In some dogs, even the prolonged duration insulin is used up very quickly and is no longer effective after 12 or 14 hours. This means that clinical signs will reappear in the second half of the day. This situation is best discovered by serial glucose analyses (12-24 hour blood glucose curve) and can be remedied by the use of twice-daily injections or a longer acting preparation.
In diabetic animals treated with insulin there is some risk that hypoglycemia may occur. It is rare for a dog or cat to die of this condition but it is possible and owners should be appropriately warned and trained by the veterinary team responsible for their pet’s management. It is most likely to happen if the animal is accidentally over-dosed with insulin, over-exercised or fails to eat its morning meal. The first noticeable clinical sign is hunger followed by lethargy and sleepiness. If untreated, stumbling and staggering ensue followed progressively by twitching, convulsions, coma and death. If the animal is still conscious, treatment is by offering food, particularly glucose containing foods such as biscuits or chocolate. If it is unable to eat, then glucose must be administered by mouth or by intravenous injection. Honey, corn syrup, or glucose gel will be absorbed quickly through the mucosa if poured into the side of the mouth.
Ketoacidotic animals are usually collapsed, dehydrated and smell of ketones (like nail polish remover). These dogs require more intensive therapy than normal diabetic dogs and this should include intravenous fluid and special IV insulin therapy. Often the treatment of diabetic ketoacidosis is an intensive care situation.
The blood glucose concentration in the normal pet is between 80 and 120. Diabetic animals cannot be regulated this well and are considered under control if their blood glucose concentration is maintained between 65 and 220. Low blood glucose concentration (hypoglycemia) and high blood glucose concentrations (hyperglycemia) can be expected from time to time even in the stabilized diabetic. Most diabetics will have normal control of their blood sugar concentration and can compensate for lower blood glucose by releasing cortisol, which increases blood glucose. If the glucose concentration exceeds 220, there will be large quantities of glucose present in the urine. The signs of hyperglycemia (lethargy – dullness) do not usually occur until the pet has been severely hyperglycemic (400) for several days.
Check-list For Clients With Diabetic Animals
Puppy Housebreaking Pads or Depends Pads
(If the pet is urinating frequently)
Puppy Housebreaking Pads are scented to attract dogs to use them. They can be substituted with Depends® Pads, which are much less expensive. If your dog will not use the Depends, try putting a couple of drops of their urine on the pad.
Glucose Test Strips for Urine
Use these test strips to check whether glucose is still spilling into the urine while the pet is being regulated. Do not use the test strips once the pet is close to being regulated, as the strips only indicate when the pet’s glucose levels are still high. They do not tell if he/she is getting too low. Once your test strips read negative, switch to a Blood Glucose Meter.
Use only the Insulin prescribed. Do not change the dosage or schedule without first consulting us. If you have never given an Insulin injection, do not attempt to do so without proper instruction from your pet’s health care professional. Insulin should always be refrigerated. Opened Insulin should be discarded after 30 days, regardless of the expiration date.
There are syringes made especially for injecting insulin. Consult your veterinarian or your pharmacist for the proper gauge syringe to use on your pet. Reusing your syringes may result in contamination or infection.
White Corn Syrup (or other veterinary approved glucose source)
Always keep this on hand in case your pet has a hypoglycemic episode. If you travel or leave your pet with a sitter, always make sure you have some on hand.
Blood Glucose Meter
Blood Glucose Meters are used to check the pet’s blood glucose levels. We use the same meter for pets as for humans, but beware. Some meters require large samples of blood, which may be difficult to obtain from the pet. Blood meters are an expensive item, so make your choice wisely. Also keep in mind the cost of the test strips for the meter, when making your choice. Read the instructions carefully, and make sure the meter is properly calibrated with each new box of strips.
Lancing Device and Lancets
These normally come with the Blood Glucose Meter purchase. You may be able to use the lancing device to prick the skin, depending on how thick the skin is. Using the lancets themselves, and manually poking the ear very quickly may work for some clients. Holding a piece of cardboard, or something solid behind the ear, aids in this process. Warming the ear also helps the blood flow. SoftClix® lancing device has been shown effective in most pets when set at the highest setting.
Proper food prescribed by your veterinarian
Do not stray from the feeding schedule provided. Always feed the proper foods, and do not allow any deviations. If the pet is accustomed to treats, ask about treats that are allowed in the diet.
Pet sitter with knowledge of Diabetes
If you have to leave your pet for a long period of time, make sure you have a care taker who can give injections and recognize the symptoms of Hypoglycemia. Some pet sitting services offer this knowledge. Make sure you leave the service with phone numbers to get in contact with your veterinarian. Your best choice is to leave your pet at the veterinary clinic, or at the home of a qualified employee of your veterinarian.
Medical Alert Tag
Most of the companies that manufacture pet tags, offer a medical alert tag. In case of an accident, or the pet getting lost, this alerts the finder of the medical condition. It contains the number of the veterinarian so the finder can contact us. It is a good idea to denote on the tag that the owner will pay all medical expenses. This will let the finder know they are not obligated to pay the medical bills for the animal, ensuring the pet gets the proper medical attention.
Client Questions Regarding Diabetes
Q I think my pet may be diabetic, what are the symptoms?
Excessive urination, excessive water consumption, weight loss (or gain), Increased appetite, Exercise intolerance, cataracts, infections (particularly of the bladder).
Q My pet is having problems holding its urine, does that mean it is diabetic?
Frequent urination is a sign of bladder infection, bladder stones or other irritation to the bladder. Large volumes of urine can be due to kidney failure, excessive water drinking, or diabetes insipidus or other problems. If your pet is having problems with excessive urinations a veterinary examination is in order.
Q How much water should I let my pet drink?
If your pet is diabetic, and drinking excessive amounts of water, give him/her all they can drink. Your pet’s body is trying to combat the high blood glucose level by expelling the excess sugar out of their body through the urine. Once your pet is regulated this will stop
Q My pet was recently diagnosed, what advise would you give me?
Learn everything you can about diabetes. Talk to our veterinarians, your personal doctor, other owners of diabetic animals, and friends or relatives with diabetes. Your pet’s recovery will depend a lot on what you know. You will need to work closely with our veterinarian(s), and offer your input. Don’t be afraid to ask questions, or ask for training from us on giving injections and monitoring blood glucose levels.
Q My pet has been diagnosed with Diabetes Insipidus, is this similar to Diabetes Mellitus?
Even though the symptoms are similar, the causes and treatments for Diabetes Mellitus and Diabetes Insipidus are completely unrelated.
Q How long will my pet live after diagnosis?
If your pet is older, the average life span after diagnosis is about 3 years. Each pet is different, and depending on overall health, your pet could live longer than 3 years, or sometimes less than a year.
Q Is diabetes in animals similar to that in humans?
Yes, it is very similar. When looking for information, don’t pass over the information on human diabetes. They are often excellent resources. Your pet will be using the same medications, equipment and monitoring methods as human diabetics use.
Q Are there other pet owners I can talk to?
Yes, please talk to our staff about a list of people who have pets with diabetes. They will offer helpful advice.
Q What is the importance of making sure my pet is regulated?
Diabetes that goes unregulated will eventually cause disease of major organs such as the liver and kidney. Ketoacidosis that results from persistent high blood sugar causes coma and death. Other signs include cataracts and blindness as well as neurologic deficits.
Q How long does it take to regulate an animal?
Each animal is different. The simplest cases are regulated within two weeks of administration of the insulin at home. Some animals will require hospitalization for a period of time. Others will require adjustment of the insulin after a Glucose Curve is performed. Most animals are regulated within 4 to 6 weeks of diagnosis.
Q My pet is ill, and not eating. Should I still give the insulin?
Ill pets require insulin to prevent ketoacidosis, therefore, give one half the regular dose. These animals that are not eating or drinking or that seem to be getting worse need to be seen by the veterinarian as soon as possible.
Q How can I monitor the blood glucose at home?
During the first phase of regulation, you can use urine strips such as Diastix, to monitor your pets glucose level. They can be purchased in most pharmacies, and are inexpensive. Your pharmacist can normally help you find the right product if you are unsure. Once your pet is regulated, and the strips start reading negative, they are no longer an accurate judge of your pet’s condition. Glucose Meters are available which require only a small quantity of blood. You may obtain the blood by using a lancet on the ear or footpad of your pet.
Q How do I choose a Blood Glucose Meter?
Consider that most good meters are over $100.00. Consider this as well as the quantity of blood and the cost of the test strips that are used by the meter when purchasing. You will want to practice collecting a blood sample prior to purchasing a meter to be sure this is right for you and your pet.
Q How do I get a blood sample?
Sometimes it is very difficult to get a sample. The ear is the most common location. Anywhere on the ear may be used if a small sample is required. Larger samples can be acquired from the ear margin. The ear should be massaged or heated with a lamp to stimulate circulation prior to the collection. The base of the ear just below the site of blood collection should be held tightly between the thumb and forefinger to act as counter pressure and distraction while collecting the sample. A lancet is used to prick the ear. Automatic lancets work well and the “SoftClick”® has a good reputation with pet owners. Manual lancets may also be tried. After the ear is lanced continue to hold the ear with one hand while the other uses the foil wrapper of the test strip to collect the blood drop. The pet is then released and the blood is transferred to the test strip. The foil is easier because there is less need for precision than the test strip. After the pet is let loose there are two hands to accurately place the blood into the test strip. The hind food pad has also been used in cats as a easy place to collect a sample. The foot is pulled back and the largest pad is used. The automatic lancet is usually not felt by the pet and the blood is collected onto a transfer surface (foil) and the pet let free while the rest of the test is performed.
Q What is the life span of insulin?
Unopened insulin is good until the expiration date on the package. Opened insulin is discarded after 30 days. There is no need to take a chance on your pet. The more times you use a bottle of insulin the more chance it will be contaminated with bacteria. Some people recommend the insulin bottle discarded after 100 punctures.
Q Are there any alternatives to the insulin injections?
There are oral medications that are helpful in humans and felines, but right now, injections are the only treatment for Canine Diabetes Mellitus.
Q Should I reuse the insulin syringes?
We do not recommend reusing syringes or needles. There is a greater risk of infection by following these practices. We recommend using one syringe/needle and then discarding it.
Q What should I do if I am not sure the injection went in the pet?
Never give a double dose. Do not give another dose or half dose. Your pet will be fine if it misses one insulin dose. If you are not sure about your technique, please ask us to help you.
Q Should I feed my pet before or after the injection?
It is important that your pet eat in close proximity to the time you give the insulin. If your pet does not eat, the injection of insulin could be more that the body can tolerate. Hypoglycemia may result. To prevent this, feed your pet 20 minutes prior to the injection.
Q What can I give my pet as a treat?
Science Diet Light Formula Treats are good for pets with diabetes. Do not give any other people food as this may greatly upset the balance that we are trying to maintain.
Q What is the typical diet?
A consistent diet is necessary since a consistent amount of insulin is given. Any variation will cause the insulin amount to be too much or too little. Higher fiber foods slow the glucose absorption and even out the need for insulin. These diets are Science Diet W/D and R/D.
Q What are the symptoms of Hypoglycemia?
Low blood sugar causes mental confusion first followed by lethargy and sleepiness. If untreated convulsions may result followed by death.
Q I think my pet is having a hypoglycemic episode, what should I do?
If the animal is still conscious, offer food – sweet food is acceptable in this case. Candy, chocolate, peanut butter. If the pet is not able to eat then corn syrup, honey or other thick sugar water can be rubbed into the mouth. It can be absorbed directly through the gum tissues. Rectal administration can also be successful in seizing animals suing a tube and syringe.