… 35 Treatment of Diabetes Mellitus in Dogs and Cats ENDOCRINOLOGY Thomas Schermerhorn, VMD, Diplomate ACVIM, Kansas State University Acute complications are those directly related to insulin administration and can occur in new and established diabetics. Chronic complications occur when diabetes therapy is in the maintenance phase and …

Types of Complications The complications associated with diabetes mellitus fall into two general categories: those that arise from untreated diabetes and those that develop during treatment for diabetes ( Table 1 ). The emergency management of complicated diabetes has been reviewed in detail1and is not addressed here. This article focuses on the causes and treatments of complications that develop in dogs and cats during treatment of diabetes mellitus. Complications associated with diabetes treatment may be classified as acute or chronic. can cause significant morbidity and may be fatal in some patients.2In some poorly regulated dia- betic patients, chronic subclinical hypoglycemia or episodic bouts of clinical hypoglycemia may occur. The latter situations largely reflect problems with diabetic management that require reevaluation of the insulin therapy protocol. Hypophosphatemia: In diabetic dogs and cats, hypophosphatemia usually develops after insulin treatment has begun and is caused by rapid insulin-mediated cellular uptake of phosphorus. Severe hypophosphatemia (phosphorous levels < 1.0 mg/dl) causes hemolysis, which can be life-threatening. Decreased serum phosphorus impairs adenosine triphosphate generation and reduces 2,3-diphosphoglycerate concentrations in red cells, which leads to red cell fragility and reduced oxygen delivery. Massive hemolysis can develop when serum phosphate falls below the critical level needed to maintain red cell integrity. Hypophosphatemia may also cause varying degrees of rhabdomyoly- sis, ileus, and encephalopathy. 3 Hypokalemia and hypomagnesemia: These may be noted at diagnosis or develop during the treatment of ketoacidosis and other complicated forms of diabetes. Total-body potassium and magnesium may be depleted in diabetics because of reduced dietary intake and increased renal and gastrointestinal losses. During diabetes treatment, fluid diuresis promotes renal loss of potassium and magnesium, and insulin treatment can precipitate or exacerbate hypokalemia and hypomagnesemia by promoting cellular water and solute uptake.4,5 complications continues Table 1. Complications of Treatment of Diabetes Mellitus Acute Hypoglycemia Hypophosphatemia Hypokalemia Hypovolemia Chronic Persistent hyperglycemia Cataracts Neuropathy Weight gain Episodic hypoglycemia Susceptibility to infection

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