Diabetes mellitus in dogs
- What is diabetes mellitus and what causes it?
- I have heard about diabetes insipidus; is this the same as diabetes mellitus?
- What signs do dogs with diabetes typically show?
- What do the terms polyuria, polydipsia, and polyphagia mean?
- My dog is having problems holding its urine; does that mean it has diabetes?
- How is diabetes diagnosed?
- Are all dogs susceptible to diabetes?
- What other problems can be associated with diabetes?
- What other diseases have the same signs as diabetes?
- Did I do something to cause the diabetes?
- What is the difference between type 1 and type 2 diabetes?
- What is the expected lifespan for a diabetic dog?
- My dog was recently diagnosed. What advice would you give me?
- Is diabetes in animals similar to that of humans?
- Are there other dog owners I can talk with?
Vetsulin® (porcine insulin zinc suspension)
- Where on my dog’s body should Vetsulin be injected?
- Can I still use a vial of Vetsulin if it freezes?
- Can I still use a vial of Vetsulin if it was forgotten outside the refrigerator between doses?
- What else should I know about Vetsulin?
- How do I dispose of insulin syringes?
Management of diabetes mellitus in dogs
- What must I do if I know that I missed a full dose or part of an injection?
- What should I do if I have or think I have given too much insulin?
- What should I do if I think that my dog has very low blood sugar (hypoglycemia)?
- How much water should I let my dog drink?
- What is the importance of making sure my dog is regulated?
- How long does it take to regulate a diabetic animal?
- My dog is ill and not eating. Should I still give him/her an insulin injection?
- Should I feed my dog before or after an injection?
- What can I give my dog as a treat?
- What does the typical diet consist of?
- What is a blood glucose curve?
- What are some problems with blood glucose curves?
- How often should a blood glucose curve be done?
- What is stress hyperglycemia?
- What is fructosamine?
- What makes VetPen unique?
- Is VetPen difficult to use?
- Is VetPen more accurate than using an insulin syringe?
- Can VetPen be used with different insulins?
- How does selecting a dose with VetPen differ from drawing up a dose with a syringe?
- How do I know when the injection is complete?
- Why does the VetPen need to be tested before each injection?
- What should the insulin cartridge look like after mixing and priming?
- Is VetPen reusable?
- What type of needle is used with VetPen?
- Can VetPen needles be reused?
- Does VetPen need to be kept refrigerated when it contains an insulin cartridge?
- What is the proper care of VetPen?
When experiencing any issues using VetPen, the first step should always be to confirm that air was properly removed from the cartridge through priming. Air bubbles in the cartridge can create multiple issues that result in the pet receiving too much or too little insulin.
- What if insulin drips actively from the needle after injection?
- What if the dose selector does not return to the start line after testing VetPen?
- What if there is not enough insulin in the cartridge to complete an injection?
- What if a dose too large for the pet is selected?
- What if no insulin drips actively or squirts from the needle after priming or preparing for use?
Diabetes mellitus in dogs
What is diabetes mellitus and what causes it?
Diabetes mellitus is caused by an absolute or relative deficiency of insulin. Animals with an absolute or relative deficiency of insulin are called diabetics.
Insulin deficiency can develop for different reasons:
- Disorders of the pancreas—the pancreas is unable to secrete enough insulin.
- Other diseases or the presence of other hormones—may be antagonistic to insulin or cause resistance to insulin. Insulin is unable to function normally in the body.
I have heard about diabetes insipidus; is this the same as diabetes mellitus?
No. Diabetes insipidus, also known as water diabetes, is caused when large amounts of dilute urine are produced. It is a far less common condition than diabetes mellitus. Diabetes insipidus is caused by problems in part of the brain or in the kidneys. There is no glucose present in the urine of animals with diabetes insipidus.
What signs do dogs with diabetes typically show?
The most common signs of diabetes mellitus are:
- Increased drinking
- Increased urination
- Increased appetite
- General signs, such as lethargy and poor coat condition
What do the terms polyuria, polydipsia, and polyphagia mean?
- Polyuria is the production of large amounts of urine in a given period (eg, per day)
- Polydipsia is chronic excessive thirst
- Polyphagia is great hunger
My dog is having problems holding its urine; does that mean it has diabetes?
No, your dog could have a bladder or kidney infection, or some other medical problem. If your dog is having problems holding its urine, you should schedule a trip to your veterinarian as soon as possible.
How is diabetes diagnosed?
Your veterinarian will measure your dog’s blood glucose and test your dog’s urine for the presence of glucose and ketones.
Persistently high blood glucose levels along with glucose in the urine usually means that your dog has diabetes mellitus.
Are all dogs susceptible to diabetes?
Dogs of all ages can get diabetes. Diabetes most typically occurs in older dogs. Obesity, genetics, and other conditions can contribute to the development of diabetes.
What other problems can be associated with diabetes?
Problems associated with diabetes are generally seen in long-standing cases; they include cataracts in dogs and chronic infections.
What other diseases have the same signs as diabetes?
Dogs with diabetes mellitus drink and urinate a lot. They may also have a good or increased appetite but usually lose rather than gain weight. Other common diseases where some or all of these signs are also seen include:
- Cushing’s disease (hyperadrenocorticism)
- Exocrine pancreatic insufficiency
- Kidney disease
To reach a definitive diagnosis of diabetes mellitus, your veterinarian will test your dog’s blood glucose levels and for the presence of urine glucose and ketones.
Did I do something to cause the diabetes?
No. Diabetes mellitus is due to a lack of insulin produced by the pancreas. It is not caused by a virus or infection. Diabetes in dogs is thought to be an autoimmune disease.
What is the difference between type 1 and type 2 diabetes?
Insulin is produced by the beta cells in the pancreas. Type 1 diabetes is due to the destruction of the beta cells with progressive and eventual complete loss of insulin secretion. This type always requires insulin therapy. Type 2 diabetes is characterized by dysfunctional beta cells (irregular insulin production) or the other cells of the body not responding to insulin properly. Type 2 diabetes may or may not require insulin therapy. In general, all diabetic dogs have type 1 diabetes and require insulin to control their disease.
What is the expected lifespan for a diabetic dog?
It is only recently that dogs were treated aggressively for diabetes. Sadly, not many years ago these animals would have automatically been euthanized. Today, studies suggest that, if a dog is kept well regulated and does not have any other health problems, he or she should be able to have a normal life expectancy.
My dog was recently diagnosed. What advice would you give me?
Learn everything you can about diabetes—talk to your veterinarian. Your dog's quality of life will depend on what you know and how well you manage its diabetes. You will need to work closely with your veterinarian, and offer your input. Do not be afraid to ask questions, or ask for training from your veterinarian on giving injections and monitoring blood glucose levels.
Yes, it is very similar. Your dog will be using similar medications, equipment, and monitoring methods as human diabetics use.
Are there other dog owners I can talk with?
Where on my dog’s body should Vetsulin be injected?
Injections should be given subcutaneously (under the skin) about 1 to 2 inches below the spine or backbone. Constantly vary the injection location from behind the shoulder blade to just in front of the hip bone, and alternate injections between the dog’s left and right sides. Your veterinarian can help guide you as to the recommended locations for injections. Download the Administration Sheet for instructions on how to administer Vetsulin to your dog.
No, freezing will damage the insulin molecules and reduce the efficacy of the product. If a vial of insulin accidentally freezes in the refrigerator, it should be discarded and a new vial should be used.
Ideally, Vetsulin should be stored upright, protected from light, between 2°C and 8°C (35°F and 46°F). After the vial has been used, it can remain at room temperature, not to exceed 25°C (77°F), for up to 42 days.
What else should I know about Vetsulin?
- Always have a spare vial on hand.
- Keep it in the box to protect it from light.
- Keep it refrigerated.
- If it has gotten too hot, or frozen, discard it immediately.
- Discard 42 days after first vial puncture of use.
The guidelines for each community are different. You will need to check with your own. All syringes should be disposed of in an appropriate sharps/biohazard container.
Management of diabetes mellitus in dogs
If you missed a dose or part of a dose, it is best to wait until the next insulin dose is required and then continue as normal. A brief period of high blood sugar (hyperglycemia) due to too low an insulin dose is not as serious or as dangerous as the possibility of causing low blood sugar (hypoglycemia) by administering too much insulin.
Contact your veterinarian and explain the situation.
Monitor your dog carefully for signs of low blood sugar (hypoglycemia):
- Very quiet or sleepy
If you see any of these signs, try to encourage your dog to eat a small meal or if this fails, rub some corn syrup on your dog’s gums.
The following signs may indicate hypoglycemia:
- Trembling or shivering
- Unusual movements or behavior
- Unusual quietness or sleepiness
- Loss of consciousness (coma)
If your dog is conscious, rub approximately one tablespoon of corn syrup on your dog’s gums. When it is able to swallow, feed its usual meal and contact your veterinarian. If your dog is unconscious or having a seizure, this is a medical emergency. CONTACT YOUR VETERINARIAN.
In the meantime, you should immediately treat your dog rather than delaying management. Pour a small amount of a sugar solution (eg, corn syrup) onto your finger and then rub the sugar solution onto your dog’s gums. The sugar is absorbed very quickly and your dog should respond in 1 to 2 minutes. The sugar solution should never be poured directly into your dog’s mouth since there is a risk that the solution will be inhaled into the lungs. Once your dog has responded to the sugar administration and is sitting up, it can be fed a small, high-protein meal. Once the dog has stabilized, it should be transported to your veterinarian for evaluation.
If your dog is diabetic, and drinking excessive amounts of water, give him/her all it can drink. Your dog's body is trying to combat the high blood glucose level by expelling the excess sugar out of its body through the urine. Once your dog is regulated, this will stop.
If diabetes is left untreated or unregulated, it could cause many complications. These include cataracts, blindness, and in extreme cases, death.
Each dog's case is different. There is no way to put a specific time on it. Sometimes the regulation process will require you to try different dosages, diets, and one to multiple injections a day. Regulation can be achieved sometimes within a month, and in some cases, over a year from the time therapy first started. It is very important to work closely with your veterinarian during this process to avoid further complications. Even after your dog is regulated, you will still need to maintain this relationship with your dog's veterinarian. Frequent check-ups will be necessary to maintain good health.
If your dog is not eating—do not give Vetsulin! If your dog has a reduced appetite and eats only half of its meal, reduce the daily dose of insulin by half. If the situation lasts more than 2 days (due to illness, for example), consult your veterinarian.
It is very important that your dog eats before you administer the injection of Vetsulin. The safest method is to feed your dog first, then give the injection (about 20 minutes later).
Your veterinarian will be the best person to determine your dog's diet, as he/she best knows its needs. Ask about treats. He/she can probably help you find a restricted calorie treat for your dog.
To keep diet constant from day to day, it is best to use commercially produced rather than homemade diets. Certain high-fiber prescription veterinary diets can be a useful adjunct to Vetsulin therapy. These diets should be avoided in underweight diabetic dogs. If special diets are unavailable, or your dog does not eat the diets, then standard canned dog foods are acceptable.
This is where the blood glucose is measured every 1–2 hours through the day. The dog should be on the same food schedule as at home. For most dogs, a 10–12 hour curve is adequate but in some instances a longer curve may be needed. Insulin effectiveness, glucose nadir (the lowest glucose reading), and duration of insulin effect are the critical parameters one learns from a glucose curve. The dosage of insulin, frequency of insulin administration, and feeding times may be altered based on these results.
The results of the curve can be affected by several factors that may make the curve done at the veterinarian's office an inaccurate portrayal of what is occurring at home. Things such as inappetence (not eating) and stress (causing hyperglycemia) may occur at the veterinarian's office. Because some dogs refuse to eat at the veterinarian's office, the dog is fed at home first and samples are done until the next scheduled meal. This will give a more representative curve than a dog that has not eaten. In addition, it is not uncommon for curves to vary from day to day because many things can affect blood glucose levels such as appetite, digestion, metabolism, exercise, hormones, stress, etc.
Once regulated, probably minimally every 3–6 months, or more frequently if a problem is suspected. Your veterinarian will advise you on the frequency.
Stress hyperglycemia is caused when the animal is frightened or stressed. It is caused by the release of epinephrine (adrenaline). Glycosuria (glucose in the urine) is usually absent with stress hyperglycemia because the blood glucose does not stay high for a significant period and therefore does not spill into the urine. Stress hyperglycemia does not influence the diagnosis of diabetes because the blood glucose level does not stay elevated long enough to cause glucose to spill into the urine.
A type of protein in the blood that can be used to measure glycemic (glucose) control over a longer period. Unlike blood glucose measurements, fructosamine is not affected by stress or the timing of the insulin injection. Your veterinarian may recommend periodic measurements of fructosamine to evaluate how well your dog’s blood glucose level has been controlled over the last few weeks.
As the first insulin pen for use in diabetic dogs and cats, VetPen:
- Is more convenient and can be less intimidating to use than insulin syringes. The ergonomic design of VetPen makes it easier to give your dog insulin injections discreetly anywhere, without the hassle of dealing with vials and syringes.
- Makes it easier to deliver an accurate dose consistently over time. By simply turning the dial, you can accurately select a dose. In a laboratory study, VetPen was found to be consistently more accurate than syringes for low doses.11
- Helps enhance insulin delivery safety. The all-in-one construction of VetPen, double needle caps, and sharps remover reduce the risk of accidental needle stick injuries.
- Takes fewer steps to prepare doses than using syringes. VetPen contains a multi-dose insulin cartridge that allows you to prepare doses easily once a new cartridge has been primed (air removed from cartridge) for use.
VetPen is ergonomically designed for easy handling and dosing. Additional adaptors are provided to further assist you if you have visual or manual dexterity issues.
Yes. In a laboratory study, VetPen was shown to be consistently more accurate than syringes for low doses. Even when drawn up by trained lab technicians, study results showed that syringes delivered at least 20%-25% more insulin than needed for a 1-unit dose.11 Unlike syringes, VetPen provides a precise and accurate dose every time, without relying on your capability to draw up an accurate dose.
No. VetPen must be used with specially designed 3 mL cartridges containing 2.7 mL of 40 IU/mL concentration of Vetsulin, the world's most trusted veterinary insulin, proven safe and effective for more than 20 years in hundreds of thousands of diabetic pets.* To avoid damaging VetPen and dosing errors, cartridges containing other insulin should not be used with VetPen.
* Vetsulin is known as Caninsulin outside the US.
While the overall injection process is similar, VetPen allows you to select doses more accurately. With just the turn of a dial, you can select a customized dose of insulin down to 0.5 units for your dog. And, with a push of the release button, the VetPen’s internal mechanism works to deliver the precise dose each and every time.
To make sure your dog's dose is injected precisely and accurately, you need to hold down the release button until the arrow (▶) points to the start line (—) on the dose selector. Then, wait at least 5 seconds before removing the needle from the skin. This allows for VetPen’s internal mechanism to optimally deliver the selected dose.
It is important to remove the air bubbles from the needle prior to injection to ensure that your dog receives an accurate dose of insulin. To do so, measure a small dose and ensure that the insulin flows freely through the needle.
Each cartridge contains 2 glass beads to help with the mixing of the Vetsulin before use. The cartridge should be shaken thoroughly before inserting it into the VetPen. After shaking, the insulin should appear uniformly milky. Do not use the cartridge if clumps persist after shaking thoroughly. Do not mistake the glass mixing beads for air bubbles, which should be removed during priming.
Yes. VetPen contains an insulin cartridge that allows multiple doses to be provided with minimal preparation time, even when away from home. Just be sure that there is enough insulin in the cartridge for a full dose before leaving home. When all the insulin has been used, simply remove the empty cartridge and insert a new one. Please note that sterile needles are designed for single use only and should not be reused. Tests show that VetPen lasts for at least 3,000 uses.11
VetPen is designed to work optimally with specific 29 gauge/12 mm needles, which are small, thin, triple-sharpened, and specially lubricated to lower penetration force and minimize discomfort for your dog. These are the only needles that should be used with VetPen. Always use a new needle for each injection to minimize your dog's discomfort and ensure the needle is sterile.
No. Sterile needles are designed for single use only. A new needle should be used for each injection. A needle may become blunt or bent after use, which may cause your dog discomfort. The needle should be removed with the needle remover and safely disposed of immediately after use.
Yes, VetPen should be refrigerated after a cartridge has been loaded and the VetPen is in use. Vetsulin cartridges should also be refrigerated before use. At all times cartridges should be protected from light. Vetsulin cartridges should not be frozen.
To clean VetPen, simply wipe with a damp cloth. Do not immerse it in water.
Whenever experiencing any issues using VetPen, the first step should always be to confirm that air was properly removed from the cartridge through priming. Air bubbles in the cartridge can create multiple issues that result in the pet receiving too much or too little insulin.
What if insulin drips actively from the needle after injection?
This may be a sign that the needle may have been removed before the injection was completed. If the VetPen needle is removed from the skin too early, the pet did not receive its full insulin dose.
To make sure the pet receives its full dose, be sure to press the release button down fully and hold it until the arrow (▶) points to the start line (—) on the dose selector. Then, to allow the VetPen to deliver the full dose, wait at least 5 seconds before removing the needle from the skin.
What if the dose selector does not return to the start line after testing VetPen?
There are 4 likely causes for this:
- If the release button is not fully pushed toward the needle, it sometimes prevents the dose from being released completely. Be sure to push the release button down fully during each injection so that the dose selector can rotate back to the start line. Then, wait at least 5 seconds before removing the needle.
- You may be closing your hand too tightly around the dose selector, which can prevent it from fully rotating back to the start line. Avoid this from happening by holding the VetPen like a pen so that the dose selector is able to rotate freely after the release button has been completely depressed.
- The needle could potentially be blocked. Replace the needle on VetPen with a new one. It is important to use a new needle for each injection for hygiene and safety reasons.
- The cartridge may not have contained enough insulin for the full dose. If the cartridge is empty, replace it with a new one and complete the priming process. For additional information, see the next question.
What if there is not enough insulin in the cartridge to complete an injection?
If there is not enough insulin left in the cartridge to give the pet its full dose, you can tell how many units of the dose were not given by looking at the number where the dose selector stopped. You may need to give the remainder of the dose. If so, write that number down.
Put in a new cartridge and prime (remove air from cartridge) and prepare the VetPen for use. Then, turn the dose selector to the number you wrote down and inject the pet as usual.
What if a dose too large for the pet is selected?
If too high a dose has been selected, it is very important not to try to turn the dose selector back to a lower dose. This can damage or break the VetPen. The dose selector is designed to move from low to high numbers, but cannot be moved back from high to low numbers. If too high a dose has been selected, release the insulin through the needle into a tissue or swab by pressing the release button. Then select the correct dose.
What if no insulin drips actively or squirts from the needle after priming or preparing for use?
There are 2 likely causes for this:
- The needle is blocked.
To fix, replace the needle on VetPen with a new one. Remember to use a new needle for each injection. The needle is designed for single use only.
- The cartridge plunger is stuck.
Follow these steps to fix this:
- Place the protective cap back onto the needle and unscrew the cartridge holder.
- Slide the release button towards the internal plunger and hold it until the arrow points to the start line.
- Dial 2 units without screwing the device back together.
- Push and hold down the release button until the arrow points to the start line.
- Without rewinding the internal plunger, screw the cartridge holder and the VetPen body back together. This should release the cartridge plunger and expel some of the insulin.
If healthy and well regulated, most experts recommend every 3 months. Talk to your veterinarian about how often they would like to see your dog.
It is perfectly safe for your diabetic dog to receive its vaccinations. In fact, this annual visit also gives your veterinarian a good opportunity to give your dog a complete check-up. By keeping your diabetic dog healthy, there will be fewer fluctuations in its insulin requirements.
Normally animals need to have an empty stomach before they are anesthetized. A diabetic dog that has not been fed needs far less insulin. Your veterinarian will advise you on how much insulin to give your dog before it is admitted or may wish to administer a reduced dose of insulin for you. Usually a diabetic dog is administered intravenous fluid therapy during anesthesia. This is a means of giving fluid to the animal when it cannot drink. Apart from needing a reduced amount of insulin and fluid therapy (which is also given to some non–diabetic animals undergoing anesthesia), your diabetic dog is not at any additional risk from anesthesia than a non–diabetic dog of the same age.