Canis ISSN: 2398-2942

Diabetes mellitus: dietary management

Contributor(s): Carmel Mooney

Dietary considerations

  • Insulin therapy provides the mainstay of treatment for most diabetic dogs Diabetes mellitus but management of other factors including diet and exercise can influence overall glycemic control.

Dietary management

  • Almost all diabetic dogs require insulin therapy to control hyperglycemia of diabetes mellitus Diabetes mellitus: pathophysiology : dietary management alone is not appropriate.
  • Dietary management should aim to:
    • Achieve and maintain optimal body condition.
    • Provide a complete balanced ration that is palatable, readily accepted and predictably consumed on a daily basis.
    • Maintain consistency in type of food including calorific content, formulation and volume.
    • Timed to provide adequate substrate for insulin activity.
    • Avoid sharp postprandial increases in blood glucose concentration.
  • There is no clear evidence that any one particular diet is essential to achieve good glycemia control.
  • There are a number of diets that have been specially formulated for the management of diabetic patients with some evidence that they may improve glycemic control but without a discernable effect on insulin dose administered.
  • The nutritional requirements of any concurrent illness for which there is a known dietary therapy should take precedence in diabetic cases.
  • Dry or canned foods are appropriate but semi-moist diets should be avoided as they contain large amounts of simple sugars that can result in large increases in postprandial glucose concentrations.
  • Adequate day-to-day consistency in caloric content, formulation and volume can be more difficult to achieve with home-made rations.
  • Both obesity Obesity and poor body condition are associated with poor diabetic stability and need appropriate management in individual dogs.

Carbohydrate content

  • The glycemic index ranks a food based on its potential to increase blood glucose concentrations. Foods with a high glycemic index result in more rapid and higher postprandial blood glucose concentration, whilst those with a low glycemic index result in a lower and more prolonged postprandial blood glucose concentration.
  • The glycemic index is based on the type of carbohydrate present, the matrix in which it is found, the processing undergone and the total amount ingested.
  • Simple sugars of low glycemic index should be avoided.
  • Complex carbohydrates of high glycemic index are potentially beneficial. These are unlikely to be found in digestible diets designed for gastrointestinal disease.

Fiber content

  • Fiber reduces postprandial hyperglycemia by delaying gastric emptying, slowing starch hydrolysis, interfering with glucose absorption and altering gastrointestinal transit time.
  • Improved glycemic control has been demonstrated in diabetic dogs fed a diet high in insolule fiber or a mixture of soluble and insoluble fiber compared to when fed a low fiber diet.
  • There is less difference in glycemic control achieved using high fiber moderate carbohydrate compared to moderate fiber low carbohydrate diets.
  • High fiber diets of low energy content may result in weight loss in dogs as a result of reduced intake because of reduced palatability or increased satiety. They are not suitable for dogs that need to gain weight.
  • Dietary fiber may have additional beneficial effects on lipid profiles in diabetic dogs.

Fat content

  • The lipid derangements in human diabetic patients predispose to coronary artery disease and may impact diabetic stabilization.
  • Increased fiber and decreased dietary fat content, or a combination, result in lower circulating cholesterol, free glycerol and free fatty acid concentrations in diabetic dogs and may have a beneficial effect on triglyceride concentration compared with low fiber and high fat diets.
  • Hypertriglyceridemia is a risk factor for pancreatitis Pancreatitis: acute and increased fiber and restricted fat diets may be beneficial in at risk cases.

Protein content

  • To prevent protein catabolism, the diet should provide protein of adequate quantity and quality.
  • Diabetic nephropathy Diabetes mellitus: glomerulonephropathy , whilst common in humans, is rare in dogs and restricted protein diets are therefore no considered necessary.

Micronutrients

  • If the diet is balanced and complete and fed in an appropriate quantity for optimal body condition, there is no need for additional vitamin and mineral supplementation.
  • There is limited evidence that dietary supplementation with chromium or vanadium has any effect on glycemic control in diabetic dogs.

Other considerations

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Fleeman L M, Rand J S & Markwell P J (2009) Lack of advantage of high-fibre, moderate carbohydrate diets in dogs with stabilised diabetes. JSAP 50 (11), 604-614 PubMed.
  • Graham P A, Maskell E, Rawlings J M et al (2002) Influence of a high fibre diet on glycemic control and quality of life in dogs with diabetes mellitus. JSAP 43 (2), 67-73 PubMed.
  • Kimmel S E, Michel K E, Hess R S et al (2000) Effects of insoluble and soluble dietary fiber on glycemic control in dogs with naturally occurring insulin-dependent diabetes mellitus. JAVMA 216 (7), 1076-1081 PubMed.
  • Nelson R W, Duesberg C A, Ford S L et al (1998) Effect of dietary insoluble fiber on control of glycemia in dogs with naturally acquired diabetes mellitus. JAVMA 212 (3), 380-386 PubMed.
  • Graham P A, Maskell I E & Nash A S (1994) Canned high fiber diet and postprandial glycemia in dogs with naturally occurring diabetes mellitus. J Nutr 124 (12 Suppl), 2712S-2715S PubMed.
  • Blaxter A C, Cripps P K & Gruffyddd-Jones T J (1990) Dietary fiber and post prandial hyperglycemia in normal and diabetic dogs. JSAP 31 (5), 229-233 VetMedResource.
  • Holste L C, Nelson R W, Feldman E C et al (1989) Effect of dry, soft moist and canned food on postprandial blood glucose and insulin concentrations in healthy dogs. Am J Vet Res 50 (6), 984-989 PubMed.

Other sources of information

  • Zoran D L (2014) Diet and diabetes. In: Kirk's Current Veterinary Therapy XV. Eds Bonagura J D & Twedt D C, Elsevier Saunders, St Louis, Missouri. pp 199-204.


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