What Shelters and Veterinarians Should Learn From Bella's Diabetes
When we first brought Bella home more than 7 years ago, we did not think she was likely to live very long. She weighed only about 15 pounds when she probably should have weighed much closer to 30. She was skin and bones. She looked like a skeleton with skin stretched over it, in spite of the fact that she was eating a lot of food every day. She was consuming large numbers of calories but her little body was unable to utilize them. Her food would come out the back end, undigested and looking pretty much like it did when it went in. Even though she was not absorbing nutrition from her food, her blood sugar would regularly spike so high that her readings would be off the chart of her glucometer, which meant that it was higher than 750. For perspective, 250 is the maximum peak a diabetic dog should see if their insulin is well-regulated and organ damage can occur with blood glucose levels above 250.
On the low end of the blood glucose scale, anything below 40 can be a serious problem. 50 - 130 is considered the normal non-diabetic range for dogs.
Bella's blood sugar would spike into the off-the-charts range in spite of not absorbing her food while also getting large doses of insulin to try to regulate her diabetes, which was doing ever more damage to her organs and making her condition worse. Multiple veterinarians had tried unsuccessfully over a period of years to get Bella's blood sugar regulated with insulin.
Frustrated with what I considered to be a fundamental lack of common sense in the way the veterinary industry treated diabetes in dogs (more on that later), I brought Bella home in 2012 not expecting she would live much longer if I didn't. We had no idea what a positive path forward for her would look like. By the time I brought her home she had been repeatedly in and out of the animal shelter I was running. None of the veterinarians who had treated her were able to get her diabetes under control. Nearly all of them were hostile to the approach that ended up saving her life, as were some of the staff at the animal shelter.
In spite of all of that, getting her regulated was shockingly easy. Within a couple of weeks of bringing her home her blood glucose was stabilized. Over the years since, it has become increasingly stable. I'm hoping her story will help other shelters, rescues and veterinarians begin to rethink the way they care for pets in fundamental ways.
One of the best ways to measure the overall progress of a diabetic is to take regular blood sugar readings and map them on a graph commonly called a glucose curve, which depicts the normal up and down shifting of the blood sugar (glucose) level over time. Yesterday we mapped did a glucose curve for Bella, beginning at 7 AM and ending at 10 PM. That chart is pictured below.
To create Bella's glucose chart we took blood sugar readings at 3-hour intervals and mapped them on to a line graph. Bella's curve is indicative of a very well regulated diabetic, even resembling the curve of a non-diabetic dog, an achievement multiple veterinarians told me would be an impossibility for a severely diabetic dog.
The Standard Approach that Did Not Work
Before getting into what worked for Bella I would like to take some time to talk about what absolutely did not work. Not only did it not work, it nearly killed her. It was also the most common approach used by veterinarians to treat diabetic pets, often with limited or no success.
In very general terms, the standard approach makes perfect sense: Manage the diet and use insulin to lower blood sugar levels. When we brought Bella home she was eating an expensive prescription food often recommended by veterinarians for diabetic pets: Science Diet W/D formula.
Having read the book Not Fit for a Dog, and having spoken to two of its authors, including Dr. Elizabeth Hodgkins, who worked as a senior nutritionist for Hill's Pet Nutrition, the makers of Science Diet W/D food, I was highly skeptical of this food. In the book Hodgkins and her co-authors, Dr. Michael Fox and Elizabeth Smart pulled the covers back to reveal some of the dirty secrets of the pet food industry and, more specifically, what scams the expensive prescription diets, like W/D, can be.
A simple review of the ingredients list of Science Diet W/D formula shows its ingredients to be mostly high sugar starches and grains.
Listed by order of weight, the first five ingredients in W/D are: Whole Grain Wheat, Powdered Cellulose, Chicken Meal, Whole Grain Corn and Corn Gluten Meal. Three of the five ingredients (wheat, corn and corn gluten meal) are sugary grains not even recommended in large quantities for diabetic humans. A fourth ingredient is powdered cellulose, which is a dietary fiber, usually made of wood. It is added to the food to slow the absorption of all of the sugar in the other ingredients. As if the makers of W/D felt corn, corn gluten meal and wheat did not offer enough sugar the seventh and eighth ingredients are more grains: barley and oats. In other words, the very expensive prescription food being prescribed to Bella - a very diabetic dog - was mostly made of sugary grains. To be clear: a growing number of veterinarians are saying that these kinds of ingredients are not part of a species-appropriate diet, even for healthy dogs, which is probably one of the reasons we do not ever see packs of wolves, coyote or even stray domestic dogs grazing in wheat or corn fields. Yet, it is routine practice to prescribe diets loaded with them for diabetic pets, or animals suffering a host of other ailments. Unsurprisingly, eliminating this diet loaded with sugar was one of the keys to getting Bella's diabetes under control. A simple reading of the ingredients list combined with some basic common sense should have been enough to tell that to anyone who had even a simple understanding of nutrition.
What Worked to Get Bella Healthy
When we brought Bella home it was for the purpose of changing her diet to see if we could get her insulin dose regulated. In consultation with a local veterinarian open to alternative diets we began feeding Bella a homemade diet made primarily of raw meat. To help her digest her food, we initially added pancreatic enzymes to each meal. Because Bella's sugar intake was being significantly reduced, we needed to also slash the amount of insulin given to her after each meal. When we began feeding her natural, raw and healthy foods combined with cutting her insulin dose, her blood sugar stabilized almost immediately.
Bella's initial glucose curve following the change looked fantastic. A medical note from Bella's veterinarian dated 7/24/2012 read:
"07-24-12 at 9:17a: Bella doing really well so far. Gained 2 lbs, appetite no longer insanely hungry, no PU, PD, great energy. Mike very pleased so far. I told him the glucose curve is excellent and they should continue [plan]."
The general goal for managing a diabetic dog is to keep the blood sugar levels below 250. I had, however, heard that if managed strictly, and blood sugar were to remain under 200 for an extended period of time, her pancreas might be able to begin healing. We, therefore, set the upper limit of blood sugar for her at 200 and managed her food intake accordingly.
After about 18 months, she began absorbing her own food, without the aid of digestive enzymes added to her food. Additionally, over that time the fluctuations in her curve have flattened out and her overall blood sugar levels have lowered.
Eight years later, Bella is a very senior dog who has lived a happy and full life; and, as I reflect back on her story, I realize that animal shelters and veterinarians are failing many animals due to their fundamental lack of education about pet nutrition. Over the years I have spoken with many veterinarians about Bella's diabetes and about the expensive prescription diets they recommend. When I do I nearly always ask them the same question, "Do you know what is actually in that food?" I have never once had a veterinarian answer that question affirmatively. I have concluded, therefore, that they are prescribing these foods without knowing what is in them, or using the most basic nutritional common sense available. Then the animal shelters and rescues that end up getting these animals simply follow along and the animals suffer as a result. And, it is not just diabetic pets that suffer. A host of medical and behavior issues have been associated with the feeding of commercial pet foods in general (link, link, link).
This is not because they are bad or wrong or stupid. But, the fact of the matter is (as many veterinarians will tell you) they receive almost no training in nutrition in veterinary school. Furthermore, the little they do receive is funded by pet food manufacturers, like the maker's of Science Diet W/D. These manufacturers have vested interests in including cheap, sugary grain in their diets in order to maximize profit. Yet, too many veterinarians look to these same companies as the experts, even though they have proven (repeatedly) unworthy of that trust.
It is time we all begin thinking more holistically about our pets nutrition, because nutrition is the foundation for all health and as professionals advocating for proper pet care, animal shelters, rescues and - in particular - veterinarians need to do a much better job of looking outside the profit-driven information system to learn what is best for our pets.
Note: Excessive amount of grain and sugar are not the worst things found in pet foods. If you look deeper, the secrets the pet food industry do not want you to know get much worse. Watch my YouTube video Soylent Pets - What is really in your pet food to begin learning more.