In this VETgirl online veterinary continuing education blog, sponsored by Blue Buffalo. Please note the opinions in this blog are the expressed opinion of the author, and not directly endorsed by VETgirl.

September 2021

Diabetes Mellitus and Diet for Dogs and Cats: Current Recommendations and Future Considerations
By Dr. Kevin Mallery, DACVIM

Introduction
Hippocrates is quoted as saying “Let food be thy medicine, and let medicine be thy food” in 390 BC. Diet is an important part in the treatment of many diseases today, and Diabetes mellitus in cats and dogs is no exception. Diabetes mellitus is a common disorder affecting both dogs and cats. Dogs typically are diagnosed with type 1 Diabetes, an autoimmune destruction of B-cells in the pancreas. They can no longer make insulin, and this is also called “insulin-dependent Diabetes mellitus (IDDM). Cats typically are diagnosed with type 2 Diabetes, which can be associated with obesity. Type 2 Diabetes is common in people, and is characterized by high blood sugar, insulin resistance, and a relative lack of insulin. This is also commonly referred to as “non-insulin-dependent Diabetes mellitus (NIDDM). Insulin injections are the main therapy for our diabetic dogs and cats. Diet also plays an important role in the management of both types of diabetes, as we will discuss.

Current Recommendations for Dogs
Feeding a high fiber diet is very important for diabetic regulation in dogs. It has been associated with significantly lower mean 24-hour and postprandial plasma glucose concentrations in a study of diabetic dogs. Feeding of the high fiber diet was also associated with significant reductions in plasma concentrations of fructosamine, glycated hemoglobin, and there were significant improvements in activity level in the study group. The results indicate that a high fiber diet can significantly improve glycemic control and quality of life in dogs with Diabetes mellitus. The type of fiber is important, and there are various types of fiber which can have different properties and benefits. The different types of fiber can be categorized as soluble (able to dissolve in water) and insoluble (bulking fibers). Insoluble fibers, such as cellulose, add bulk and can slow digestion and absorption of dietary carbohydrates, which can be a benefit to sugar regulation for diabetic dogs. Although reduction of dietary carbohydrates in dogs with diabetes may seem like a good idea for better blood sugar control, clinical studies have shown that carbohydrate content in diets is not as important as fiber content for dogs. Weight loss is important for diabetic dogs who are overweight, and a weight loss plan should be developed by the dog’s veterinarian. Meal feeding is important for diabetic regulation for most dogs, and they should be fed twice daily, at the time of the insulin injection. It is highly recommended that a diabetic dog is fed one of the commercially available veterinary therapeutic diets (such as Blue Buffalo Natural Veterinary Diet, Hill’s Prescription Diet, Purina ProPlan Veterinary Diets or Royal Canin veterinary diets) that have shown benefits for maintaining stable glucose values in a diabetic dog. The diet that should be chosen for a specific patient should always be based on a discussion between the veterinarian and the pet owner.

If food must be withheld for any reason, such as an anesthetic procedure, it is generally recommended to give 50 percent of the usual dose of insulin, with careful follow-up monitoring of blood glucose values.

Current Recommendations for Cats
Nutrition plays a key role in the management of feline Diabetes mellitus. Lower carbohydrate diets may be beneficial for some cats with diabetes, but the optimal amount and type of carbohydrate for diabetic cats remains unknown. Many clinical trials have underscored the importance of lower carbohydrate diets. Feeding higher protein diets to cats with diabetes can also be helpful, as it can help maintain muscle mass. For some cats, fiber may be helpful in controlling blood sugar. Fiber may also have some benefits for overweight cats by helping them feel fuller with fewer calories. With aggressive treatment using insulin and diet, it is possible for some cats to go into diabetic remission and no longer require insulin therapy. However, many cats still require lifelong insulin treatment.

Obesity plays a big role in cats with diabetes, especially because most cats have type 2 (non-insulin-dependent diabetes, NIDDM). Obesity contributes to peripheral insulin resistance, which exacerbates type 2 Diabetes. It is very important to measure food intake and monitor a diabetic cat’s weight carefully. Gradual weight loss is ideal for an overweight diabetic cat. As the patient loses weight, their insulin requirements may decrease, so careful blood glucose monitoring is also necessary. Many of the diabetic veterinary diets for cats are high in calories, which can make it difficult for patients to lose weight or maintain an ideal weight.

Veterinarians typically recommend feeding diabetic cats a measured amount of food twice daily at the time of insulin administration. While most cats can be converted to twice daily feedings, some prefer grazing on food throughout the day. This may work for some diabetic cats (particularly those that are underweight) depending on the type of insulin they receive. Despite the meal feeding recommendation, there is no definitive evidence that the timing and meal frequency in diabetic cats protects them against hypoglycemia or contributes to better diabetic regulation. Free choice feeding is acceptable for cats who prefer to eat throughout the day, especially if a longer-acting insulin preparation (ex. glargine) is used. It is important to keep all food and treats as consistent as possible. Both dry and canned diets can be fed to diabetic cats. Canned diets may be preferred, in part because they are typically lower in carbohydrates. The diet that should be chosen for a specific patient should always be based on a discussion between the veterinarian and the pet owner.

Diabetes VETgirl Blue Buffalo Blog Photo

If food must be withheld for any reason, such as an anesthetic procedure, it is generally recommended to give 50 percent of the usual dose of insulin, with careful follow-up monitoring of blood glucose values.

Important Future Considerations: Diabetes mellitus and Intestinal Dysbiosis
Intestinal dysbiosis is defined as an alteration in the composition and/or richness of the intestinal microbiota. Such alterations in the gut microbiome are associated with multiple GI diseases, as well as disease states distinct of the GI tract. An association between intestinal dysbiosis has been documented with Diabetes mellitus type 1 and type 2 in humans and in rodents. Significant changes in the composition of the gut microbiome and changes in the properties of the gut barrier have been found in human patients with diabetes. However, whether the dysbiosis is a cause or an effect of the disease remains unclear. Recently, increasing evidence has supported a causal link between intestinal dysbiosis and development of Type 1 Diabetes. There are active clinical trials evaluating the role of intestinal dysbiosis in dogs and cats. Therapies aimed at improving intestinal dysbiosis and maintaining a healthy gut barrier will likely one day be considered as prevention or treatment strategies for Diabetes mellitus. Diet plays a major role in treating intestinal dysbiosis, through the use of prebiotic fibers, such as resistant starches. Discoveries in the field of intestinal dysbiosis are likely to change the recommendations for the optimal diet, as we learn more about the intestinal microbiome and the dietary components necessary to keep the intestinal microbiota in a healthy balance.

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References
1. Graham PA, Maskell IE, Rawlings JM, et al. Influence of a high fibre diet on glycaemic control and quality of life in dogs with diabetes mellitus. J Sm An Prac 2002:43,67–73.
2. Frank G, Anderson W, Pazak H, et al. Use of a high-protein diet in the management of feline diabetes mellitus. Vet Ther 2001;2(3):238-46.
3. Mazzaferro EM, Greco DS, Turner AS, Fettman MJ. Treatment of feline diabetes mellitus using an alpha-glucosidase inhibitor and a low-carbohydrate diet. J Feline Med Surg 2003;5(3):183-9.
4. Zoran DL, Rand JS. The role of diet in the prevention and management of feline diabetes. Vet Clin North Am Small Anim Pract 2013;43(2):233-43.
5. Bennett N, Greco DS, Peterson ME, et a; Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus. J Feline Med Surg 2006;8(2):73-84.
6. Yoon HS, Cho CH, Yun MS, et al. Akkermansia muciniphila secretes a glucagon-like peptide-1-inducing protein that improves glucose homeostasis and ameliorates metabolic disease in mice. Nat Microbiol 2021;6(5):563-573.
7. Abdellatif AM, Sarvetnick NE. Current understanding of the role of gut dysbiosis in type 1 diabetes. J Diabetes 2019;11(8):632-644.
8. Zhou H, Sun L, Zhang S, et al. Evaluating the Causal Role of Gut Microbiota in Type 1 Diabetes and Its Possible Pathogenic Mechanisms. Front Endocrinol (Lausanne) 2020;11:125.
9. Vallianou NG, Stratigou T, Tsagarakis S. Microbiome and diabetes: Where are we now? Diabetes Res Clin Pract 2018;146:111-118.
10. Sharma S, Tripathi P. Gut microbiome and type 2 diabetes: where we are and where to go? J Nutr Biochem 2019;63:101-108.
11. Suchodolski JS. Diagnosis and interpretation of intestinal dysbiosis in dogs and cats. Vet J 2016;215:30-7.

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