Diabetes in Dogs and Cats

Diabetes mellitus, DM, or diabetes, is a condition that occurs when the body cannot use blood glucose normally or does not produce appropriate levels of insulin to manage blood glucose. Dogs are typically Type 1 diabetics and stop producing insulin thus requiring insulin injections for life. Cats are commonly Type 2 diabetics, meaning the body doesn’t use the insulin it produces properly, they too typically require insulin injections for life but it is possible to achieve remission through proper monitoring and regulation.

In a healthy body, when food is consumed the digestive system will break down the carbohydrates into simple sugars like glucose which is then absorbed into the bloodstream through the intestines and called blood glucose. The rise in blood glucose levels triggers the release of a hormone called insulin which is produced in the pancreas. Insulin acts as a key allowing blood glucose to enter cells where it is used for energy thus lowering blood glucose levels back to normal.

There is no medical cure for diabetes. However, following a lifestyle characterized by proper weight, physical activity, healthy diet, closely monitoring glucose levels, and strictly following a prescribed care plan can help avoid or prolong co-morbidities, such as cardiovascular disease and renal failure. Diabetes is a growing concern globally amongst humans, with an estimated 537 million diabetics worldwide. Lesser known is the growing population of diabetic pets with an estimated 1 in 175 cats1 and 1 in 300 dogs2 having diabetes.

Regulation: Maintaining Proper Blood Glucose Levels

Whether a diabetic cat or dog doesn’t have enough of their own insulin or just can’t use it properly, the goal is always to help the pet maintain the proper blood glucose levels through Diet, Exercise, and Insulin Injections. By looking at these three areas in more detail, we can then better examine why diabetes care has been so difficult in the past and how the GluCurve Pet CGM can now change that.

Diet refers to eating healthy foods, in moderate amounts, at regular mealtimes to help control the pet’s blood sugar. Blood sugar levels typically rise after eating because glucose (sugar) mainly comes from food rich in carbohydrates and gets absorbed through the intestines into the bloodstream. Since diabetic pets lack the ability to use their natural insulin normally to prompt glucose to enter cells from the bloodstream, the glucose accumulates in the blood at high amounts causing hyperglycemia. Eventually it will overflow into the urine taking large amounts of water with it which is why common symptoms of diabetes are excessive thirst and increased urination.

Exercise is important for a number of reasons, it utilizes glucose (energy) which helps to lower blood glucose, it increases blood flow which can potentially improve the absorption of insulin, and it will help keep the pet at a healthy weight if obese. However, exercise should be regulated as part of a complete care plan because it affects the pets blood glucose. Routine is an important aspect of diet, exercise, and insulin injections.

Insulin injections are normally required in diabetic pets to maintain constant levels of glucose in their blood. In healthy pets, Beta cells from the pancreas would check blood sugar levels constantly and release natural insulin when blood glucose levels rise, this lowers glucose levels by moving it into cells where it can be used as energy or stored for later in glycogen bundles. When blood glucose levels go down, the pancreas would produce a hormone called glucagon that would tell the glycogen to turn back into glucose this maintaining the proper balance of glucose levels at all times. Veterinarians must prescribe the proper dose and kind of Insulin injection needed to bring blood glucose levels down to healthy levels without reducing glucose levels to unhealthy levels. To do this, Blood Glucose Monitoring is required.

Standard of Care before the GluCurve Pet CGM: A Lose/Lose Scenario

Blood Glucose Monitoring is critical in diabetic pets, it refers to checking the actual level of blood glucose at a given moment in time and is needed to guide veterinarians when figuring out the proper insulin dose. Too high of a dose will lower blood glucose to dangerous levels, and too low of a dose of insulin will allow blood glucose to remain dangerously high. In order to properly prescribe the right amount of insulin, veterinarians need to know what blood glucose levels look like through the day.

Before the GluCurve Pet CGM, there were two ways of monitoring blood glucose levels in diabetic pets:

In-Clinic Blood Glucose Curves have long been the standard method of monitoring blood glucose in diabetic pets to determine insulin doses and care plans. It consists of the pet spending 10-12 hours at a veterinary clinic where they will undergo blood draws every two hours. This will give the veterinarian 6-7 glucose readings to create a graph called a Glucose Curve that they can use to see how the pets blood sugar levels rise and fall over the course of the day. Before being dropped off the pet with eat breakfast and receive an insulin injection so the veterinarians can see how the pet is responding to the insulin.

There are a number of major problems with conducting an in-clinic glucose curve to monitor blood glucose levels. First, pets (especially cats) get very stressed from being housed in a veterinary clinic, in an unfamiliar environment with lots of noise, commotion, and other pets. That stress is significantly amplified by the process of getting stuck by a needle and blood drawn every two hours. Stress causes the blood glucose levels to elevate and can give drastically different numbers then what would be normally seen under normal homelife conditions. The second major problem is that being housed in a crate in a veterinary clinic does not depict the normal homelife of the pet which includes activity/exercise, stress, eating and drinking habits, insulin injection times, etc. Another challenge is that because blood glucose levels are checked every two hours, the highs and lows are often missed between the gaps in readings.

Human CGM’s (Continuous Glucose Monitors) being used off label have been gaining in popularity and practice over recent years and are now recommended as the standard for care by diabetes specialists in veterinary medicine. A small 2-3 inch patch is shaved on the pet and a CGM that has an adhesive patch on the bottom is applied to the area. The device will read blood glucose levels every 5 minutes for 14 days while the pet is at home which offers many huge advantages compared to doing an in-clinic glucose curve. While still a better method then an in-clinic glucose curve, these devices are designed for human use and create a lot of different problems when used in veterinary medicine. They require a prescription so the pet owner must go and pick it up from a pharmacy and set up a return visit to the veterinary clinic, although it should be noted there is a company illegally selling them directly to veterinary clinics through access to the product from their parent company. Another major problem is that the human CGM company will not support the use on animals so there is no customer or technical support, no instructions, no warranties on defective products. Worse yet, the software is not meant for animals and difficult to use a lot of the data (glucose readings) it collects. The commonly used human CGM can only store glucose readings for up to 8 hours so if it isn’t scanned it will start losing the glucose readings it has collected.

The GluCurve Pet CGM: The Next Generation in Diabetic Pet Care

GluCurve CGM attached to a cat

To solve all the problems of in-clinic glucose curves and using a human CGM off label, ALR Technologies (stock ticker: ALRTF) has developed the first and only Continuous Glucose Monitoring System for diabetic cats and dogs called the GluCurve Pet CGM.

Both the hardware and the software for the GluCurve Pet CGM have been designed based on feedback from veterinarians and diabetic pet owners, with even more revolutionary features under development from the input provided by diabetes specialists and pet parents. Our animal health division is dedicated to bettering the lives of diabetic cats, dogs, and those who care for them.

The GluCurve is applied using a button to eliminate the discomfort found in human CGM which have to be pressed into the pet’s body using compression. The adhesive pad is stickier than a human CGM but carefully formulated to avoid any skin irritation. Once applied the GluCurve records blood glucose levels every 1 minute for 14 days while the pet is in the comfort of their home going about their regular daily life to give veterinarians the data they need to better dose insulin injections. It comes equipped with a 14 day memory chip giving pet owners the freedom to go about their daily lives as well without having to scan it every 8 hours for fear of losing the readings.

The blood glucose readings are automatically uploaded to the pet owner’s phone or tablet using the GluCurve app whenever they are within Bluetooth range, from there all the data is securely sent to a veterinary patient management platform where it is stored for the veterinarian to access at any time, even live time. The veterinary platform is custom built with one of a kind features to make it as quick and easy as possible for the veterinarian to properly dose and adjust insulin injections, diet, and exercise to ensure the pet maintains optimal blood glucose levels possible. ALR Technologies fully supports veterinarians and pet owners with instructions, information, and tech/customer support. The GluCurve is sold directly to veterinarians through a partnership with Covetrus so it can be stocked in clinic and ready to use when needed without the need for a trip to the pharmacy.

The Future of Diabetic Pet Care

GluCurve CGM attached to a dog

Covetrus is one of the largest animal health companies in the world, they were chosen to be the exclusive distributor of the GluCurve to veterinary clinics in the US and EU because of their exceptional reputation and dedication to empowering veterinary practice partners to drive improved health and financial outcomes.

ALR Technologies leadership is also seeking collaborations with pharmaceutical companies who manufacture insulin to leverage ALRT’s proprietary, FDA-cleared, AI-based insulin dose adjustment technology (originally developed for human applications) to explore the opportunity to introduce an insulin dose suggestion feature to its veterinary web portal platform.

1O'Neill, D G et al. “Epidemiology of Diabetes Mellitus among 193,435 Cats Attending Primary-Care Veterinary Practices in England.” Journal of veterinary internal medicine vol. 30,4 (2016): 964-72. doi:10.1111/jvim.14365

2Yoon, Samuel et al. “Epidemiological study of dogs with diabetes mellitus attending primary care veterinary clinics in Australia.” The Veterinary record vol. 187,3 (2020): e22. doi:10.1136/vr.105467