Recognizing the Final Stages of Canine Diabetes

One of the hardest parts of pet ownership is facing up to the fact that they don’t live forever. The death of a pet is a hugely emotive subject, especially as in many cases, it will be the owner’s decision to end that pet’s life. However, euthanasia means ‘good death’, and this is something we are hugely fortunate to be able to provide to them. The ability to prevent unnecessary suffering is a massive privilege but it is, and always will be, a hard decision to make. For pets living with a chronic condition such as diabetes, the end is very rarely clear-cut, meaning this decision can be even more difficult for their owners.

Table of Contents

1. What is diabetes in dogs?
2. Symptoms of diabetes in dogs
3. Diagnosis
4. Canine diabetes treatment
5. Lifespan of dogs with diabetes
6. Emergency conditions & complications
7. Signs of advancing diabetes in dogs – recognizing the final stages of canine diabetes
8. When should euthanasia be considered for a dog with diabetes?

What is diabetes in dogs?

Many people are familiar with diabetes in humans, but it is also a relatively common condition in pets, affecting around 1 in 300 dogs¹. Canine diabetes closely resembles Type 1 diabetes in people, meaning it is caused by a deficiency in or loss of certain cells in the pancreas which produce the hormone insulin. Insulin is needed to trigger the absorption of glucose from the blood into the cells of the body to be used for energy. A lack of insulin means that the glucose will remain within the bloodstream causing a condition known as hyperglycaemia. Subsequently, the cells of the body will be effectively ‘starved’, despite very high blood sugar levels.

Symptoms of diabetes in Dogs

The classic symptoms of diabetes in dogs are:

• increased appetite
• weight loss
• increased urination
• increased thirst

The increased appetite and weight loss are due to the ‘starvation’ of the body’s cells because they cannot access the sugars in the blood. When the glucose level reaches a certain threshold in the blood, it will also end up being excreted in the urine, drawing with it large volumes of water – hence the increased urination and thirst.

Alongside these, are other, maybe less noticeable or less common, symptoms including:

• lethargy
• recurrent infections such as urinary tract infections
• cloudy eyes
• poor coat quality
• vomiting

Diagnosis

Thankfully, diagnosis of canine diabetes is relatively straightforward. Initially, your vet will examine your dog and ask you questions about their appetite and thirst. They will then follow up with blood and urine samples. High blood glucose levels alongside glucose in the urine, is almost certainly going to mean diabetes. For clarification, a blood sample is also checked for fructosamine levels. Fructosamine is a test that gives us an indication of long-term hyperglycaemia and therefore will confirm a diagnosis of diabetes.

Canine Diabetes Treatment

The mainstay of treating diabetes in dogs is with daily injections of insulin. This is designed to replicate the body’s own insulin and allow the transfer of glucose into cells, enabling a return to normal bodily functions. Although daunting at first, many owners quickly become used to injecting their dog and it simply becomes part of their routine.

Dietary control can also help to moderate treatment. Insulin injections tend to be given around mealtimes, so it is vital that a diabetic dog is fed a diet that they will eat reliably, and that they are given set mealtimes rather than being allowed to graze. This will also help to prevent spikes and dips in blood sugars. Diets should also be carefully formulated: similar to human dietary requirements, carbohydrates should be closely monitored. There is evidence to suggest that higher fibre diets can help to regulate blood sugars too. The easiest way to achieve all this, is to use a veterinary prescription diet designed for diabetic dogs. These come in both wet and dry forms.

In the initial stages of diabetes management, it can take a little while to find the most appropriate insulin dose. This may require repeated blood samples and sometimes short periods of hospitalisation in order to track the dog’s blood sugars over a number of hours (a “Glucose Curve”). Once stabilised, longer term monitoring can be achieved with regular urine samples and fructosamine blood samples or even at-home monitoring with new interactive and digital devices.

Lifespan of Dogs with Diabetes

The recorded survival time for dogs with diabetes varies greatly between studies, likely due to a huge number of variables that play a part – age, concurrent conditions, breed, owner lifestyle, owner finances, and ease of treatment. One UK study put the average survival time at 15.6 months². But with some reports claiming that as many as 1 in 10 dogs are euthanised at diagnosis³, when these are taken out of the equation and long-term survival of dogs from 7 days post-diagnosis is looked at, the median survival time was put at 20.2 months. Considering the average age at diagnosis is around 10 years old, and this median survival time equates to nearly 2 years, the prognosis can be looked on favourably.

As with any condition though, both owner and animal factors need to be considered and reassessed to ensure that animal maintains a good quality of life.

Pet factors associated with a shorter longevity include increased age, certain breeds especially Cocker Spaniels, not being neutered, severely high blood glucose readings at diagnosis, potentially concurrent conditions including pancreatitis and hyperadrenocorticism (Cushing’s disease) and previous management with steroid treatment.

Having a diabetic dog is a commitment and for many owners, it may not be feasible. In order to maintain a good quality of life, treatment with insulin is vital and if this is not possible, either because the owner, for whatever reason, is unable to inject their pet once or twice daily or for financial reasons (insulin, needles and syringes or insulin pens, sharps bins, blood monitoring, urine monitoring etc), then it may be in the pet’s best interests to euthanise.

Quality of life is typically a very individual and subjective parameter which can mean different things to different people and their pets. A useful guide, however, is the JOURNEYS scale…

J – Jumping or mobility – how mobile they are with or without medication

O – Ouch or pain – how much pain they are in, if any, with or without medication

U – Uncertainty and understanding – expected outcomes and prognosis of any current medical condition

R – Respiration or breathing – how much their breathing is affected

N – Neatness or hygiene – issues with toileting or grooming

E – Eating and drinking – whether they are eating and drinking normally

Y – You – how affected you are by your pet’s condition, how worried you may be.

S – Social ability – how much time they spend with their human family

Even easier, you can use our online Quality of Life Assessment, here.

Emergency Conditions & Complications

Unfortunately, diabetes cases don’t always run smoothly and there are a number of complications that can occur. Two of the most serious are when the blood sugar remains too high, and when it drops too low.

Diabetic ketoacidosis

Diabetic ketoacidosis is a condition that can arise if the blood sugar remains high for a prolonged period of time. Because the cells cannot utilise the sugars for energy, the body starts to break down fat instead which produces acids known as ketones. These also collect in the blood, upsetting the acid balance, fluid balance and electrolytes in the body and can cause symptoms including lethargy, vomiting and decreased appetite or even abnormal muscle function or heart function. Some people can also detect a sweet smell to the animal’s breath. If not treated, diabetic ketoacidosis can be fatal. Any unwell diabetic dog will be checked for diabetic ketoacidosis which can be picked up on blood and urine tests.

Hypoglycaemia

Unlike a high blood sugar level, a low blood sugar level (hypoglycaemia) only needs to occur for a matter of minutes to cause symptoms. Signs of a low blood sugar level should be familiar to every owner of a diabetic dog and it’s vital to know how to respond immediately. The main symptoms seen are:

• weakness
• collapse
• tremors
• seizures

If any of these are witnessed, it is vital to give the dog a source of sugar, most commonly by either giving them a meal or spreading honey or jam on their gums, as long as they are conscious. Further treatment is likely to be required so always seek veterinary assistance.

Signs of Advancing Diabetes in Dogs – Recognising the Final Stages of Canine Diabetes

Eventually, the treatment for diabetes may not be enough to contend with the disease process itself. The signs of advancing diabetes will be very similar to those initial diagnostic signs – excessive thirst and urination, lethargy, dehydration, weight loss and muscle wastage. In the final stages of canine diabetes, these symptoms will not be able to be alleviated by medical interventions and the dog’s quality of life will begin to suffer.

When should euthanasia be considered for a dog with diabetes?

When it comes to the timing of euthanasia for a diabetic dog, the approach is not dissimilar to that for any other condition. They will likely have good days and bad days and that balance will need to be assessed for the time that it tips into more of the latter.

It can also be very helpful to refer to the quality of life scale, as detailed above, and don’t be afraid to discuss your pet’s condition with your vet. Euthanasia of a dog with a chronic condition is often a two-sided discussion between the owner and the veterinarian in order to gain a complete, overall picture of the pet’s current living situation, expected prognosis, and possible options. The owner is the person who knows the dog best and can judge how happy they are and whether they are still enjoying life. The vet can draw on previous experience of similar cases to guide the owner but will also support them in their decision making. It can also help greatly to be prepared for that final decision and know what your options are. When the time comes, it will be a highly emotive situation and if practical decisions have already been made, it means the owner can concentrate on saying a proper goodbye to their pet. Our team will be happy to talk you through the decision making, the euthanasia options, euthanasia process and what will happen afterwards, in advance of the actual day itself.

FAQs

How long can a dog with diabetes live with appropriate treatment?

The expected lifespan of a dog being treated for diabetes is approximately 15 to 20 months, though there will be many variables involved.

What are the signs of diabetic ketoacidosis in dogs?

The main symptoms of diabetic ketoacidosis in dogs are:

• • increased thirst and urination
  • weakness and lethargy
  • vomiting and diarrhoea
  • reduced appetite
  • sweet smelling breath

When should euthanasia be considered for a dog with diabetes?

Euthanasia should always be considered when there a substandard quality of life and there is a risk that the dog is suffering. There are many factors to potentially consider so it is always recommended to speak to a vet wherever possible.

References:

1. Canine diabetes mellitus; can old dogs teach us new tricks? Catchpole B, Ristic JM, Fleeman LM,Davison LJ. Diabetologia 48:1948-1956, 2005.

2. Heeley, A.M., O’Neill, D.G., Davison, L.J. et al. Diabetes mellitus in dogs attending UK primary-care practices: frequency, risk factors and survival. Canine Genet Epidemiol 7, 6 (2020)

3. Niessen SJM, Hazuchova K, Powney SL, Guitian J, Niessen APM, Pion PD, et al. The Big Pet Diabetes Survey: Perceived Frequency and Triggers for Euthanasia. Vet Sci. 2017;4(2)