH
ALKP		=		763 U/L		23-212
ALT		=		153 U/L		10-100
GLU		=		408.1 mg/dl		77.0-125.0

For a review of what all these blood values mean, you can look back at March 2000 for details. ALKP and ALT are liver-related enzymes; diabetes often affects the liver by changing the type of metabolism taking place there, and sometimes can trigger hepatitis. Monster's glucose was very high. Levels of more than 300 in dogs are often associated with ketone formation.

TREATMENT

Fortunately, diabetes can be treated. We started Monster on insulin, the same as you'd expect in a person. His family learned to give hime injections once a day, which was quite an achievement because he hated needles! We had him return regularly to evaluate his glucose level and make adjustments.

DISCUSSION

Diabetes is caused by a lack of insulin in the body. Insulin is produced by the pancreas, and is released regularly to keep blood sugar levels within a normal range. In diabetes of this type (there's another type of diabetes involving the way the kidneys concentrate urine), the body doesn't produce enough insulin, so sugar levels are always high. Often diabetes appears spontaneously, but can also appear as a result of pancreatitis or a pancreatic tumor.

Diabetes is a disease we see in both dogs and cats. Some of the symptoms include:

• Increased thirst and urination
• Increased appetite
• Weight loss
• Increased susceptibility to infection
• Cataracts

The main means of controlling diabetes is insulin. Other helpful components of a diabetes control program are a high-fibre diet, regular timing of meals, and infrequently, oral glucose controlling agents. Diabetes is sometimes unpredictable, but often can be controlled for a long time (up to 7-10 years).

Monster has done relatively well with his treatment. Unfortunately, he did develop cataracts, and has had a couple of instances where his glucose got out of line and his insulin needed to be adjusted, but otherwise he's done well and has been happy in spite of his disease.

We'll have another case next month.

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