Diabetes In Your Pet Monkey

Why It Happens In Captive Monkeys, What You Need To Do

 
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2ndChance Hospital

 

 

 

Ron Hines DVM PhD

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Is Diabetes Common In Pet Monkeys?

Diabetes is the most common disease affecting pet monkeys in the United States. It also occurs in zoo monkey, but diabetes is less of a problem there because the diets of those monkeys are often healthier. Zoo animals also have more space to exercise and they usually are kept in larger groups that keep them active and less centered on eating. It occurs in wild monkeys in Asia
and Africa when they are fed too much sugar and high calorie snacks by tourists.

Which Form Of Diabetes Is Most Common?

Type II Diabetes

Type II diabetes is also called non-insulin dependent diabetes mellitus (NIDDM). In humans it was also called adult-onset diabetes.
It is far and away the most common form of diabetes seen in monkeys. Early in this type of diabetes, the monkey’s pancreas still produces enough - or more than enough insulin. But the animal’s body has lost the ability to utilize the insulin in processing the blood sugar (glucose) that is in its system. This inability to utilize insulin to process blood sugar is called insulin resistance.

Gestational Diabetes

Just as in humans, pregnant monkeys are at a higher risk of becoming diabetic. But this is only if they are already headed down the diabetes road before their pregnancy. Pregnancy puts just enough extra stress on their insulin/glucose energy utilization system to make it fail at this time. Once the stress of pregnancy is over, the monkey’s blood sugar level usually returns to normal. But it will almost certainly become diabetic some time again even without the stress of pregnancy. Ref: 1 & 2

The best way to identify monkeys that are likely to experience gestational diabetes is through a glucose tolerance test that I discuss a bit later. If that test can not be run, persistent high-normal or high blood glucose levels or high A1C/fructosemide levels are a warning that your pet is likely to experience this problem if it becomes pregnant. Monkeys with gestational diabetes may appear perfectly normal. But they experience a high number of stillbirths, difficult births and deaths in labor (dystocia). It is one of the reasons it is dangerous to breed an old monkey for the first time.

When gestational diabetes is discovered in a pregnant monkey, the pregnancy can often be saved if the animal is immediately switched to a diet that is lower in sugar, fat and calories.

Type l Diabetes

This form of diabetes is much rarer in monkeys. It occurs when the monkey’s pancreas can no longer produced enough insulin. The pet’s pancreas has several functions. In diabetes l, the cells that normally produce insulin are destroyed by the animal’s own immune system.

When Type I diabetes does occur, it occurs in monkeys of any age that are not necessarily overweight. In humans, it was once called juvenile diabetes. When this rare disease occurs in monkeys, it is managed in the same way as the Type ll form. If it is considered possible in a pet monkey, it can be confirmed with a C-peptide assay with the results compared to a normal monkey of the same species.

Rotavirus

There are a number of simian rotavirus that cause transient diarrhea in monkeys. SRV-1 , YK1 , etc. Monkeys also develop diarrhea from infection with human rotavirus. Experimentally, one of these virus, RRV-1, has been found to produce or hasten Type l diabetes in mice. Whether it could have similar effects on diabetes in monkeys is unknown.

Is Diabetes More Common In Certain Species Of Monkeys?

When veterinarians think about type II diabetes in primates, they used to think about rhesus, cynomolgus and other macaques. We certainly see a lot of diabetes in macaques. But they are also the most common monkeys in the large research primate colonies in the US and Europe. With their full-time veterinarian care - we would naturally know more about their health. These research colonies are being managed better now. That, plus the fact that there are more New World monkeys than ever in private homes have changed the statistics of the disease.

It is hard to develop hard numbers regarding the prevalence of diabetes in pet monkeys because they are so scattered. But we know a lot about diabetes statistics in macaque colonies. Over 35% of the monkeys in these colonies have gone on to become diabetic sometime in their lives. In some colonies the incidence has reached 50%.

I know that Type II Diabetes occurs in rhesus, bonnet, pig-tail, Formosan and cynomolgus macaques; sacred and mandrill baboons, tamars, tamarins, monas, bushbay, green vervet monkeys, capuchins, guenions, squirrel monkeys, chimps, orangs, gorillas and bonobos. That probably means that given the proper risk factors, any species of monkey will develop diabetes II.

Woolly monkeys have always been a tough species to keep successfully. Gestational diabetes (a form of Diabetes II) and high blood pressure have always been a problem when raising them.

Diabetes is very prevalent in pet capuchins – but there are so many of them around.

We see diabetes occasionally in prosimian lemurs as well. Unlike monkeys, these animals , when diabetic, can usually be managed indefinitely with diet change and oral hypoglycemic medications.

What Are The Risk Factors That Would Make It Likely That My Monkey Will Develop Type II Diabetes?

Monkeys that are at higher risk of developing Diabetes have many - if not all - of these important things in common. The 10-point life style :

1) They are feed too many sugary, starchy and fatty foods
2) Their total daily food intake is too high
3) They were bottle fed as infants
4) They do not receive enough fiber in their diet
5) They are overweight
6) They live alone or in very small groups
7) They live indoors
8) They do not get enough exercise (sedentary lifestyle)
9) They are not given enough stimulating activities
10) They are middle-aged

At What Age Does Diabetes Commonly Occur?

It is possible to predispose a monkey to diabetes very young. But the signs of the disease do not generally become apparent until the pet is a mature adult. Basically, the earlier in life the monkey’s weight, blood sugar, triglycerides and cholesterol rise above normal, the earlier in life it will develop type II diabetes.

In a large rhesus monkey colony , it was found that 30-50% of the animals that were allowed to eat as much monkey chow as they desired, became diabetic at some point in their lives. The earliest ones were about 10 years old at the time – equal to a human of 20. The oldest was 29 years – equal to a human of 75. Based on high blood sugars (over 126mg/dl), 5% were diabetic at 10-14 yrs, 20% at 14-18 years, and 50% when over 26 years old.

Are There Any Signs That My Monkey Is In A High Risk Group?

If your pet monkey lives the Ten-point life style I mentioned earlier, it is in the high-risk group.

Your monkey is also in a higher than normal risk group if:

1) It has had several fasting blood glucose reading of over 80mg/dl
2) It’s fasting triglycerides level is over 37mg/dl
3) It’s fasting cholesterol level is over 110mg/dl
4) It’s high-density lipoprotein (HDL-C) is less than 48mg/dl
5) It is overweight

The sugar metabolism of monkeys in the high risk group needs a second look.
Monkeys, like humans, process sugar abnormally long before they begin to spill sugar into their urine or develop other symptoms of diabetes.

If your female monkey develops recurrent or persistent urinary tract infections, wounds that do not heal, self-mutilation, sudden loss of weight, depression, apathy, miscarriages, stillbirths, uterine infections or any other evidence of chronic disease, it’s urine and blood sugar levels need to be checked as well.

What Are The Signs I Will See If My Monkey Does Develop Diabetes?

Many owners do not realize their pet has a problem until it is late in the disease. Diabetes creeps up slowly. By the time symptoms are obvious, they are often due to irreversible destruction in basic body organs due to many months or years of high blood sugar. In monkeys, blood sugar levels tend to be 15-25mg lower than they are in humans in the various stages of diabetes.

These tasty, but deadly diets that cause diabetes in monkeys are too high in sugars, carbohydrates and fats. But they are usually deficient in balanced proteins, vitamins, and minerals. So other disease problems usually complicate matters - give a mixed bag of signs.

The first sign owners often notice is more frequent urination and drinking more. As I mentioned earlier, recurrent urinary infections and urine dribble are also common.

Although pre-and early diabetic monkeys are fat, they loose weight as the disease progresses. Sometimes the first signs that alert owners that something is seriously wrong with their pet is general listlessness, apathy for the things the monkey used to enjoy doing and a lack of interest in its favorite foods.

Mouth infections and dental problems have been related to underlying diabetes. In capuchins, regurgitating and reswallowing their food has been associated with diabetes; although these same signs can occur for many other reasons.

Some monkeys develop cataracts and vision problems (retinopathies) . Others no longer use their tails as they used to - due to diabetes-induced nerve damage (neuropathy).

In other pets, the persistent high blood sugar of diabetes damages the pet’s kidneys.

Eventually, the depression, listlessness and disinterest in food progress to coma and death.

What Tests Will My Veterinarian Run?

If your veterinarian is suspicious that your monkey might have a diabetic or pre-diabetic problem, the first thing the vet will do is look for sugar in your pet’s urine. The urine sample does not need to be taken at the veterinarian’s office – but it needs to be refrigerated or placed on ice until it arrives there. Sugar in the urine is quite stable for 24 hours, although the glucose level will go down with time if the sample is highly contaminated with bacteria.

If the urine sample is positive for sugar, the veterinarian will want a blood sample. That is something your monkey will not like – but it needs to be done. Giving the pet a ketamine injection to keep it still for the blood draw will not affect the results as much as forcibly restraining a frightened monkey. Stressing the monkey during blood collection is why published figures on blood sugar level in primates tend to be too high. Bring your monkey to the vets office in a pet carrier still wearing a tethered collar – not on your shoulder. Schedule an appointment when the waiting room is not full of waiting clients, dogs, cats and children. If you use a house call vet, have the monkey caught up before he/she gets there. Be sure a larger monkey has not eaten for 6-8 ours on the day of the visit. If you have marmosets, squirrel monkeys or other monkeys of less than 3 pounds – ask the vet how long you can safely fast the pet.

The veterinarian will send the blood sample off to a central testing laboratory. I prefer national labs because their testing machines give more accurate results than smaller, in-office machines.

Many things other than diabetes can cause a single blood glucose reading to be moderately higher than normal. The most common ones are stress, fear and agitation (stress hyperglycemia) . This problem can also make mild cases of diabetes appear to be more severe than they actually are and it can give false reading to other tests as well. Monkeys know “when something is up” and begin releasing blood chemicals that raise their blood sugar levels.

What is considered to be a normal blood glucose level varies between laboratories and veterinarians. But some normal fasting blood glucose level that are considered normal are: common marmoset, about 126mg/dl (30-150), Capuchins 44-94 (although some report higher), lemurs 127 (55-180), owl monkey 130, rhesus 53-80, cynomolgus 40-123, baboon 80-95, chimpanzee 62-94, capuchins 47-73. If your pet’s fasting blood glucose reading is much above these values, it needs to be retested at a later date. In the USA, figures are given in mg/dl (milligrams per deciliter) if you live outside of the USA; they are given in mmol/l (millimoles/liter), in which case you need to multiply the amount by 18. If you want more data, you need access to the ISIS website.

What If, On Several Occasions, My Monkey’s Blood Glucose Level is Higher Than The Values You Gave ?

If you find that your monkey’s fasting blood glucose levels are only moderately higher than the ones I gave, several other blood tests should be run:

Intravenous Glucose Tolerance Test (IVGTT)

The theory behind this test is to give the monkey’s system a large sudden dose of sugar to handle and see how efficiently the pet deals with it.

In humans, the glucose used in this test is given orally. This can be done in monkeys. But when liquefied sugar is offered to monkeys, it is hard to know if all was eaten in an acceptably short period of time. Besides, many monkeys become suspicious and don’t drink it. So the sugar solution is usually give intravenously (0.25 - 0.75 gm/Kg). It is best if the monkey is given a low dose of ketamine or another immobilizing agent to calm it during the glucose injection. This is usually done through the saphenous vein – the long, easily visible vein that runs down the inner side of your monkey’s leg. If the rapid method is used, a blood sample is taken jut before the glucose is injected and a sample taken 30 and 60 minutes later. If the more accurate method is used, a blood sample is collected 5,10,20,30,60 and 120 minutes after the glucose is injected (I just don't like stressing out the monkey so many times). Then a number, called the K-value is calculated. In normal squirrel monkeys, K values should be around 7.75 +/- 2.84 with peak blood glucose level at 15-30 minutes . In normal cynomolgus monkeys, the K value should be 3.12 +/- 0.48 with blood glucose peaking at 5-30 minutes.

Immunoreactive Insulin Level (IRI)

Because performing the glucose tolerance test is complicated, some veterinarians rely on another simpler test, fasting blood insulin levels, to confirm diabetes in monkeys or identify monkeys that are in the pre-diabetic stage of the disease. In one study, apparently normal Rhesus monkeys, had fasting plasma insulin levels of 20-70 µU/ml. While those that were diabetic, or on their way to become diabetic had levels of 100 or higher. In another, normal rhesus monkeys had fasting plasma insulin levels of 123 ± 37, while pre-diabetic and diabetic monkeys had levels as high as 623. John's Hopkins/U.MD considers fasting plasma insulin of up to 70 µU/ml to be normal in their rhesus monkeys.

A1C Glycolated (glycated, glycosylated)Hemoglobin & Serum Fructosamine

If you or your veterinarian suspect that catching and holding down your fearful monkey falsely raised its blood sugar value, the A1C test (Ref 2) or the serum fructosamine test may clear the question up.

These are also a good test to see how well you are doing in the long term management of your monkey’s diabetes. The value of these tests are that they reports what the average blood glucose level has been in the pet over the last 120 days or so. Normally , non-diabetic monkeys stay about 5% glycated. The test does not appear to work well in lemurs. Because labs and veterinarians run so few of these tests, it is best to submit the sample from your monkey with one or two samples from healthy monkeys of similar age and species.

Nerve Conduction Studies

Monkeys that have suffered from diabetes for extended periods of time loose nerve function just like humans do. If you have a diabetic monkey that is loosing its normal agility, reluctant to hang by its tail, limping, or loosing bowel or bladder function, nerve conductivity studies can confirm that it is due to diabetes-caused nerve degeneration ( diabetic neuropathy). There is nothing that will repair these damaged nerves, but cage and lifestyle modifications will keep the monkey's life as pleasant as possible.

Why Did My Monkey Develop This Problem?

Although monkeys sold for pets in the US are more inbred than they should be, there is no real evidence yet that genetics has any part to play in the development of diabetes in pet monkeys as it sometimes does in people .
With time, that may no longer prove to be the case (Ref 2) .

Mother monkeys housed in stressful situations (small cages, incompatible side-by-side groups, etc.) can have hormone surges that lead to abnormal fat metabolism in their babies – a risk factor for later diabetes.

Bottle-fed Infants And Stressed Mothers

Even if we don't know if genetics plays a role in diabetes in pet monkeys, we do know that what is fed to baby monkeys from birth probably does influence their susceptibility to diabetes later in life. . It also influences their lifelong taste preferences and eating habits.

Go back to the Ten Point Life Style that I mentioned earlier and you will recognize the factors that lead to your monkey’s current problem.

Too Many Sweets, Starches And Fats

Monkeys are perpetual children in their taste preferences. Given their choice, they will always go for the sweetest, starchiest and fattiest foods available. And they will instinctively eat them greedily and quickly so the rest of their imaginary troop doesn’t eat them first. Eating any of these foods in quantity is a path directly to the doorstep of diabetes.

Eats Too Much

We know that monkeys, given the chance, will eat too much for their own good. We know that in rhesus monkeys, eating 30% less calories over their lifetime considerably reduces the incidence of Type II diabetes. and greatly increases how healthy they will be and how long they will live. Ref 1, Ref 2 . Most pet monkeys are very small in relation to us. It is very easy for you to over-estimate its food needs based on what you, yourself eat.

Not Enough Fiber

The natural diet of monkeys in the wild is much higher in fiber than the diets we usually feed pet monkeys. Even store-bought fresh produce, fruit and many vegetables have considerably less fiber that the foods monkeys normally eat in the wild. For example, wild jungle fruit have much more fiber, more protein, a lower sugar content and different sugars than the cultivated fruits and berries that we buy in supermarkets. Ref 1

Inactivity – Not Enough Exercise

Bad diets, too much food and inactivity = fat monkey. In the wild, food does not come easy. In the movies, the jungle is full of fruit, nuts and berries. But it really isn’t that way. Monkeys must climb and travel long distances throughout the day to find enough to eat. In doing so, they burn a lot of calories and get the exercise they need to keep their bodies healthy. That just doesn’t occur in cages, and home environments where food arrives in a bowel every morning. God did not design monkeys to live a lazy life style in a human family. In the wild, monkeys in a group are constantly interacting, chasing each other and vying for their place in the peck order. The Alpha individuals regulate the food intake of all the subservient monkeys in the troop and, themselves, burn more calories doing so and guarding the group from danger.

Birth Control Products

The implantable and injectable birth control products sometimes used in monkeys puts them at risk for Type II diabetes. as it does in women and cats.

What Treatments Are Available?

Oral Hypoglycemics Medications

Some monkeys, with early diabetes, can be manged with medicines that are given orally. Not all can. And many will need injections of insulin as time goes by. They work best when the monkey's body weight is returned to normal with proper diets. They are just as easy to overdose with as the injectable products. If the container of good-tasting medicine is left around where the monkey can drink it, it can be fatal.

The standby medication in this group is Glipizide (Glucotrol), although there are a number of similar compounds in this group (sulfonylureas). It works best in monkeys when diabetes is mild and when it is combined with a strict, healthy diet. It has been used successfully to control diabetes in monkeys at 1.25mg/kg given once a day. Ref 1, Pfizer ref

Another oral hypoglycemic is metformin (Glucophage). It has been used in rhesus monkeys for short periods to control gestational diabetes. It might have advantages in monkeys that are known to have already developed heart disease or in combination with glipzide when glipzide alone is not keeping blood glucose levels under control. The pet's kidney function needs to be adquate to handle metformin and no long term information on its use in monkeys is available. In humans, metformin also helps diabetics to loose weight and seems to keep their triglyceride and cholesterol levels lower.

Before resorting to giving these medications to your monkey, you should see if controlling its diet alone is enough to keep its blood glucose level in the normal range. Although once-a-day dosing is sufficient in people, small monkeys can metabolize drugs at different rates than humans and may need their medication more or less frequently. This means that a slightly wrong dose or missed breakfast can put your monkey into a state of potentially fatal hypoglycemia. ref 1 . Kleiber’s law

Another drug in this group, tolbutamide (Ornase®), has been used to control blood sugar levels in capuchins.


Scientists are always looking for oral alternatives to insulin injections when treating diabetes in humans and most of the products that are in development eventually get tested in monkeys. But I do not know of any veterinarians using these agents to treat pet monkeys.

Insulins

Unlike dogs and cats, there is very little difference between the insulin human bodies make and the ones monkeys make. So the human insulin’s that pharmacies sell tend to work well in monkeys. As with humans, monkeys on insulin injections need to have their blood sugar level monitored frequently and their insulin doses adjusted. Particularly when they are just beginning their injections or when their situations change.

No matter which insulin is used, it is best to begin at half the calculated required dose – just to be safe. If too much insulin is given, the monkey will go into shock (hypoglycemia). After beginning cautiously, the dose should be slowly adjusted upward depending of the pets glucose level after it has eaten (postprandial blood glucose level).

There are a number of insulins on the market. They are sold in rapid acting, short acting, intermediate acting and long acting forms.

NPH Insulins

NPH insulin; also known as Humulin N, Novolin N,Novolin NPH, NPH Lletin II, are intermediate-acting insulins that cover insulin needs for about half a day . It is recommended by Carpenter at 0.25-0.5 units/kg per day as a starting dose.

When given in its 70/30 form it worked well in rhesus monkeys when given at 0.25 IU/kg twice a day.

Porcine (Pig) Insulin

Porcine insulin is still available because it works better than human insulin in dogs and cats. It has been replaced by human NPH insulins in treating people because human insulins are less likely to cause eventual destruction of the product by the patients own body - this may also be true in monkeys. But porcine insulin has controlled diabetes well in monkeys – at least for limited periods of time – when given twice a day. I would avoid using it in pet monkeys for the same reason it is no longer commonly used in people.

Long Acting Insulins

Long-acting insulins (Ultralente (U), Lantus and Levemir (detemir), etc.) can control blood sugar levels in people for 20-36 hours. They do control blood sugar levels in monkeys - but not for as long a period as they do in humans.


No matter what insulin you and your veterinarian choose to use, your pet’s blood glucose level needs to be checked frequently and its urine needs to be regularly checked for sugar or ketones. A chart also needs to be kept of your pet’s body weigh to be sure things continue to go well. In this way, the insulin dose can be fine-tuned to the monkeys daily needs. These will vary with daily activity level, food type and amount, outdoor or room temperature and stress level. The required dose is likely to creep up with time as the disease progresses.

Fenofibrate

This drug has been used experimentally in fat rhesus monkeys. Incidental to its intended use, it was found to also lower their blood insulin levels as well as their triglycerides and bad cholesterol. It is not a drug that will control diabetes in pet monkeys, but in high diabetes risk pets that have failed to loose weight dieting and who have persistently high blood triglycerides levels - the drug might offer some help.

Larger Enclosures

With enough exercise, many monkeys can get off insulin – at least for a while. Most private owners just do not have enough space to build zoo-size enclosures and islands. What I have found helpful is to construct long hanging “skyway chases” runs or tubes at different heights leading to smaller enclosures. Plenty or ropes, resting ledges and environmental enrichment are also very important.

Return To Group Living

When you have to choose between the responsibility of treating a diabetic monkey in your home situation and curing the animals through moving it to a new home – sometimes the kindest thing you can do for your furry friend is to send him to a place where its health will improve. There are many monkey refuges in the United States that re-introduce monkeys to more natural group settings. You will be able to find one that will let you visit your friend from time to time. This does not always work – but it often does. In my experience with rhesus and capuchins , three out of four monkeys can learn to be monkeys and not human children again. I do not like to see human imprinted monkeys abused by monkey-imprinted animals - even when intentions were good. Do not leave off a monkey if there is no prior agreement that the refuge will returned it to you if group living does not benefit its health. In rhesus monkeys, blood glucose levels can rise and fall depending on their social setting.

How Long Can My Monkey Be Successfully Treated?

The length of time a diabetic pet monkey can be successfully treated depends entirely on how tightly its blood sugar level can be controlled and at what stage of the disease treatment is begun. With good care, 10-12 additional years is possible.

Nutrition

I discussed some of the factors that I believe cause the high incidence of type II diabetes in pet monkeys earlier. Of all the factors, what and how much the monkey eats is by far the most important. Please also read my article on chubby monkeys.

Properly caring for diabetic monkeys and lemurs means limiting their consumption of simple sugars, starches and fats and increasing the amount of fiber in their diet. It also requires spreading their meals throughout the day to minimize spikes in their blood glucose level. You can do this by eliminating all sugary fruit and starchy vegetables from their diet and increasing the amount of green vegetables and fresh leafy browse and alfalfa cubes they get and by switching to a primate biscuit that is higher in fiber. Items like unsweetened canned or cooked pumpkin are excellent, as are green beans.

The Wisconsin (ref 2) primate nutrition study proves that following this type of program can increase the lifespan of monkeys from 50% to 80% over a twenty year period.

So does the fact that no monkey living in a wild setting has ever been found to have diabetes. Orangutans and chimps were once thought to have a high natural incidence of diabetes. But once they were given higher fiber diets, more exercise space and environmental enrichment, the disease became much less common. .

I personally saw dramatic health improvement in my spider monkeys when I eliminated sugary and starchy fruits from their diet.

It does not take long for the bad effects of a rich diet to take effect. Marmosets placed on a high fat diet (that they loved) had a 27% increase in their weight and a 51% increase in body fat. Their blood glucose, cholesterol and triglycerides shot up significantly.

Many primates that normally eat high-fiber plants are fiber fermenters. That is, they are designed to eat very fibrous plants that have little available nutrients. These primates are designed to get a large portion of their nutrients from healthy bacteria that live in their digestive system. These bacteria break down the tough plants into produce nutritious short-chain fatty acids and microbial protein , which the monkey can absorb – similar to grazing animals
Many lemurs, colobus, langur and howlers fit into this group, capuchins, and squirrel monkeys do not. Macaques, chimps, spiders and and baboons fall somewhere in the middle.

If you plan to make modifications in your monkey’s diet, do so very gradually. Do not do anything major without first purchasing an accurate digital scale and getting the pet used to standing on it. Purchase a second food scale to weigh what you feed the pet.

Be especially cautious when changing the diet of ill monkeys or monkeys in fragile health due to the effects of diabetes - eating anything is always preferable to eating nothing. While you change diets, add a complete human pediatric multivitamin. Put the drops in its mouth, not on its food and do not exceed the bottle’s recommendations for human infants. Mix new foods with familiar old foods, experiment with ingredients chopped to many sizes and present the food in many ways and at different times of day until you find out what works best. Do not be concerned if the monkey experiences transient diarrhea as it adapts to higher fiber foods. Rinse all fresh produce with mixture of one tablespoon households bleach in a gallon of water and then let the produce drip dry and rinse it again before giving it to the monkey.

Increased Dietary Protein

In people, a modest increase in the amount of protein consumed, in relation to the amount sugars and other carbohydrates, lowers blood sugar levels - sometimes as significantly as giving oral anti-diabetic medications. Ref A primate research scientist recently pointed out to me that this may also be true in monkeys and that increasing the protein and fiber in their diets could have beneficial effects in stabilizing their diabetes.

Gastric Bloat

Monkeys are fast eaters - particularly when they are hungry or worry that someone else might eat their food. When you put your monkey on a diet, you must be very cautious to avoid a problem called gastric bloat or gastric dilitation. I only saw this problem in monkeys fed diets with a high proportion of commercial monkey chow biscuits. The problem with these biscuits is that they swell after they are eaten. Vets only notice the problem when it is fatal. But I am sure it causes many more tummy aches than fatalities. So either soak these biscuits before you feed them or, better still, feed them only in small portions throughout the day. You can also pass them through a meat grinder and add the crumbles to other things you feed. dis.ref

Hypoglycemia

Hypoglycemia (dangerously low blood sugar level) is the greatest risk when treating diabetic monkeys. Most monkeys do not weigh very much. So very small changes in the amount of diabetic medicines you give will have great effects. This goes for establishing the initial dose and for changes upward in their daily dose. If you utilize a human diabetic specialist or nurse technician that deals with human diabetics, they may recommend dose changes that are to large or too abrupt because they have not dealt with many patients as small as your monkey. Do everything much more gradually as it is generally done in adult or adolescent humans.

Also, do not begin establishing the insulin dose and a major dieting plan at the same time. Cutting back you monkey's calories will increase the power of the insulin dose or tablet. When you begin the dieting , blood glucose levels need to be checked frequently again because the correct amount of insulin the animal needs - and possibly the frequency - will drop.

What Is The Best Way To Give My Monkey His Insulin Shots?

First off - you are going to get bitten doing this. Read my article on the dangers of monkey bites. If you are uncomfortable with what you read there and the potential risks to your health, you have no business working with monkeys.

As you know, or will soon find out, getting a monkey to cooperate in receiving shots can be quite a challenge. Monkeys are highly intelligent, you won’t outfox one more than once with any particular trick. They are fast as lightening as well. The only way you will succeed in getting your pet to take insulin is if the monkey receives something it really wants in return for letting you give it the shot.

Begin by buying some diabetic injection syringes with needles attached. For small monkeys, use the smallest and shortest gauge of needle available (31-G, 8mm). These needles cause the least pain and they are the least likely to cause damage if the monkey moves. You cannot inject them as quickly as you can with the larger diameter needles – so if your monkey is going to fidget, you may not be able to use them. Most monkeys resent being covered with a towel and will squirm even more and fear the towel the next time you try to use it.

Take one syringe and break off the needle. A week or two before you attempt to give an injection, get the monkey to associate the syringe with a food treat it really likes. I know, I told you not to give treats. It is the flavor of the treat – not its amount – that the monkey is going to think about. It need be no larger than a single raisin. Continue doing this every day until the monkey willingly sits for the syringe procedure.

Many monkeys can be trained in this way to present their arm, leg or tail through a cage for their daily insulin shots. If it won’t give you its arm – try to teach it to lean against the cage as you offer it treats. This technique usually works – most, but not all monkeys will accept it. Ref 1 , Ref 2
Scientists call this technique, operant conditioning. Watch how it is done in cats on U-tube

Use the same technique to try to get your monkey to cooperate in checking its blood glucose with a meter. Watch the technique used in cats on the Marvista site as well and network with experienced monkey owners. If you prick the monkey’s fingers, do not prick on the side that has the finger prints. I prefer pricking their tail - clip off the hair on a small area near the end.

If all else fails, you can roughly judge the effectiveness of the insulin dose by measuring the amount of glucose in the monkey’s urine. This is not an accurate way to plan or keep up with the health of a diabetic monkey – but sometimes it is the only way. The danger in only doing urine checks is that you will not be warned if you are giving too much insulin and you will not know if you are not giving enough until the monkey’s blood sugar level is above 160-180 mg/dl or so.

When it comes time to load the syringe with insulin, get exact instructions from your pharmacist. Diabetic syringes are often marked in several scales and it is very easy to become confused as to the number of units you are injecting. Once you pick a brand of syringe and needle, stick with that brand. If you change, ask the pharmacist again to show you which mark represents the correct number of units. Overdosing because of syringe confusion is the most common accident when giving insulin.

Are There New Treatments That Might Help?

There are a number of ultra-long acting insulins in the human drug pipeline. I know that one of these, GlaxoSmithKline’s GLP1- Syncria (albiglutide) , has been tested in monkeys. These insulins are designed to keep blood glucose levels in check for a week or longer after a single injection.

DPP-4 Inhibitors such as sitagliptin (Januvia), might have use in diabetic monkeys. There were some skin problems and rashes associated with Januvia, a once-a-day oral tablet, when Merck used it in rhesus monkeys. Merck has since added other warnings to the drug label including difficult breathing and potentially fatal skin reactions.