Diabetes Mellitus is the Diagnosis - What Next?
First, an insulin type and dose will need to be selected. There are several types of insulins and it is not possible to know how much insulin your individual patient will require. Most pets require injections twice a day, approximately 12 hours apart, following a meal.
Proper Insulin Dosing
You may not be surprised to find that the most common reason for a pet having difficulty achieving regulation is that the owner is not giving the injections properly.
To determine whether dose adjustments are needed (or if a different type of insulin is more appropriate), the patient will need a glucose curve where blood sugar levels are monitored every 2 to 4 hours or so for 12 to 24 hours. This kind of testing tells you how long the insulin injection is lasting as well as what the lowest and highest glucose levels of the day are. It is important to find out when the patient's curve is due. Often in the beginning, it takes several dose selections and several curves before the right dose is determined.
What About Home Glucose Testing?
Not every pet is amenable to getting pricked with a lancet so that a drop of blood can be harvested for testing. We do not want the pet to fear interaction with their owner. Some pets are comfortable with periodic glucose monitoring at home and home testing may work best for pets that become so agitated by going to the vet that their blood sugar levels are altered at the office and cannot be interpreted. Further, a pet owner can save a great of deal of money if they can produce their own glucose curve at home when you request one.
If your patient is too sensitive for a valid glucose curve at the clinic, and the pet owner is not up to blood sugar testing at home, the fructosamine blood test may be particularly useful. Again, this test looks at average glucose levels so wide fluctuations will not be discovered but at least there is a monitoring option for this situation.
Some Pets Are Simply Difficult to Regulate
Your patient will probably require re-regulation at some point. There may be an underlying reason to sort out. If your patient seems to fit in this category, some reasons could be:
- Improper administration of insulin. If possible, observe your client giving the insulin to their pet. Another possibility is that the insulin may be out of date.
- Rapid insulin metabolism. Insulin wears off quickly in some animals. Your patient may require a different type of insulin or a second injection during the day or even additional injections during the day.
- Insulin overdose may actually lead to elevated glucose levels (and clinical signs of diabetes mellitus). In this situation, too much insulin brings the blood glucose too low and other hormones respond to bring it back up (and generally over-do it).
- Steroid administration (such as prednisone, prednisolone, etc.) will interfere with insulin.
- Progesterone, a female hormone, also interferes with insulin. Unspayed female diabetics should be spayed once they are sufficiently regulated.
Feeding A Diabetic Pet
Regulation is achieved via a balance of diet, exercise, and insulin. Realizing that therapeutic diets are not always attractive to pets, there are some ideal foods which should at least be offered. The most up-to-date choice for cats is a low carbohydrate high protein diet. These diets promote weight loss in obese diabetics and are available in both canned and dry formulations. For dogs, high fiber diets are still in favor as fiber seems to help sensitize the pet to insulin. Avoid soft-moist diets as sugars are used as preservatives.
Encourage An Annual Dental
It is important for diabetic pets to have their teeth cleaned annually. Dental tartar seeds the body with bacteria and when blood sugar levels run high, infections in important organs can take root. The kidneys and heart are particularly vulnerable.
If we can assist in the regulation and management of any diabetic patient, please do not hesitate to call.
Melissa Riensche, DVM, DACVIM
Janet Bailey, DVM, DACVIM
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