General Information

Diabetes mellitus is an endocrine disease which leads to a deficiency of insulin.  Insulin is normally secreted by the endocrine portion of the pancreas and is essential for metabolism of glucose within the body's cells.  Insulin deficiency leads to excess glucose in the blood and a lack of glucose inside cells where it is necessary for metabolism. Glucose is 100% conserved by the kidneys in the normal animal, but when glucose levels in the blood exceed 200 mg/dL, glucose spills over into the urine.

The clinical signs of diabetes mellitus include drinking excessive amounts of water, the production of large amounts of urine and increased appetite. In addition, we also see cataract formation leading to blindness and recurrent urinary tract infection.  All of these signs are attributable to lack of insulin.  Without therapy, serious changes occur which eventually lead to diabetic coma and death.

The cause of diabetes mellitus is multifactorial.  Inciting factors for the development of diabetes include: genetic predisposition, infection, and drugs and other diseases which antagonize the effects of insulin.

Diagnosis of diabetes is based upon clinical signs,  blood tests and urinalysis.  These tests are often repeated several times before diabetes is fully controlled.

Diabetes mellitus is controlled, NOT CURED.  The mechanics of control may seem complicated and be discouraging at first, but, soon you will find that the treatment will fall into the family routine.  Control of diabetes involves careful control of exercise, diet,  checking the urine for glucose and injecting a small amount of insulin under the skin once or twice per day.

Treatment for Diabetes Mellitus:

The goal of therapy is to balance insulin dose, exercise and diet so that there is a trace of glucose in the urine every morning.  In order to monitor the effectiveness of your therapy, it is necessary to monitor urine glucose every morning.

Testing the urine:  Collect a urine sample from your pet every morning.  At first, this is often difficult but your pet can be trained to cooperate with your efforts over a relatively short time.  Purchase one of the many types of test kits available at your pharmacy.  We recommend Keto-Diastix, which check for urine glucose and ketones.  These strips are dipped into the urine and the resulting color change is compared to a scale on the strip container.  The veterinarian will go over the collection and testing procedure with you.

Insulin therapy:  There are several types of insulin available at your pharmacy.  In almost all cases, we will be using NPH u-100 insulin.  The syringe you will use is calibrated in units so that you will easily visualize the dosage to be given.  We, in most cases,  will administer insulin twice per day, approximately 12 hours apart.  Insulin is given sub-cutaneously. The following are important points of insulin therapy:

ยง               Keep insulin refrigerated.

ยง               Gently mix insulin by rolling the bottle between your palms before drawing the dose     into the syringe. Insulin molecules are fragile and are damaged by vigorous mixing.

ยง               If the insulin bottle is dropped, replace it.

ยง               Read the insert that comes  with the insulin.  This information pertains to humans, but  you will gain some important information.

ยง               When buying insulin, always bring in the previous bottle and packaging so that you  get the same insulin every time.

ยง               Replace insulin vials that are beyond their expiration date.

Because the body's requirements are not always the same, insulin dosage will vary from day to day.  Daily dosage will be based upon the morning's urine dipstick reading. The following are the guidelines for dosage adjustment and are based upon the use of Keto-Diastix:

ยง               If the dipstick reads glucose negative, decrease the next day's insulin doses by 2 units. In ther words, if you are giving 16 units in the morning and 16 units in the evening and the next morning's dipstick reading is glucose negative, decrease the morning insulin dose to 14 units and the evening dose to 14 units.

ยง               If the dipstick reads 100 - 250 mg/dL, do not change insulin dose.

ยง               If the dipstick reads 500 mg/dL, increase each insulin dose by one unit.

ยง               If the dipstick reads 1000 mg/dL, increase each insulin dose by two units.

ยง               If the dipstick reads >2000 mg/dL, increase each insulin dose by three units.

ยง               If there is any positive ketone reading, call your veterinarian as soon as  possible.

Do not change the insulin dosage every day. At most, change dosage every  other day.  This will help prevent roller coaster dosage changes.

Diet: 

Your pet's diet is extremely important. Each day's food intake should meet your pet's caloric needs. The day's total food intake should be divided into two equal meals.  For instance, if your dog eats four cups of food per day, it should get two cups in the morning and two cups in the evening.  The diet needs to be consistent. Feed the same brand of dog food all of the time and never feed human food or table scraps.  Feed at the same time each day. Remember, consistency is the key.  We recommend that diabetic dogs and cats eat a diet low in fat and high in fiber, such as Hill's W/D of Waltham Low Fat.

Exercise: 

The key to exercise is again consistency: Keep the amount and time of exercise the same each day.

Hypoglycemia: 

If your pet's blood glucose level drops too much, you will see your pet become weak and possibly begin to shake or twitch and stumble.  This is a dangerous condition and may progress to seizures, coma and death.  If you see these signs, feed your pet Karo syrup (~2 teaspoons / 10 lbs body weight).  Undiluted syrup can be poured slowly into the pouch at the corner of your pet's mouth.  Karo syrup is a ready source of glucose and is quickly absorbed and will help return blood glucose levels to normal.  This type of emergency is not common, but can happen if food intake is inadequate, insulin dose is too high or in the face of concurrent infection.  It is a good idea to have insulin and Karo syrup on hand when traveling.

Tying It All Together

Tying all of this together is relatively simple.  Insulin, exercise and excitement all lower the blood glucose.  Food intake raises the blood glucose.  Remember to try to keep exercise, food consumption and excitement consistent.  Manage blood glucose levels by making controlled changes in insulin dosage based upon the above dosage adjustment guidelines.  Any time that you have questions, call your veterinarian.  It is a good idea to keep a log of your daily urine glucose readings, food intake, insulin dosage and injection site.  The last page of this handout is a sample of such a log.

Since infection always antagonizes proper insulin function, illness in the diabetic animal is serious.  Never "wait to see if it'll be better tomorrow".  Call your veterinarian. Tomorrow may be too late.

After two to four weeks of treatment, it will be necessary to have a glucose curve preformed on your pet.  This requires a day long visit to the veterinary hospital.  Blood is drawn every two hours to verify the effect of the insulin therapy on blood glucose.  At this time changes may be made in your pet's therapy regime.

Insulin type__________________________________________________________________
Insulin dose and frequency_______________________________________________________
Daily caloric intake requirement___________________________________________________
Type of food_________________________________________________________________
Amount to be fed in the am and pm________________________________________________

Remember to keep diet and exercise program consistent.  No table scraps.
Notify your veterinarian if any of the following occur:

ยง                                         You are unable to administer medications as directed.

ยง                                         Your pet has diarrhea or vomits.

ยง                                         Your pet shows the signs of hypoglycemia: trembling, stumbling etc.

ยง                                         Your pet becomes ill or suffers any type of trauma.

Daily log for the Diabetic Pet
Date Urine Glucose Insulin Dose am = pm Injection Site Notes