Diabetes Mellitus

Diabetes mellitus is a chronic metabolic disorder characterized by the body's inability to properly regulate blood glucose levels due to insufficient insulin production or inadequate cellular response to insulin. In dogs, the condition most commonly results from destruction of the insulin-producing beta cells in the pancreas, similar to Type 1 diabetes in humans, rendering the dog dependent on external insulin administration for survival. This condition affects approximately one in every three hundred dogs, with prevalence increasing significantly in middle-aged and older animals, making it an important consideration in geriatric canine health management.

The fundamental mechanism of diabetes involves the hormone insulin, which is produced by specialized cells in the pancreas and is essential for allowing glucose to enter cells where it can be used for energy. When insulin production is inadequate or cells become resistant to insulin's effects, glucose accumulates in the bloodstream while cells are starved of their primary energy source. The body responds by breaking down fat and muscle tissue for alternative fuel, leading to weight loss despite increased appetite. Excess glucose spills into the urine, drawing water with it and causing the characteristic symptoms of increased urination and thirst that often alert owners to the problem.

The impact of uncontrolled diabetes on a dog's health is substantial and can affect virtually every organ system. Persistent high blood glucose damages blood vessels and nerves over time, potentially leading to complications affecting the eyes, kidneys, and nervous system. Dogs with diabetes are particularly prone to developing cataracts, often rapidly, which can lead to blindness if untreated. The metabolic imbalance can progress to diabetic ketoacidosis, a life-threatening emergency requiring immediate veterinary intervention. Additionally, diabetic dogs are more susceptible to infections and may have impaired wound healing, complicating management of concurrent conditions.

While diabetes mellitus cannot be cured in most dogs, it can be effectively managed with commitment and proper veterinary guidance, allowing affected dogs to maintain good quality of life for years. Management requires twice-daily insulin injections, careful dietary control, regular exercise, and consistent monitoring of blood glucose levels. The initial regulation period can be challenging, requiring frequent veterinary visits and adjustments, but most owners become comfortable with the routine over time. Early detection and proper management significantly improve outcomes, emphasizing the importance of recognizing early symptoms and seeking prompt veterinary care for any dog showing signs of excessive thirst, urination, or unexplained weight loss.

The primary cause of diabetes mellitus in dogs is immune-mediated destruction of the pancreatic beta cells, the specialized cells responsible for producing insulin. In this process, the dog's own immune system mistakenly identifies beta cells as foreign and attacks them, progressively destroying the pancreas's ability to produce adequate insulin. This autoimmune process is thought to be triggered by a combination of genetic susceptibility and environmental factors, though the specific triggers remain incompletely understood. By the time clinical signs appear, approximately seventy-five to eighty percent of beta cells have typically been destroyed, making the condition irreversible in most cases.

Genetic factors play a significant role in determining which dogs develop diabetes, with certain breeds showing markedly higher incidence rates. Australian Terriers, Samoyeds, Miniature Schnauzers, Miniature and Toy Poodles, and Bichon Frises are among the breeds with elevated risk, suggesting inherited susceptibility factors. The genetic predisposition likely involves multiple genes affecting immune function, pancreatic development, and metabolic regulation. Family history of diabetes in closely related dogs increases individual risk, though the inheritance pattern is complex and not fully characterized. While genetics cannot be modified, awareness of breed predisposition can prompt heightened vigilance for early symptoms.

Hormonal factors significantly influence diabetes development, particularly in female dogs. Unspayed females are approximately twice as likely to develop diabetes as spayed females or males, with pregnancy and the diestrus phase of the reproductive cycle (the period following heat) being particularly high-risk times. The hormone progesterone, which rises during these periods, induces insulin resistance and can trigger persistent diabetes in predisposed dogs. Additionally, conditions causing excess production of hormones that counteract insulin, such as Cushing's disease (excess cortisol) or acromegaly (excess growth hormone), can overwhelm the body's insulin production capacity and precipitate diabetes.

Obesity represents a major modifiable risk factor for diabetes development, though its role in canine diabetes differs somewhat from its central role in human Type 2 diabetes. Excess body fat causes insulin resistance, meaning higher amounts of insulin are required to achieve the same glucose-lowering effect. While dogs rarely develop pure insulin resistance diabetes as commonly occurs in humans, obesity can stress an already compromised pancreas beyond its capacity, accelerating the progression from prediabetes to clinical disease. The chronic inflammation associated with obesity may also contribute to pancreatic damage. Weight management therefore plays an important role in both prevention and management of canine diabetes.

The mechanism of diabetes development involves a progressive loss of functional beta cell mass combined with increasing metabolic demands. Chronic pancreatitis, repeated bouts of pancreatic inflammation, can directly destroy beta cells and is a significant cause of diabetes in some dogs. Certain medications, particularly corticosteroids used to treat allergies or immune conditions, can induce insulin resistance and may trigger diabetes in susceptible individuals. Once beta cell destruction reaches a critical threshold, the remaining cells cannot produce sufficient insulin to meet the body's needs, and blood glucose levels rise persistently. Without insulin to facilitate glucose entry into cells, the body enters a catabolic state, breaking down its own tissues for energy while excess glucose causes progressive damage to blood vessels and organs throughout the body.

The earliest warning signs of diabetes often develop gradually over weeks to months and may initially be attributed to other causes or dismissed as minor changes. Owners frequently first notice their dog drinking more water than usual, which may manifest as more frequent trips to the water bowl, emptying the bowl faster, or seeking water from unusual sources such as toilets or puddles. This increased thirst, called polydipsia, results from the body's attempt to compensate for fluid losses caused by excessive urination. Subtle weight loss despite a good appetite may occur during this early phase, though it can be difficult to detect in dogs with thick coats or gradual changes.

The classic symptoms of established diabetes, often remembered as the four Ps, are among the most commonly observed signs that prompt veterinary evaluation. Polyuria, or increased urination, results from excess glucose spilling into the urine and drawing water with it, leading to production of large volumes of dilute urine. Polydipsia, increased thirst, follows as the body attempts to replace lost fluids. Polyphagia, increased appetite, occurs because despite high blood glucose, cells are starved for energy they cannot access without adequate insulin. Paradoxically, weight loss continues or accelerates despite the increased food intake, as the body breaks down fat and muscle for fuel it cannot obtain from dietary glucose.

Behavioral and energy level changes are common in diabetic dogs and may be among the first signs owners notice. Affected dogs often become lethargic, sleeping more and showing reduced interest in activities they previously enjoyed. Exercise intolerance develops as muscles are deprived of their preferred fuel source. Some dogs show weakness, particularly in the hind legs, which may cause difficulty jumping, climbing stairs, or rising from rest. Changes in demeanor including depression, irritability, or decreased interaction with family members may occur. These behavioral changes can be subtle and are sometimes attributed to normal aging, particularly in older dogs.

Physical signs of diabetes become more apparent as the condition progresses. Weight loss becomes more obvious, with muscle wasting visible along the spine and over the hips. The coat may become dull, dry, or unkempt as the dog feels too unwell to groom normally. Sweet or fruity-smelling breath may be noticeable, resulting from the production of ketones when the body relies heavily on fat breakdown for energy. Cloudy eyes indicating cataract formation may develop rapidly, sometimes within weeks of diagnosis, and can lead to apparent sudden blindness that prompts veterinary consultation. In male dogs, the prepuce may appear moist or sticky from glucose in the urine.

As diabetes advances without treatment, symptoms become increasingly severe and can progress to life-threatening diabetic ketoacidosis. Dogs may develop vomiting and diarrhea as metabolic derangements affect gastrointestinal function. Dehydration becomes apparent with dry gums, sunken eyes, and reduced skin elasticity. Weakness progresses and may cause difficulty walking or even standing. Labored breathing may occur as the body attempts to compensate for metabolic acidosis. Mental dullness, disorientation, or decreased responsiveness develop in severe cases. Without treatment, diabetic ketoacidosis progresses to coma and death.

Emergency symptoms requiring immediate veterinary attention include any sudden change in a diabetic dog's condition, whether newly diagnosed or already under treatment. Vomiting or refusal to eat in a diabetic dog can indicate ketoacidosis or, in treated dogs, hypoglycemia from excessive insulin. Sudden weakness, collapse, trembling, or seizures in a dog receiving insulin may indicate dangerously low blood glucose requiring immediate intervention with sugar and emergency veterinary care. Rapid breathing, extreme lethargy, or loss of consciousness are life-threatening emergencies. Any sudden vision changes or signs of discomfort in the eyes warrant prompt evaluation for rapidly progressing cataracts or other complications.

The diagnostic process for diabetes mellitus typically begins when an owner reports the characteristic symptoms of increased thirst, urination, and appetite accompanied by weight loss, or when routine blood work reveals elevated glucose levels. During the initial veterinary examination, the doctor will obtain a thorough history including onset and progression of symptoms, changes in eating and drinking habits, any recent weight changes, and current medications. Physical examination may reveal weight loss, dehydration, muscle wasting, cataracts, or other signs consistent with diabetes. The characteristic sweet or fruity odor on the breath, when present, is highly suggestive of diabetic ketoacidosis.

Confirmation of diabetes requires demonstration of persistently elevated blood glucose (hyperglycemia) along with glucose in the urine (glucosuria). A blood chemistry panel reveals the blood glucose level, with diabetic dogs typically showing values well above the normal range of approximately sixty-five to one hundred twenty milligrams per deciliter. However, because stress during veterinary visits can temporarily elevate blood glucose, particularly in cats and some dogs, additional testing may be needed to confirm the diagnosis. Fructosamine measurement provides an average blood glucose level over the preceding two to three weeks and helps distinguish true diabetes from stress-related glucose elevation. Urinalysis confirms the presence of glucose in the urine and may also reveal ketones indicating diabetic ketoacidosis, protein suggesting kidney involvement, or signs of urinary tract infection, which is common in diabetic dogs.

Additional diagnostic testing helps assess overall health, identify complications, and detect concurrent conditions that may affect treatment. A complete blood count evaluates red and white blood cells and can reveal evidence of infection or other abnormalities. An expanded chemistry panel assesses kidney function, liver enzymes, and electrolytes, all of which may be affected by diabetes or its complications. Testing for Cushing's disease is often recommended, particularly in dogs that do not respond well to initial insulin therapy, as this common hormonal condition can cause or worsen diabetes. Thyroid function testing may be performed to rule out hypothyroidism, which can complicate diabetes management. Pancreatic lipase testing may be conducted if pancreatitis is suspected as an underlying cause.

Differentiation of diabetes from other conditions causing similar symptoms ensures appropriate treatment. Kidney disease can cause increased thirst and urination and may occur concurrently with diabetes. Cushing's disease produces many overlapping symptoms and frequently coexists with diabetes. Urinary tract infections cause increased urination and may be the primary problem or a secondary complication of diabetes. Certain medications, particularly corticosteroids, can cause temporary glucose elevation that resolves when the medication is discontinued. Once diabetes is confirmed, the veterinarian will assess severity, check for ketoacidosis or other immediate complications, discuss management options, and develop an initial treatment plan tailored to the individual patient and owner circumstances.

Emergency treatment for dogs presenting in diabetic ketoacidosis or with severe complications takes priority over long-term management planning. These critically ill patients require hospitalization for intravenous fluid therapy to correct dehydration and electrolyte imbalances, along with careful insulin administration to gradually reduce blood glucose levels. Correction must proceed slowly to avoid dangerous shifts in fluid and electrolyte balance that can occur with too-rapid treatment. Underlying triggers such as infection must be identified and addressed. Once stabilized, usually over one to three days, the dog can transition to outpatient management with the standard insulin protocol.

Insulin therapy forms the foundation of diabetes management in dogs, as the vast majority require lifelong insulin injections to survive. The most commonly used insulin types in dogs include intermediate-acting insulins such as Vetsulin (porcine insulin zinc suspension) and NPH, as well as longer-acting options like glargine or detemir for dogs requiring more sustained effects. Treatment typically begins with a conservative dose based on body weight, administered twice daily by subcutaneous injection. Owners learn to draw up and administer insulin, typically using small insulin syringes with very fine needles that cause minimal discomfort. The injection is given at the same times each day, usually twelve hours apart, coordinated with feeding.

Dietary management works in concert with insulin therapy to maintain stable blood glucose levels. Most diabetic dogs benefit from a consistent, high-fiber, complex-carbohydrate diet that slows glucose absorption and minimizes post-meal blood sugar spikes. Commercial prescription diabetic diets are available, or veterinarians may recommend specific formulations based on individual needs. Feeding the same amount of the same food at the same times each day provides consistency that simplifies insulin dosing. Treats should be limited to low-carbohydrate options and given in consistent amounts. Dogs receiving insulin should never miss a meal, as this can lead to dangerous hypoglycemia; if a dog refuses food, the insulin dose must be modified according to veterinary guidance.

Ongoing monitoring and dose adjustment are essential for achieving and maintaining good glycemic control. Blood glucose curves, where glucose is measured every two to four hours over a twelve to twenty-four hour period, help assess how well the current insulin dose is working and when insulin is having its peak effect. These curves may be performed at the veterinary clinic or, increasingly, at home using portable glucose meters with instruction from the veterinary team. Fructosamine levels are monitored every few months to assess average glucose control. Urine glucose and ketone monitoring at home can provide early warning of problems. The insulin dose is adjusted based on this monitoring data, clinical signs, and body weight, with adjustments made gradually to avoid overcorrection.

Additional treatment considerations address complications and concurrent conditions that affect overall management. Cataracts, which develop in approximately seventy-five percent of diabetic dogs within a year of diagnosis, can be surgically removed to restore vision, though this is an elective procedure that requires stable diabetes control first. Urinary tract infections, common in diabetic dogs due to glucose in the urine, require appropriate antibiotic treatment. Underlying conditions such as Cushing's disease or hypothyroidism must be managed for optimal diabetes control. Dental disease should be addressed, as chronic infection can worsen insulin resistance. Weight management is incorporated into the treatment plan, with gradual weight loss for overweight dogs and monitoring for unhealthy weight loss in those that were initially thin.

The treatment approach is individualized based on multiple factors including the dog's overall health, the owner's ability to provide care, and practical considerations. Some dogs require more or less intensive monitoring based on how easily they are regulated and their risk for hypoglycemia. Owners with variable schedules may need modified protocols that accommodate timing flexibility. Financial considerations affect choices about monitoring frequency and testing location. The veterinary team works with owners to develop sustainable management plans that optimize the dog's health while remaining practical for long-term implementation. Regular communication between owners and the veterinary team is essential for successful diabetes management.

The initial regulation period following diabetes diagnosis typically spans several weeks to months as the optimal insulin dose and management routine are established. During this phase, frequent veterinary visits for blood glucose monitoring are necessary, with dose adjustments made based on glucose curves and clinical response. Some dogs regulate quickly and smoothly, while others require extended trial and adjustment before achieving stable control. Owners should expect some ups and downs during this period as the insulin type, dose, and timing are fine-tuned. Good communication with the veterinary team helps navigate challenges and ensures appropriate adjustments are made promptly.

Ongoing care requirements once stable control is achieved include consistent twice-daily insulin administration, regular feeding of an appropriate diet, and periodic monitoring to ensure continued good control. Most owners develop efficient routines that integrate diabetes management smoothly into daily life. Monthly weigh-ins help track body condition, as changes may indicate the need for dose adjustment. Periodic blood glucose curves or fructosamine measurements, typically every three to six months when stable, confirm continued good control. Annual comprehensive examinations and blood work assess overall health and screen for developing complications.

Prognosis for diabetic dogs has improved substantially with advances in treatment understanding and owner education, with many dogs living normal lifespans after diagnosis. Factors affecting prognosis include how well diabetes is controlled, the presence of concurrent diseases, development of complications, and the owner's ability and commitment to provide consistent care. Dogs that achieve good glycemic control generally feel well and maintain good quality of life. The median survival time for treated diabetic dogs ranges from two to five years after diagnosis, with many dogs exceeding this, though outcomes vary widely based on individual circumstances.

Long-term outlook depends heavily on consistent management and monitoring for potential complications. Cataracts are the most common complication, affecting the majority of diabetic dogs, though surgical removal can restore vision when the dog is otherwise well-controlled. Recurrent urinary tract infections may occur and require prompt treatment. Some dogs develop diabetic neuropathy affecting the hind legs, though this is less common in dogs than in diabetic cats. With attentive care, many diabetic dogs maintain excellent quality of life for years, enjoying normal activities and a strong bond with their families despite requiring daily medication and monitoring.

Primary prevention of diabetes focuses on modifiable risk factors, as genetic predisposition cannot be altered. Maintaining dogs at a healthy weight throughout life reduces strain on the pancreas and decreases insulin resistance that can contribute to diabetes development. Feeding a balanced diet appropriate for the dog's life stage and activity level, avoiding excessive treats, and ensuring adequate exercise help prevent obesity. These same lifestyle measures benefit overall health and longevity regardless of diabetes risk. While lean dogs can still develop diabetes, avoiding obesity reduces one significant contributing factor.

Spaying female dogs eliminates the hormonal fluctuations that significantly increase diabetes risk, particularly the progesterone surges during diestrus and pregnancy. Spaying is recommended for female dogs not intended for breeding, ideally before the first heat cycle for multiple health benefits including reduced diabetes risk. For females that have already had heat cycles or pregnancies, spaying still provides benefit by preventing future hormonal stress on the pancreas. The strong association between intact female status and diabetes makes this one of the most impactful preventive measures available.

Nutritional management supporting pancreatic health includes feeding high-quality commercial diets appropriate for the dog's needs and avoiding frequent dietary indiscretions that can trigger pancreatitis. High-fat meals, table scraps, and garbage ingestion are common causes of pancreatitis, which can damage insulin-producing cells and precipitate diabetes. Dogs with a history of pancreatitis should be fed low-fat diets and protected from accessing fatty foods. Maintaining consistent feeding schedules and avoiding sudden dietary changes supports digestive health and reduces pancreatic stress.

Regular veterinary care facilitates early detection of prediabetic changes or conditions that increase diabetes risk. Annual or biannual wellness examinations with routine blood work can identify elevated glucose levels before clinical diabetes develops. Early detection of Cushing's disease, hypothyroidism, or other conditions affecting glucose metabolism allows treatment before diabetes results. Dogs showing subtle early symptoms such as mildly increased thirst or urination should be evaluated promptly rather than waiting for more obvious signs. Breeds with elevated genetic risk may benefit from more frequent screening.

Early intervention when risk factors or prediabetic changes are identified may slow or prevent progression to clinical diabetes in some dogs. Weight reduction in overweight dogs improves insulin sensitivity and reduces metabolic demands on the pancreas. Treatment of concurrent conditions affecting glucose metabolism, such as Cushing's disease, may prevent associated diabetes from developing. Dietary modification to reduce glycemic impact may be beneficial for dogs showing borderline glucose elevations. While not all diabetes can be prevented, addressing modifiable factors provides the best opportunity to reduce risk in susceptible individuals.

Daily management of a diabetic dog centers on consistent timing and technique for insulin administration, feeding, and monitoring. Most owners establish a routine where the dog is fed, then receives insulin immediately after eating, at the same times each morning and evening. Using an alarm or reminder helps ensure doses are not missed or doubled. Insulin should be stored properly, handled gently without shaking, and discarded according to manufacturer recommendations. Many owners find that their dogs quickly accept injections as part of the normal routine, particularly when followed by positive reinforcement. Having a dedicated supply of equipment and a backup insulin pen or vial prevents problems if supplies run low unexpectedly.

The home environment should support consistent diabetes management and provide for the dog's safety. Insulin, syringes, and monitoring supplies should be stored in a consistent, accessible location. A sharps container for needle disposal protects family members and allows proper waste handling. The dog should have constant access to fresh water to accommodate increased thirst, with multiple water sources if the home is large. A consistent feeding area and schedule reinforces routine. For dogs prone to hypoglycemia, corn syrup or a similar rapidly-absorbed sugar source should be readily available at all times for emergency treatment of low blood glucose.

Maintaining quality of life for diabetic dogs involves adapting activities to their energy levels while keeping them engaged and happy. Most well-regulated diabetic dogs can participate in normal activities including walks, play, and training. Exercise should be reasonably consistent from day to day, as dramatic variations in activity level can affect blood glucose. Long hikes or unusually strenuous activity may require adjustments to feeding or insulin timing, discussed in advance with the veterinary team. Mental stimulation through puzzle toys, scent games, or training sessions provides enrichment that does not require intense physical exertion. Many diabetic dogs maintain completely normal, active lives.

Ongoing monitoring at home and through veterinary visits ensures continued good control and early detection of problems. Owners learn to recognize signs of both high blood glucose and hypoglycemia, knowing when to contact the veterinary team. Daily observations of appetite, thirst, urination, energy level, and overall demeanor provide valuable information about glycemic control. Some owners perform periodic blood glucose testing at home using portable meters, while others prefer to rely on veterinary monitoring. Keeping a log of observations, insulin doses, and any unusual events helps identify patterns and facilitates communication with the veterinary team. Regular rechecks allow assessment of glycemic control and adjustment of the management plan as needed.

Caregiver support is essential for successful long-term management of a diabetic dog, as the commitment required can be significant. Finding a backup person who can administer insulin allows owners to travel or handle emergencies without compromising the dog's care. Online communities and support groups for owners of diabetic dogs provide emotional support, practical tips, and understanding from others facing similar challenges. Financial planning for ongoing costs including insulin, syringes, monitoring supplies, and veterinary visits helps prevent financial stress. The veterinary team serves as an ongoing resource for questions, adjustments, and encouragement. With proper support, most owners successfully manage their diabetic dogs and find the routine becomes second nature over time.

Several breeds demonstrate significantly elevated risk for diabetes mellitus, with genetic factors playing a clear role in susceptibility. Australian Terriers show the highest relative risk among breeds studied, with incidence rates several times higher than mixed breed dogs. Samoyeds also have markedly increased risk and may develop diabetes at younger ages than other breeds. Miniature Schnauzers, prone to pancreatitis and lipid metabolism abnormalities, frequently develop diabetes, particularly females. Other breeds with elevated risk include Miniature and Toy Poodles, Bichon Frises, Pugs, and Cairn Terriers. The consistent breed patterns strongly suggest inherited susceptibility factors, though the specific genes involved are still being researched.

Medium-risk breeds and categories deserve increased vigilance for early signs of diabetes. Many terrier breeds beyond Australian and Cairn Terriers show moderately elevated risk. Small breed dogs generally have higher diabetes rates than large breeds, though exceptions exist. Mixed breed dogs with ancestry from high-risk breeds may inherit susceptibility. Female dogs of any breed face roughly double the risk of males, particularly if unspayed. Middle-aged to older dogs represent the primary affected age group, with most diagnoses occurring between seven and nine years of age. German Shepherds and Golden Retrievers, while not among the highest-risk breeds, are diagnosed frequently simply due to their popularity.

Breed-specific screening and awareness allow earlier detection and intervention in predisposed dogs. Owners of high-risk breeds should familiarize themselves with early diabetes symptoms and report any changes in thirst, urination, appetite, or weight promptly. Annual blood glucose screening during routine wellness visits may detect prediabetic changes before clinical disease develops. Breeders of affected breeds should consider diabetes history when making breeding decisions, avoiding producing puppies from two parents with strong family histories of diabetes. Spaying female dogs of high-risk breeds provides significant risk reduction. While breed cannot be changed, awareness of inherited predisposition enables proactive monitoring and early intervention.

Diabetes mellitus frequently coexists with other metabolic and hormonal conditions, and recognizing these relationships is important for comprehensive management. Cushing's disease, characterized by excess cortisol production, is commonly found alongside diabetes and may be a primary cause of insulin resistance. Dogs with poorly controlled diabetes despite appropriate insulin doses should be tested for Cushing's disease, as treating the underlying cortisol excess often dramatically improves diabetes control. Hypothyroidism can also affect glucose metabolism and should be evaluated in diabetic dogs. Pancreatitis frequently precedes diabetes development and may recur, requiring dietary management to prevent flares that can destabilize diabetic control.

Several conditions produce symptoms overlapping with diabetes, requiring differentiation for appropriate treatment. Kidney disease causes increased thirst and urination similar to diabetes and may occur concurrently or independently. Urinary tract infections cause increased urination and are both a differential diagnosis and a common complication of diabetes. Cushing's disease produces the classic symptoms of increased thirst, urination, and appetite with muscle wasting, closely mimicking diabetes. Certain cancers can affect glucose metabolism. Accurate diagnosis ensures appropriate treatment, and when multiple conditions coexist, management must address all components for optimal outcomes.

Complications of diabetes extend its impact beyond glucose regulation to multiple organ systems. Diabetic cataracts develop in the majority of diabetic dogs, typically within one year of diagnosis, due to glucose accumulation in the lens causing osmotic damage and opacity. These cataracts can progress rapidly from minor changes to complete blindness. Recurrent urinary tract infections result from glucose in the urine providing nutrients for bacterial growth and may require extended antibiotic courses. Diabetic neuropathy, though less common in dogs than cats, can cause weakness and abnormal gait, particularly in the hind limbs. Chronic kidney disease may develop over time in poorly controlled diabetic dogs. Hepatic lipidosis, fatty infiltration of the liver, can occur when uncontrolled diabetes causes excessive fat mobilization.