Insulin Resistance & Progeterone Levels

Canine diabetes mellitus (CDM) is considered insulin-dependent, and diabetic remission is rare. One exception occurs in intact female dogs with insulin resistance caused by progesterone excess (eg, during pregnancy or diestrus). Progesterone is known to inhibit insulin binding and to block the tyrosine-kinase–dependent glucose transport mechanism. It also causes an increase in growth hormone secretion. CDM during pregnancy may resemble gestational diabetes in women. This retrospective case study investigated CDM remission in diabetic female dogs with insulin resistance mediated by high progesterone levels. Out of 117 female dogs diagnosed with CDM, 72 were identified as intact. Of these, 57 were subsequently spayed, and 6/57 achieved CDM remission. The progesterone-related conditions for which resolution was associated with CDM remission included diestrus (n = 1), pregnancy (n = 1), ovarian remnant syndrome (n = 1), and pyometra (n = 3). Four had presented with severe diabetic ketoacidosis. Ovariohysterectomy (OHE) was performed 3–81 days following CDM diagnosis, and remission occurred 4–39 days after OHE. OHE was recommended for all intact female dogs that develop CDM, even when ketoacidosis was initially present or when several weeks elapsed from the time of diagnosis.

CommentaryThe study suggests that diabetic remission can be achieved in female dogs with ovarian activity and that OHE is essential to achieving diabetic remission. Unfortunately, most CDM dogs that underwent OHE did not achieve remission. In the one patient that did achieve spontaneous remission after diestrus, diabetes signs returned permanently after the subsequent heat cycle. Considering the small sample size, for many intact female dogs, CDM will not resolve with OHE, but it should be recommended to maximize the chance of diabetic resolution.—Jennifer Ginn, DVM, DACVIM

SourceDiabetes mellitus remission after resolution of inflammatory and progesterone-related conditions in bitches. Pöppl AG, Mottin TS, González FH. RES VET SCI 94:471-473, 2013.