By Joy Pape, FNP-C, CDCES and Nicole Cerniello, DVM
Last month we wrote about types of diabetes, risk factors and symptoms in humans as well as cats and dogs. This month we’re following up on how to diagnose, prevent and treat diabetes.
Scheduled blood tests during check-ups can help screen for and diagnose prediabetes and diabetes. However, if you or your pet have the classic symptoms, reach out to your health care provider at any time.
The classic symptoms are similar for both pets and animals:
- Urinary frequency
- Increased thirst
- Weight loss without trying to lose weight
- Increased hunger
- Blurry vision
- Numbness or tingling of your hands or feet
- Feeling very tired
- Sores that heal slowly
- More infections than usual
Tests to diagnose prediabetes and diabetes
A1C measures average blood sugar level over the past few months. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have prediabetes, and 6.5% or higher indicates you have diabetes.
Fasting blood sugar measures blood sugar after not eating overnight. A fasting blood sugar level of 70-99 mg/dL is considered normal, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes.
Glucose tolerance test measures blood sugar before and after you drink a liquid that contains glucose. You’ll fast overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked one hour, two hours, and possibly three hours afterward. At two hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140 to 199 mg/dL indicates you have prediabetes, and 200 mg/dL or higher indicates you have diabetes.
Random blood sugar test measures blood sugar at the time you’re tested. You can take this test at any time and don’t need to fast first. A blood sugar level of 200 mg/dL or higher indicates you have diabetes.
*If type 1 diabetes is a concern, your blood may also be tested for autoantibodies (substances that indicate your body is attacking itself) that are often present in type 1 diabetes but not in type 2 diabetes. You may have your urine tested for ketones (produced when your body burns fat for energy), which may also indicate type 1 diabetes instead of type 2 diabetes.
Tests to diagnose gestational diabetes (GDM)
Blood tests are taken between 24 and 28 weeks of pregnancy. If your risk is higher for gestational diabetes, testing may be earlier. Blood sugar that’s high early in pregnancy may indicate type 1 or type 2 diabetes rather than gestational diabetes.
Glucose screening test measures blood sugar at the time you are tested. You’ll drink a liquid that contains glucose, and then one hour later your blood will be drawn to check your blood sugar level. A normal result is 140 mg/dL or lower. If your level is higher than 140 mg/dL, you’ll need to take a glucose tolerance test.
Glucose tolerance test measures blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked one hour, two hours, and possibly three hours afterward.
Your health care provider will discuss your results with you.
Prevention of diabetes
For many who have prediabetes or are at risk, type 2 diabetes can be prevented or delayed by managing weight, eating healthy and being active. You can learn more by attending a diabetes prevention program in person or online. Ask your health care professional for a referral. You can also learn more by reading and or watching educational programs from qualified health care professionals such as board-certified diabetes care and education specialists (CDCES).
One size does not fit all, but treatment will consist of a personalized healthy eating and activity plan. Your plan may also include medication prescribed specifically for and with you. This is called shared decision making which means you and your health care team agree on a treatment plan that will help you prevent complications of diabetes and live a healthy and enjoyable life.
Early diagnosis is key to help manage diabetes in cats and dogs. This is why annual and semiannual bloodwork is recommended. Diabetes is diagnosed by the presence of high blood glucose (sugar) accompanied by excess glucose in the urine. In some cases, where we are suspicious of diabetes but it is unclear, a fructosamine level or a blood glucose curve may be recommended. A fructosamine level gives the pet’s average blood glucose over two weeks. A blood glucose curve involves your pet spending the day at your vet’s office and having its blood glucose checked every hour or two to track glucose over 12 hours.
Diabetes is difficult to predict in cats and dogs as we normally do not have their family history. We do know that keeping pets at a lean weight and on a well-balanced, commercially available pet food helps them live long and healthy lives.
The mainstay of treatment is generally insulin injections. A lesson from your vet and some practice will make it easy for you to do at home. In some cases, cats may revert to a state of diabetes remission. This is not documented in dogs. We keep these cats on a lower carb diet and monitor for clinical signs closely. A new oral medication for cats may delay the need for insulin injections. However, just about every cat will need injections at some point.
Joy Pape, FNP-C, CDCES, CFCN is a board-certified family nurse practitioner, Certified Diabetes Educator and Specialist in Weight Management & Obesity at Weill Cornell’s Comprehensive Weight Control Center and has a private practice in the West Village. Dr. Nicole Cerniello, DVM, is Medical Director for the Greenwich Village Animal Hospital.