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Diabetes Mellitus

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Diabetes is a chronic disease caused by lack of insulin production by the pancreas.  The lack of insulin causes high blood sugar and clinical signs such as increased thirst, appetite, weight loss, cataracts, depression, and lethargy.  Treatment for most patients includes daily shots of insulin, a special diet, and frequent monitoring.

Insulin:

  • Insulin must be stored in the refrigerator at all times.
  • Insulin can only be stored for 3-6 months after opening.  Insulin kept longer than this amount of time is less potent and should be discarded.  Please write the date you opened the insulin vial on the vial itself to avoid confusion.
  • Your pet will be prescribed a certain number of units of a specific insulin twice daily, to be given as close to 12 hours apart as possible.  You will also be prescribed a specific insulin syringe with which to give the insulin to your pet.  Do not use any other types of syringe.
  • Do not reuse insulin syringes as this can cause contamination and bacterial growth in the insulin vial.  This will also dull the needle and cause discomfort when injecting insulin.
  • Dispose used insulin syringes by placing them in a sealed container such as an empty milk carton or jar before throwing them away.

How to administer insulin:

  1. Feed your pet its normal meal portion.  If the pet is not eating, administer only half its normal insulin dose.
  2. Mix the insulin by gently rolling the vial in your hands.  Do not shake the bottle, as this will damage the molecules.  Make sure any white material is mixed properly before administration.
  3. Rotate to a different location for insulin injection every few days.  Changing the location prevents scar tissue formation and decreased absorption.
  4. Administer the insulin as instructed.
  5. If you are unsure whether the insulin was administered properly, do not repeat the injection as this may cause signs of low blood sugar.  If there is a possibility the insulin was already administered, do not administer another dose of insulin.

Monitoring

  • Monitor for increased thirst, urine output, and appetite.  If the dose of insulin is appropriate, these signs should improve.  Recurrence of these signs in a previously well-regulated patient may indicate a problem with the insulin dose; contact your veterinarian if these signs recur.
  • KetoDiastix
    • Use the Ketodiastix at home to measure the urine glucose and ketone levels at least once weekly.  When first starting to give insulin or for the week immediately after a change in insulin dose, monitor this once daily.
    • Glucose
      • Glucose levels should read between 100 mg/dL – 250 mg/dL as a well-regulated diabetic always has a little bit of sugar in the urine.
      • If the reading is negative, the insulin dose may be too high.  If the read is 500 mg/dL or greater there may be a problem with the insulin administration or the patient may not be getting the right amount of insulin.  In either of these two cases, please call you veterinarian for further instruction.
    • Positive ketones are always abnormal.  Please call your veterinarian if you see a positive reading.
  • Blood glucose curves are required to find tune the insulin dose and achieve the best possible regulation.  A curve is usually performed over 12-24 hours in the hospital.
  • Bi-annual visits, blood work, and blood pressure checks are required for diabetics to screen for early signs of complications of diabetes even in well-regulated patients.  Diabetic patients are immune-compromised and are at increased risk for infections.  If you notice signs of illness such as vomiting, lethargy, or inappetence, please contact your veterinarian.

Low Blood Sugar

  • If too much insulin has been administered, your pet may show signs of low blood sugar such as tremors, lethargy, drooling, or seizure activity.  If you think your pet may have low blood sugar, offer it food immediately.  If your pet is not interested in food or unable to eat, call your veterinarian to the appropriate amount of Karo syrup or honey to give orally to increase the blood sugar and determine if your pet needs to be seen immediately.
  • If your pet has had a full seizure, give your pet Karo syrup or honey and seek emergency veterinary care.
  • Do not give any more insulin if you think your pet has low blood sugar and call your veterinarian as soon as possible.

Feeding

  • Feed your pet twice daily immediately before administering insulin.  This allows you to monitor for appetite and adjust dosages accordingly.  Decreased appetite can also be an early sign of illness.
  • Diabetics must eat a high protein, low carbohydrate diet.  Canned foods are ideal because they usually contain fewer carbohydrates than the dry formula.  Several prescription diets are formulated specifically for diabetic patients including:
    • Hill’s M/D for felines, Hill’s W/D for dogs
    • Royal Canin Diabetic – canine and feline formulas
    • Iams® Veterinary Formulas Weight Control D – Optimum Weight Control™
      - canine and feline formulas

Managing Diabetes in Pets

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Diabetes is a chronic disease caused by lack of insulin production by the pancreas. Glucose or blood sugar must interact with insulin to move from the bloodstream into body tissues where it’s used as the body’s main source of growth, energy and repair. In the past decade, veterinary medicine has seen the same increase in diabetes as human medicine. Diabetes affects one in 100 cats – approximately 800,000 cats in the U.S. – and one in 500 dogs. Pet obesity often leads to diabetes and results from indoor confinement, especially in the city, decreased physical activity, and feeding high carbohydrate foods.

Managing Diabetes At Home
Long-term success with diabetes in a pet depends on the pet owners’ thorough and complete understanding of the disease and its manifestations. Many factors beyond a veterinarian’s control can affect the animal’s blood glucose level, such as changes in activity, stress, and diet. Do not be discouraged; insulin requirements differ for each animal, and it may take time to find the correct dosage. In cats this is often a demanding task as their responses can be transient and deceptive. Listed below are a combination of factors that must be carried out at home to assist in the control of the disease.

Weight Loss and Diet Change
For cats a high protein, low carbohydrate diet is necessary as well as an adequate weight loss plan if obesity exists or diabetes is present. Animal General recommends the Purina DM formula or Hill’s M/D Prescription Diet for cats and Hill’s W/D Prescription Diet for dogs. Food should be offered twice a day at the same time and immediately prior to administering insulin. In dogs, a diet high in fiber and complex carbohydrates is preferred. Monitor your pet’s appetite. Ravenous eating can be a sign that blood glucose is too high and needs further adjustments.

Exercise
Exercise can be achieved with the use of throw and wiggle-jiggle toys for your dog or cat. Of course there is no substitute for a good walk or visit to the local run for your dog. Be consistent with your plan. Watch for lethargy, weakness, and depression.

Insulin
If insulin injections are required, your vet can instruct
you on how to accomplish this. It is a very simple procedure, and one that your pet will hardly notice. Oral hypoglycemic medications may be prescribed at first, but over time injections may be easier to administer. Insulin injections are always given after meals. Animal General highly recommends the video available at Cornell University’s Feline Health Center website for guidance in giving injections: http://partnersah.vet.cornell.edu/node/281

Glucose Level
Check your pet’s blood glucose at least once weekly
and log this information. You can learn to do this with a blood glucose meter or Keto-Diastix Reagent Strips. Keto-Diastix strips are a fast, convenient way of testing urine for the presence and concentration of glucose and ketones. Glucose levels on the strips should read between 100mg/dL and 250 mg/dL as a well-regulated diabetic always has a little bit of sugar in the urine.
Blood glucose curves are required to fine tune the insulin dose and achieve the best possible resolution. A curve is usually performed over 12-24 hours in the hospital.
Once your pet is on maintenance therapy and its condition is stabilized, blood work and blood pressure checks should occur every 4-6 months. Dazed behavior, excessive drinking, and increased urination are indications of heightened glucose level.

Indications for Additional Regulations
There are a number of clinical signs that may suggest a need for adjustment to your medical plan to ensure that your pet is properly regulated. These signals in a non-diabetic pet may foreshadow the onset of disease. These indicators are listed below. They are also mentioned in the text under the categories where they are most likely to occur. If you observe any of these signs in your pet, contact your veterinarian for an immediate consultation:

• Significant increase in thirst and fluid intake and increased urination.
• Failure to make it to the litter box or outdoors.
• Distinct change in appetite.
• Weight loss in the presence of voracious eating.
• Decreased activity, weakness, depression, lethargy.
• Change in gait or walking (walking on hocks).
• Poor coat.
• Increased bacterial infections, especially of theurinary tract.

Once animals have been stabilized on insulin, most are able to lead a happy, healthy life. Diabetes is a chronic disease that can be managed with close observation, dedication to a treatment plan, and good communication with your veterinarian. Thus armed you can be hopeful of many additional years with your companion animal.

Special thanks to Sally Yang, DVM for her assistance with this article.