Diabetic diagnosis:

1. ruling out other causes, to include Cushing's disease, diabetes mellitus, renal failure, liver disease, and pyometra in bitches; 
2. imagery of the pituitary with a positive finding of a tumor; 
3. water deprivation test--if animal is unable to produce more concentrated urine as water intake is restricted; 
4. ADH trial with desmopressin (the drug used to treat DI)-a positive response to the drug indicates the dog has DI

Symptoms:
If you are not known to have diabetes but are having any symptoms that suggest diabetes or concern you in any way, make an appointment to see your health care provider as soon as possible. When you make the appointment, tell the operator that you are concerned about diabetes. He or she may make arrangements for blood sugar testing before your appointment.
If you are known to have diabetes, call your health care provider right away if any of the following apply:

• You are experiencing diabetes symptoms. This may mean that your blood sugar level is not being controlled despite treatment.
• Your blood sugar levels, when you test them, are consistently high (more than 200 mg/dL). Persistently high blood sugar levels are the root cause of all of the complications of diabetes.
• Your blood sugar level is often low (less than 60 mg/dL). This may mean that your management strategy is too aggressive. It also may be a sign of infection or other stress on your system such as kidney failure, liver failure, adrenal gland failure, or the concomitant use of certain medications.
• You have an injury to your foot or leg, no matter how minor. Even the tiniest cut or blister can become very serious in a person with diabetes. Early diagnosis and treatment of problems with the feet and lower extremities, along with regular diabetic foot care, are critical in preserving the function of your legs and preventing amputation.
• You have a low-grade fever (less than 101.5°F). Fever is a sign of infection. If you have diabetes, many common infections can potentially be more dangerous for you than for other people. Note any symptoms, such as painful urination, redness or swelling of the skin, abdominal pain, chest pain, or cough, that may indicate where your infection is located.
• You are nauseated or vomiting but can keep liquids down. Your health care provider may adjust your medications while you are sick and will probably recommend an urgent office visit or a visit to the emergency department. Persistent nausea and vomiting can be a sign of diabetic ketoacidosis, a potentially life-threatening condition, as well as several other serious illnesses.
• You have a small sore (ulcer) on your foot or leg. Any nonhealing sore or ulcer on the feet or legs of someone with diabetes needs to be seen by a medical professional right away. A sore less than 1 inch across, not draining pus, and not exposing deep tissue or bone can safely be evaluated in your health care provider's office as long as you do not have fever and your blood sugar levels are in control.

When you call your health care provider, tell the operator that you have diabetes and are concerned.

• You will probably be referred to a nurse who will ask questions and make a recommendation about what to do.
• Be prepared for this conversation. Have a list of your medications, medical problems, allergies to medicines, and your blood sugar diary handy by the phone.
• The nurse may need any or all of this information to decide both the urgency of your condition and how best to recommend treatment for your problem

Diabetic emergencies:
The following situations can become medical emergencies and warrant an immediate visit to a hospital emergency department:

• The person with a severe diabetic complication may travel to the emergency department by car or ambulance.
• A companion should go along to speak for the person if the person is not able to speak for himself or herself with the emergency care provider.
• Bring a list of medical problems, medications, allergies to medications, and the blood sugar diary to the emergency department. This information will help the emergency care provider diagnose the problem and treat it appropriately.

The following are signs and symptoms of diabetic complications that warrant emergency care.

• Altered mental status: Lethargy, agitation, forgetfulness, or just strange behavior can be a sign of very low or very high blood sugar levels.
• If the person is a known diabetic, try giving him or her some fruit juice (about 6 ounces) if the person is awake enough to swallow normally without choking. Avoid giving things such as hard candy that can lodge in the throat. Your health care provider can prescribe glucose wafers that melt under the tongue.
• If the person does not wake up and behave normally within about 15 minutes, call 911.
• If the person is not a known diabetic, these symptoms can be signs of stroke, drug intoxication, alcohol intoxication, oxygen starvation, and other serious medical conditions. Call 911 immediately.

• Nausea or vomiting: If you are known to have diabetes and cannot keep food, medications, or fluids down at all, you may have diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, or another complication of diabetes.
• If you have not already taken the latest insulin dose or oral diabetes medicine, do not take it without talking to a medical professional.
• If you already have low blood sugar levels, taking additional insulin or medication will drive your blood sugar level down even further, possibly to dangerous levels.

 

• Fever of more than 101.5°F: If your primary health care provider cannot see you right away, you should seek emergency care for a high fever if you are diabetic. Note any other symptoms such as cough, painful urination, and abdominal pain or chest pain.
• High blood sugar level: Your blood sugar level is more than 400 mg/dL, and your primary care provider cannot see you right away. Very high blood sugar levels can be a sign of diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome, depending on the type of diabetes you have. Both of these conditions can be fatal if not treated promptly.
• Large sores or ulcers on the feet or legs: If you have diabetes, a nonhealing sore larger than 1 inch in diameter can be a sign of a potentially limb-threatening infection.
• Other signs and symptoms that merit immediate care are exposed bone or deep tissue in the wound, large areas of surrounding redness and warmth, swelling, and severe pain in the foot or leg.
• If left untreated, such a sore may ultimately require amputation of the limb.

• Cuts or lacerations: Any cut penetrating all the layers of skin, especially on the legs, is a potential danger to a person with diabetes. Proper wound care, although important to anyone's recovery, is especially important in diabetes to assure good wound healing.
• Chest pain: If you are diabetic, take very seriously any pain in your chest, particularly in the middle or on the left side, and seek medical attention immediately.
• People with diabetes are more likely than nondiabetic people to have a heart attack, with or without experiencing chest pain.
• Irregular heartbeats and unexplained shortness of breath may also be signs of heart attack.

 

• Severe abdominal pain: Depending on the location, this can be a sign of heart attack, abdominal aortic aneurysm (widening of the large artery in the abdomen), diabetic ketoacidosis, or interrupted blood flow to the bowels.
• All of these are more common in people with diabetes than in the general population and are potentially life threatening.
• Diabetics also get other common causes of severe abdominal pain such as appendicitis, perforated ulcer, inflammation and infection of the gallbladder, kidney stones, and bowel obstruction.
• Severe pain anywhere in the body is a signal for timely medical attention.

Exams and Tests
Doctors use special tests in diagnosing diabetes and also in monitoring blood sugar level control in known diabetics.
If you are having symptoms but are not known to have diabetes, your evaluation should always begin with a thorough medical interview and physical examination. Your health care provider asks you about your symptoms, risk factors for diabetes, past medical problems, medications you are taking, allergies to medications, family history of diabetes or other medical problems such as high cholesterol or heart disease, and habits and lifestyle.
A number of lab tests are available to confirm the diagnosis of diabetes.
Fingerstick blood glucose: This is a rapid screening test that may be performed at a medical office or at a hospital emergency department.

• A fingerstick blood glucose test is not as accurate as testing your blood in the laboratory but is easy to perform, and the result is available right away.
• The test involves sticking your finger for a blood sample, which is then placed on a strip. The strip goes into a machine that reads the blood sugar level. These machines are only accurate to within about 10% of actual laboratory values.
• Fingerstick blood glucose values may be inaccurate at very high or very low levels, so this test is only a preliminary screening study. This is the way most diabetics monitor their blood sugar levels at home.

Fasting plasma glucose: You will be asked to eat or drink nothing for 8 hours before having your blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126 mg/dL without eating anything, you probably have diabetes.

• If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to confirm the result, or you may undergo an oral glucose tolerance test or a glycosylated hemoglobin test (often nicknamed "hemoglobin A1c") as a confirmatory test.
• If your fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then you have what is called impaired fasting glucose or IFG. This is a prediabetes condition. You do not have diabetes, but you are at high risk of developing diabetes in the near future.

Oral glucose tolerance test: This test involves drawing blood for a fasting plasma glucose test and then drawing blood for a second test 2 hours after you drink a very sweet drink containing 75 grams of sugar.

• If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, you are probably diabetic.
• If the blood glucose level is between 140 and 199, then you probably have impaired glucose tolerance, which is also a prediabetic condition.

Glycosylated hemoglobin or hemoglobin A1c: This test is a measurement of how high your blood sugar level has been over about the last 120 days-the lifespan of a red blood cell.

• Excess blood glucose hooks on to the hemoglobin in red blood cells and stays there for the life of the red blood cell, which is approximately 90 days.
• The percentage of hemoglobin that has had excess blood sugar attached to it can be measured in the blood. The test involves having a small amount of blood drawn.
• A hemoglobin A1c test is the best measurement of blood sugar control in people known to have diabetes. A hemoglobin A1c result of 7% or less is considered to indicate good glucose control. A result of 8% or greater is considered to indicate that your blood sugar level is too high too much of the time.
• The hemoglobin A1c test is also beginning to be used as a diagnostic test for diabetes. A hemoglobin A1c result greater than 6.1% is highly suggestive of diabetes. Generally, a confirmatory test would be needed before diagnosing diabetes.
• The hemoglobin A1c test is generally measured about every 3-6 months for people with known diabetes, although it may be done more frequently for people who are having difficulty achieving and maintaining good blood sugar control.
• This test is not used for people who do not have diabetes or are not at increased risk of diabetes.
• Normal values may vary from lab to lab, although an effort is under way to standardize how measurements are performed.

Diagnosing complications of diabetes
If you have diabetes, you should be checked regularly for early signs of diabetes complications. Your health care provider can do some of these checks; for others, you should be referred to a specialist.

• You should have your eyes checked at least once a year by an eye specialist (ophthalmologist) to screen for diabetic retinopathy, a leading cause of blindness.
• Your urine should be checked for protein (microalbumin) on a regular basis, at least 1-2 times per year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of kidney failure.
• Sensation in your legs should be checked regularly using a tuning fork or a monofilament device. Diabetic neuropathy is a leading cause in diabetic lower extremity ulcers, which frequently lead to amputation of the feet or legs.
• Your health care provider should check your feet and lower legs at every visit for cuts, scrapes, blisters, or other lesions that could become infected.
• You should be screened regularly for conditions that may contribute to heart disease, such as high blood pressure and high cholesterol.