I get some great questions from clients. They inspire me with article ideas and keep me in tune with diabetic pet owners. I enjoy interacting with our readers, and sometimes the questions are worthy of a newsletter. I bet if one person has this question and takes the time to write me, there are likely lots of folks with a similar question. With today’s question, we talk about pet arthritis and diabetic pets!
Hi Dr. Joi, I have a miniature schnauzer that is diabetic. She is on Vetsulin, 9 units 2 times a day. I am beginning to notice some arthritis symptoms in her legs. What type of medications are a possibility that won’t interfere with blood glucose levels?
This is a fabulous question!
Now before we talk particulars, know that I advise checking a blood glucose curve about a week after starting ANY medication or diet change for a diabetic pet. I was recently surprised by a “dry eye” medication that affected a pet’s blood glucose regulation. Luckily, those clients are super diligent and did as I recommend by checking a glucose curve a week after the new medication and caught the insulin resistance caused by the eye med. Now, this does not mean we necessarily stop the new medication! Sometimes we simply adjust the insulin dosage to accommodate the new medication.
Next up, is there really arthritis or could there be some diabetic neuropathy? Diabetic neuropathy is not uncommon and if mild could clinically look like arthritis. The way to find out would be to have your veterinarian take some orthopedic radiographs and perform a thorough physical examination. Now let’s get to medications!
Tramadol is a mild narotic that we commonly use for arthritic pets. It can cause slight drowsiness, but I sometime hear just the opposite – that an arthritic pet is more energetic while on Tramadol. Here’s my theory on that: When we hurt it is hard to sleep. It’s hard to get comfortable when in pain. If we are able to stop or at least diminish the pain, the pet is likely going to get much better rest! Voila. Suddenly Fluffy seems more alert and active and mobile even though Tramadol can be sedating. I think a good trick is to start at a low dose and then increase it if needed. Since Fluffy doesn’t talk to us in pain scores, we have to play around with the dose and be pain detectives. In general, Tramadol is quite safe. Since it is a controlled drug and a narcotic, albeit a mild narcotic, be smart and tuck it out of sight a cabinet in your home. And just like any controlled drug, never “cold turkey” it if you opt to discontinue the medication. I’ve never seen Tramadol withdrawal, but let’s be nice to our pets’ brains.
NSAIDs – Non-Steroidal Anti-Inflammatory Drugs
Next up is the class of drugs we call NSAIDs. These are Non-Steroidal Anti-Inflammatory Drugs. In this class are Rimadyl (generic name is carprofen), Metacam (generic name meloxicam), Deramaxx (no generic), Previcox (no generic), Onsior (no generic) and just recently Galliprant (no generic). These are the FDA approved NSAIDs for veterinary use. I remember when Rimadyl came out in the early 90’s. Veterinarians celebrated across the land to finally have an NSAID approved for pets. Until then we would use either steroids, which are not safe for diabetics and certainly had harsh side effects regardless, or aspirin. Aspirin is really hard on a pet’s GI tract! Over the years Metacam, Deramaxx, Onsior and just this year Galliprant were also approved for use in veterinary patients.
NSAIDs in general can be hard on the tummy, and can cause liver and kidney injury. Some pets are more sensitive than other pets, but we vets don’t have a crystal ball to tell us which pets will have issues. We want even more NSAIDs to come to market for veterinary patients because we like having choices and we hope the research and developers can minimize the side effects of NSAIDs. Personally I reach for Carprofen and Meloxicam most often for dogs as they both come in generics and I’ve been using these drugs for years now. So many clients express financial concerns, and the brand names can cost significantly more than the generics. For cats, I stick with Onsior due to its safety profile for felines. Regardless of which NSAID I prescribe, I warn clients that GI ulceration and diarrhea are possible as well as liver and kidney damage. Additionally, I monitor kidney and liver values frequently – ideally every 6 months. That means a chemistry profile and a urinalysis. I rarely use an NSAID alone without also using Tramadol or Gabapentin. We like “multi-modal” analgesia. By adding in these other medications we can potentially use a lower dose of the NSAID while keeping Fluffy comfortable. We must be cautious using an NSAID if a pet is dehydrated. Personally, if I ever personally take an NSAID, I drink a lot of water to protect my kidneys.
A quick note on cats: Cats don’t tolerate NSAIDs very well in the long term. If we give a cat an NSAID it is usually a brief prescription. If we need to use a NDAID long-term for a cat, we discuss with owners that we are using it long-term without FDA approval. Cats don’t have the same liver enzymes that humans and dogs have to metabolize NSAIDs.
This is a great drug for arthritic pets. At higher doses it is an anticonvulsant, so like with Tramadol never “cold turkey” it if you opt to discontinue it. I have my own senior cat on this medication for her arthritis. My kitty takes it very well. It comes in a capsule, and I snip the tip and sprinkle it onto her canned food. For dogs, most folks give the capsule in a snack. Like Tramadol, Gabapentin can cause drowsiness, so I recommend starting low and ramping up the dose. I have twice started this med on senior arthritic dogs and had to lower the dose due to drowsiness. Now I start low and work my way up!
Glucosamine is a great choice for arthritic pets. Despite its name, which sounds like sugar, there is no contraindication for its use in diabetics. It helps thicken the joint fluid. There are numerous brands available for both human and veterinary use.
The older I get, the more I like novel medical devices. I’ve been practicing 24 years now. When I was a young whipper snapper I used to make fun of old timers, such as I am now, because they needed really good light to see and because they liked to buy any new cool medical gadget available. Now that I’m 50, I DO like good lighting. And I just can’t seem to resist the latest medical devices. I don’t want to be an outdated old fart. I want to stay abreast of medicine! I study more now than ever. It therefore won’t surprise you that I have a class 4 therapeutic laser in my small animal vet practice. It uses light energy to decrease inflammation and edema. I bought it 3+ years ago for arthritic pets. It turns out that I use it for so many more procedures and conditions besides arthritis! Nonetheless, it is great for arthritic pets. I’ve seen arthritic pets improve dramatically with the laser. Chiropractors and sports medicine doctors frequently use therapeutic lasers on the human side of medicine.
Omega 3 fatty acids have anti-inflammatory properties, so of course they can help arthritis. In general they are very safe, but do check with your vet first as they are oil. Schnauzers are prone to pancreatitis and I’m guessing that’s how your Schnauzer became diabetic. Pets with pancreatitis should be on a low fat diet long-term. Another trick when giving omega 3 fatty acids is to sneak up on the full amount. If you start at the full dose on day one you might have a pet with soft poo.
Acupuncture – The Holistic Route
Acupuncture is another largely untapped treatment for pain in veterinary medicine. My therapeutic laser actually has an acupuncture point head but I have yet to learn acupuncture. It’s on my bucket list! It’s holistic and without side effects. It’s worth a few calls to find out if there is a veterinary acupuncturist in your town if your pet has arthritis.
Finally, use it or lose it! If your pet is arthritic, be sure to include exercise in your daily routine, even if it just a little. Notice I said daily. Weekend warrior routines may be fine for humans, but arthritic pets do best with consistent daily exercise. Arthritic pets need muscle mass to support their joints. And, exercise and muscle mass helps maintain a slim figure. Obesity is the enemy to arthritic joints. Nobody with arthritis should carry around extra weight! Additionally, obesity causes insulin resistance.
Have a question or comment? Post below or email me at [email protected]. I always enjoy hearing from my readers!
NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.