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