It is probably natural for a vet to wonder what it would be like to be a dog.
The advantages are obvious: muddy walks; play-fighting; tail wagging; no work or responsibility; stretching out in front of the fire; being everyone’s best friend. But there are disadvantages too. How about anal glands? Kennels? Surgical sterilisation? Risking the sort of owners who didn’t want to be your best friend? Being owned, generally? And in my case, there’s the question of diabetic control.
Don’t get me wrong: I know many happy, healthy, tail-wagging canine diabetics. The key seems to be finding owners who are absolutely dedicated to your care – and there are many such owners around, although it helps if they have insurance (I’m sure £1000 vet-bills per annum could prove a conservative estimate).
Insured or not, it would be impractical and unfair to give dogs insulin pumps or perform multiple glucose tests every day. Diabetic dogs are kept stable through eating the same daily quantity of carbohydrate and being injected with the same doses of insulin. A precisely weighed-out portion of yummy dog-food for tea? A needle in the scruff from my owner? Woof!
Twelve hourly injections make for an impossible routine for some busy people to stick to; another hastle would be ordering and collecting insulin so as not to run out. I’d have to hope for boring, conscientious owners who pay attention to these details, for optimal control. I do hope we’d still get on.
And would they be smart enough to stop me from finding extra food – last night’s take-out from the neighbour’s bin; cake crumbs from the toddler. Would they be susceptible to begging? Perhaps their toddler would, when they weren’t looking? Would I truely want them to be? Controlling their pets’ carbohydrate intake proves an even bigger challenge to many owners than physically injecting the drug.
What with the unreliable food intake and the lack of daily testing to hone the dose, ‘well controlled’ dogs tend to keep their average sugars higher than ‘well controlled’ diabetic people. So what of complications?
I see a lot of cataracts which lead to blindness; we don’t diagnose retinopathy much. Pancreatitis often occurs at times of crisis.
Hypos are a problem: hypoglycaemic dogs just wander around feeling drunk until some food comes their way or someone notices them fall over. I have met dogs so used to hypoing that they still appear normal at less than 2mmol/l (normal 3.5-7) but death by hypo seems to be rare – and usually attributable to massive overdose.
The more serious problem is often ketoacidosis when the pooch becomes ill with something else. Ill diabetics get very high blood sugars and require more insulin. If they don’t get it, they start making toxic ketones. Without testing – or without making it obvious to my owners that I had a thumping headache – might high ketones might be overlooked and I would not see a vet until I was vomitting or even collapsed. But then again, good owners could be trained to test my urine ketones with a daily dip-stick test, which might provide a clue if they’re alert.
Diabetic-dog owners are usually alert. In fact, they are often superhuman and despite the challenges of my care, I know they’d make a decent stab at sorting things out whenever they went wrong. In any case I, being a dog, would spend no time at all worrying about diabetes and plenty of time chasing squirrels. I wonder what my mind would do with all those brain-cells no longer worrying about glucose levels? Perhaps I’d lie on my bed at night licking my groin and wondering what it’s like to be a human.
So here’s a thought: that I could have been born human, but into a different era. Diabetes was first described by the Ancient Egyptians. Insulin was used for the first time in 1922. Between these times are many unfortunate civilisations into which T1 diabetics would have been born. Even a hundred years ago, the best I could have hoped for would have been a starvation diet, which would have controlled my symptoms for a little while before I died.
I really hate those get-to-know-you questions – you know the sort: “If you could go back in time, when would you choose?” – because I wouldn’t. Not even to the sixties. Sure they had insulin then but they weren’t very good with it wouldn’t even be acceptbable to argue with one’s doctor and tell him so (usually a him, then). Maybe I’ll do my time-travelling when I’m very old and about to cark it anyway, dressing as a ghost, whispering my current knowledge in senior clinicians’ ears and possibly improving a few lives.
Or I could just take doctors and equipment to a different part of the world and make the same difference today. Insulin is expensive. A poor, Type-One child in the rural third world might be about as well-off as I would have been 100-years-ago. That is, much less well-off than the average UK dog.
The point to all this of course is that I am actually luckier than a golden aphid on a four-leaf clover. I was born into a country with an NHS: I developed my condition at a time when treatment has never been so good. My life expectancy now is lower than a ‘normal persons’, but probably only just (the existing figure of around 10% lower is based on a population following very out-dated treatment methods). A diabetic dog’s life expectancy is no sooo bad, either. For a dog.
So next time I am feeling down or my diabetes is making me want to scream, I am going to try to remember this and do a little golden aphid dance.
Pictures ‘borrowed’ from http://www.marvistavet.com/html/body_cataracts_in_the_diabetic_dog.html and http://www.123rf.com