Fundamentals of Small Animal Nutrition

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Fundamentals of Small Animal Nutrition

• Diabetes Mellitus
• Dr. Randy Ackman

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Diabetes Mellitus

• Relative or absolute deficiency of insulin
• Insulin secreted by beta cells
• Islets of Langerhans
• Stimulates transport of glucose into cells
• Anabolic processes

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Diabetes Mellitus

• Deficiency of insulin
• PU/PD
• Polyphagia
• Weight loss
• Depression
• Hyperglycemia
• Glucosuria

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Diabetes Mellitus

• Incidence
• Factors that predispose
• Obesity
• Hypothyroidism
• Cushings syndrome
• Recurrent bouts of pancreatitis
• Genetic predisposition
• Age
• Long term progestin or progesterone

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Diabetes Mellitus

• Classification of Diabetes mellitus
• Type I diabetes
• Insulin dependent diabetes
• Absolute lack of endogenous insulin
• Dependent on exogenous insulin
• Relatively common in dogs
• 70-80 of cases
• Autoimmune destruction of pancreatic beta cells

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Diabetes Mellitus

• Classification of Diabetes mellitus
• Type II
• Non-insulin dependent diabetes mellitus
• Impaired insulin secretion
• Insulin resistance
• Amyloid deposition in islets in pancreas
• Increased insulin secretion required to maintain
  normal blood glucose
• 20-30 of cases
• Cats may revert to a state that does need insulin

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Diabetes Mellitus

• Clinical signs
• PU/PD
• Polyphagia
• Weight loss
• Polyneuropathy
• Weakness
• Depression
• Bacterial infections
• Especially cystitis

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Diabetes Mellitus

• Therapeutic Goal
• Minimize postprandial hyperglycemia
• Prevent hypoglycemia when insulin is used
• Delay long term complications
• Minimize clinical signs
• Utilize
• Insulin
• Oral hypoglycemics
• Diet

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Diabetes Mellitus

• Dietary Treatment
• Improve regulation of blood glucose by delivering
  nutrients to the body during periods when
  exogenous insulin is active and minimize
  postprandial fluctuations of in blood glucose
• Does not eliminate need for insulin
• May offer reduction

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Diabetes Mellitus

• Developing a diet
• Consistency and type of food
• Nutrient adequacy
• Nutrient composition
• Pets caloric intake
• Feeding schedule

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Diabetes mellitus

• Consistency and Type of food
• Consistent diet
• Maintain consistent proportions of calories from
• Protein
• CHOs
• Fats
• Allows adequate adjustment of insulin dose
• Also oral hypoglycemics
• Use fixed formulation
• Avoid homemade as well

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Diabetes Mellitus

• Consistency and type of food
• Semi moist
• Highest postprandial blood glucose
• Due to high CHO concentration
• Requiring minimal digestion
• Dry and Canned food
• CHOs
• In form of complex carbohydrates (starch)
• Slows delivery of glucose to blood
• Fiber and complex CHO affect rate of passage
  through and absorption

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Diabetes Mellitus

• Nutritional Adequacy
• Energy containing Nutrients
• Protein
• High quality protein to meet daily requirements
• What renal disease occurs
• Fats
• Moderately restricted if overweight
• High levels of fats
• Delay gastric emptying
• Dietary fat increases insulin resistance and
  increase blood lipid abnormalities
• Diet should be low fat (adequate EFA)
• lt 20 of ME from fat

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Diabetes Mellitus

• Nutritional adequacy
• CHO
• Very important
• Greatest effect on postprandial glucose levels
• Glycemic index
• Categorizes food based on effect of blood glucose
• Starch (complex CHO)
• Lower glycemic index
• Barley
• Rice high glycemic index

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Diabetes mellitus

• Nutritional adequacy
• Diet
• Low in simple CHO
• High in complex CHO
• Moderately increased fiber
• 40 ME calories from CHO

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Diabetes Mellitus

• Nutritional Adequacy
• Fiber
• Soluble fiber
• Pectin, gums, FOS
• High water holding ability
• Delay gastric emptying
• Slow rate of nutrient absorption
• Insoluble fiber
• Cellulose, lignin
• Less initial water holding ability
• Decrease transit time
• Less fermented by GI bacteria

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Diabetes Mellitus

• Fiber
• High proportion of complex carbohydrates and
  soluble fiber dampens postprandial hyperglycemic
  effect
• Aids in glycemic control
• Flattens glucose response curve
• Postprandial hyperglycemic
• Reduced when fed soluble and insoluble fiber
• Soluble has most prominent effect

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Diabetes Mellitus

• Fiber
• Increased insoluble fiber
• Decreased energy concentration
• Led to decrease glucose absorption
• GOAL
• Create blend of soluble and insoluble fiber
• Slow gastric emptying
• Modulate glucose absorption
• Diminish postprandial glycemic curve

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Diabetes Mellitus

• Caloric Intake
• Baseline plasma insulin level and insulin
  response to a glucose load increase linearly in
  dogs as a function of obesity
• Decreased tissue sensitivity to insulin impaired
  beta cell responsiveness
• Tissue of obese animals
• Decreased numbers of insulin receptors
• Decreased receptor affinity to insulin
  

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Diabetes Mellitus

• Reduce obesity
• Low energy density diets must be balanced

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Diabetes Mellitus

• Timing of meals
• Nutrients delivered to body during peak periods
  of exogenous insulin activity
• Several small meals provided throughout day
• Minimizes postprandial fluctuations in blood
  glucose
• Feed first meal in morning
• Then give insulin
• Allows for adjustment of insulin
• Space meals over duration of insulin