What is diabetes?
Diabetes is a lack of usable insulin in the body. Insulin takes sugar out of the blood plasma and puts it into the cells where it can be used for energy; so diabetics have high levels of glucose in their blood and urine. This results in the typical symptoms of diabetes—increased urination, increased appetite, and weight loss (because they are urinating out their calories).
In dogs, diabetes is generally caused by the pancreas not producing enough insulin. In cats, it is usually due to resistance developing to the insulin. Because of this resistance, the pancreas has to work over-time to produce enough insulin to overcome the resistance. Eventually, the pancreas can no longer keep up and may stop producing insulin all together. For this reason, both dogs and cats require insulin injections to treat their diabetes. In a small number of cats, if the diabetes is caught early enough and the diabetes is controlled quickly, the pancreas may be able to recover and these cats may go into remission.
How is diabetes treated?
Diabetes in both dogs and cats is treated with insulin injections. Your pet will typically come into the hospital for a series of blood sugar curves where their blood glucose levels are tested every couple of hours to see how they are responding to the insulin. The amount of insulin is adjusted based on these results until the proper insulin dose for your pet is determined.
Additional diagnostics test may be recommended at the beginning of treatment as well. This may include blood work and x-rays to make sure that there are no other underlying problems as well as urine testing to check for a urinary tract infection.
Once your pet’s diabetes is under control, if you feel comfortable, you can buy a glucometer for dogs and cats and we can show you how to check their blood sugars at home. Otherwise, we will check their blood sugar curves every few months if they are doing well (or sooner if problems arise) to make sure they do not need to have their insulin dose adjusted.
How is insulin stored and administered?
Insulin needs to be stored in the refrigerator. When you take the bottle out to give the insulin, do not shake it as this may inactivate the insulin. Turn the vial upside down and roll it gently between your palms to warm and mix the insulin.
The insulin should be given as close to 12 hours apart as possible, and never closer than 11 hours. Your pet should eat before they are given their shot. If they do not eat, please call us to discuss what dose you should give. If we are not available, a good rule of thumb is to give only half a dose of insulin. If they miss more than one meal, do not give insulin and bring them in to be evaluated as soon as possible.
The insulin injection is given in the subcutaneous tissue (the loose tissue between the skin and muscle). This will be shown to you when you pick your pet up from their initial glucose curve. Do not give the injection in the same spot every time as this will result in scar tissue which can affect the absorption of the insulin. If you are unsure if your pet got the insulin (ie. they moved during the shot), do not give another dose, just skip it and wait until the next scheduled dose.
What is hypoglycemia?
Hypoglycemia is when the blood sugar drops too low. This can be caused by an overdose of insulin, a change in your pet’s insulin requirements, another underlying medical condition or giving insulin without food.
With mild hypoglycemia, your pet may just be more tired and sleep a lot. This will typically be most pronounced in the middle of the day between insulin doses. In more severe cases, your pet will start acting drunk and wobbly and could start to seizure.
If you are noticing signs of hypoglycemia, you should give your pet Karo syrup. If they are too sedate to swallow properly, you can rub it on to their gums. Sugar water or full sugar maple syrup may also work in a pinch. If the symptoms are severe or mild symptoms don’t resolve within a few minutes of administering the Karo syrup, your pet should be seen immediately. With more mild symptoms that resolve with at home treatment, you should still contact us so that we can adjust the next insulin dose and schedule an appointment to asses your pet for reasons they may have become hypoglycemic.
What is diabetic ketoacidosis (DKA)?
When the cells are unable to get enough sugar to complete the process of making energy, toxins known as ketones are produced. Ketones have a sweet smell to them, like nail polish remover (acetone is a type of ketone). This smell may be noticed on their breath or in their urine. These ketones will make your pet start to feel ill. They will become lethargic, loose their appetite and start to vomit. As the toxins continue to build, they can become life threatening, so if you notice any of these symptoms, your pet should be examined immediately.
DKA should not occur in a properly controlled diabetic animal. If a diabetic animal develops ketosis, it is usually due to an underlying medical condition that makes them more resistant to insulin such as an infection. It can also happen during times of stress such as when you go away.
What else should I know about managing my diabetic pet?
Other medical conditions can interfere with management of a diabetic animal, so routine screening for, and treatment of these conditions is important. Infection can increase resistance to insulin. Diabetics are prone to urinary tract infections, so a urine culture to screen for UTIs is recommended twice a year. It is also important that your pet’s dental health is well managed to control bacteria in the mouth. This involves regular brushing and, when necessary, full cleanings under anesthesia. Yearly blood screenings are also recommended to look for other conditions that might interfere with diabetes management, such as Cushing’s disease, an over production of the stress hormone, cortisol.
Managing a diabetic pet requires a lot of commitment, but can be very rewarding. A well managed diabetic pet can live just as long as any other pet, without compromising their quality of life.
There is a lot of information to take in when your pet is diagnosed. If you have any questions or concerns, please do not hesitate to contact us.