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Summary: ROYAL CANIN Veterinary DietTM/MC feline DIABETIC DS 44TM/MC is a complete and balanced diet that has been formulated with high protein, moderate energy, and reduced carbohydrate concentrations to assist with the nutritional management of feline diabetes mellitus.
Rationale: Type II diabetes mellitus is the most common type of diabetes in the cat. Hallmarks of this disease are impaired insulin secretion and peripheral insulin resistance that may eventually result in pancreatic beta-cell exhaustion and absolute insulin deficiency. The absolute or relative insulin deficiency allows uncontrolled glucagon-driven gluconeogenesis by the liver. The increased glucose production by the liver in conjunction with reduced glucose uptake by insulin dependent tissues culminates in hyperglycemia and the clinical signs of polyuria, polydipsia, and weight loss. In addition, the relative or absolute insulin deficiency stimulates the release free fatty acids by adipose tissue and stimulates protein degradation to release gluconeogenic amino acids. Risk factors for diabetes mellitus include obesity, decreased physical activity, genetics, and gender. It has been shown that obese cats have altered glucose tolerance curves suggestive of a decreased sensitivity to insulin. This decreased insulin sensitivity may progress to overt diabetes mellitus. Conversely, weight reduction has been shown to improve glycemic control. Indeed, diabetes mellitus may actually resolve in some diabetic cats with correction of the obese state. Therefore, weight maintenance is paramount to the management of feline diabetes mellitus. Moderate energy intake with a low carbohydrate and high protein content should be provided to promote ideal body weight and preservation of lean body mass. Carnitine, a quaternary amine, is critical for fatty acid metabolism and energy production. L-Carnitine functions as a transport shuttle to move long chain fatty acids into the inner mitochondria membrane for oxidation. In addition, L-carnitine transports toxic compounds out of the mitochondria and modulates the intramitrochondrial coenzyme A/acyl-coenxyme A ratio, a key component in the regulation of the citric acid cycle. Carnitine has been shown, in cats, to increase the rate of fatty acid oxidation and accelerate the rate of weight loss. L-carnitine may also promote maintenance of lean body mass during weight reduction. Both the amount and type of dietary carbohydrate have a significant influence on post-prandial insulin secretion. Diets that are rich in simple sugars should be avoided as they perpetuate post-prandial hyperglycemia. Traditionally, diets high in complex carbohydrate have been utilized in the management of diabetes mellitus. These high carbohydrate diets induce high post-prandial blood glucose concentrations and place additional stress on exhausted pancreatic beta-cells. Carbohydrates such as barley and corn have a low glycemic index producing a smaller post-prandial glucose and insulin rise. Therefore, diets for managing feline diabetes mellitus should contain low concentrations of carbohydrate. The carbohydrate source should have a low glycemic index. High fiber diets increase the frequency of defection, may contribute to constipation/obstipation, and are often less palatable which may result in weight loss. However, moderate amounts of fermentable fiber may be beneficial in the management of impaired glucose tolerance. Fermentation of fiber by intestinal bacteria produces short chain fatty acids which stimulate the release of proglucagon from the enterocytes. Proglucagon is broken down to glucagon-like-peptide (GLP-1) which increases insulin secretion from the pancreatic islet cells. In addition, GLP-1 may suppress the appetite. Therefore, fermentable fiber may improve glucose metabolism and induce satiety in diabetic cats. Mucilages such as psyllium are also beneficial in the management of diabetes mellitus. Mucilages form a viscous gel that is effective in slowing the absorption of carbohydrates by prolonging gastric emptying. Mixing cereals of low glycemic index in conjunction with the gelling action of psyllium mucilages reduces post prandial hyperglycemia, lowers insulin secretory response, and may retard the development of insulin beta-cell burnout. Cats have a high dietary protein requirement and prefer to convert protein to glucose (gluconeogenesis). Therefore, if diabetic cats are provided with high concentrations of protein, the excess protein is used as a substrate for glucose production. The glucose derived from hepatic gluconeogenesis is delivered to the blood stream at a slow, constant rate compared to the glucose derived from dietary carbohydrate. Consequently, high protein diets facilitate optimal blood glucose concentrations and may also be associated with lower insulin concentrations. Diabetes mellitus is associated with progressive destruction of pancreatic
beta-cells. A growing body of evidence suggests that reactive oxygen species
are involved in both beta-cell destruction and the chronic complications
of diabetes mellitus. Indeed, the release of cytotoxic reactive oxygen
species may be important in beta cell apoptosis and progression to overt
diabetes mellitus. Antioxidants are, therefore, indicated in the nutritional
management of diabetes mellitus. REFERENCE: |