The goals of therapy are to introduce sufficient insulin into the body so as to bring blood sugar down to about 125 mg/dl. If this is accomplished and stabilized, clinical signs will abate. Dogs and cats are administered insulin twice a day. Treatment of diabetes requires a personal and financial commitment to the animal. If the owner goes on vacation, it is recommended that the animal be boarded at the medical facility where staff can administer the insulin and keep an eye on the animal. Numerous types of insulin may be used. Suspensions such as PZI, NPH and lente are commonly used. Solution insulins such as Glargine and Detemir have been used. In cats, the goal is remission of clinical signs. Up to 50% of them will end up in remission. More expensive versions of insulin will lead to a quicker remission. Vetsulin® is relatively cheap but there is a lesser chance of remission on it.
There can be problems with the insulin, operator error or physiological changes in the patient. Changing insulin injection sites is important. If an owner thinks he or she missed the insulin dose DO NOT REPEAT IT! Retest the urine the following day and administer the insulin dose. Giving an extra shot of insulin to a dog that already actually got the shot, will lead to a crash in the dogs blood sugar. Signs such as staggering, glassy eyes and stupor are most common. Animals can easily be brought out of this by smearing KaroSyrup® (light colored version) into the mouth and oral cavity. This is found in the local supermarket. Erratic absorption, excessive exercise or poor diet will make blood sugar readings more erratic.
Dietary control is important. Food should be available to the dog early in the morning. The remainder of the food is than administered at the peak time of insulin activity; usually about 6-8 hours after injecting the insulin. There are excellent diets on the market used to manage diabetes mellitus. Hill's Prescription Canine w/d, Hill's Prescription Feline w/d and Purina® Feline DM are good diets.
If Cushing's Syndrome is diagnosed after the animal is on insulin, Trilostane is commenced to treat the Cushing's and the insulin dose is cut by anywhere from 25%-33%. By treating Cushing's, the secondary cortisol induced hyperglycemia will naturally lower. If you add the same dose of insulin to the mix, the dogs blood sugar will crash.
Day to day insulin dosing is often done by testing the urine. An excellent photo display of this technique is available in the "Learn More" section. Taking a dog out to urinate on a leash in the morning and putting a plate underneath to catch urine is pretty easy. Most diabetic cat owners always gave me that blank stare when I told them to get a sample from their cat. The easiest way to obtain cat urine is by using Kit4Cat®. This is a hydrophobic type of sand. The urine pools on the surface so a Diastix® or KetoDiastix® strip can be dipped into the urine.
Management of the diabetic patient also requires numerous physical exams and actual blood glucose readings performed at the peak of the insulins action. Periodically, the animal will be hospitalized to perform a glucose tolerance test where blood is drawn every hour throughout the day after the morning insulin injection. This data is plotted on a graph and interpreted.
Anything can happen to diabetics at any time and many of these problems will occur after hours or on weekends. It is imperative that owners have a local emergency clinic to go to in their area or the telephone number of their veterinarian that accepts after hours emergency calls.