Managing uncomplicated diabetes
Two types of patients can be categorized as uncomplicated:
- Dogs presented to the veterinarian after the owner has noted the appearance of clinical signs without general deterioration (no diabetic ketoacidosis, or DKA). These cases are not emergencies, although dogs without cataracts should be treated diligently to try to avoid this complication.
- Dogs that after initial presentation with DKA and successful treatment, are generally stable and without ketonuria.
- Perform a thorough examination and weigh the patient.
- Evaluate lab work, including complete blood count, urinalysis (including sediment examination), and serum biochemistry profile (including T4).
- Rule out hypothyroidism, renal failure, inflammatory bowel disease, pancreatitis and exocrine pancreatic insufficiency, hyperadrenocorticism, growth hormone excess or acromegaly, neoplasia, and hepatic disease.
When health status is known and diabetes mellitus confirmed:
- Thoroughly explain that with diabetes mellitus, achieving regulation may take time (up to 1 to 2 months) and what the implications are for the dog owner and family. Make sure the owner understands the therapy involved and that the dog should be able to live a happy, healthy life with consistent management. (This is crucial, as complete cooperation of the owner is essential to the success of the therapy.)
- Treat existing infections or illnesses (many diseases will affect insulin metabolism).
- Introduce an appropriate diet.
- Begin therapy with Vetsulin® (porcine insulin zinc suspension).
Initial therapy with Vetsulin:
- Establish a starting dose.
- Hospitalize for the day to verify the starting dose does not cause hypoglycemia.
- Instruct dog owner on:
- Injection technique.
- How to identify and treat hypoglycemia if it occurs.
- Send pet home for 1 week; allow the owner and dog to become accustomed to injections (some practitioners may prefer to do the initial regulation in-clinic).
- Owner should monitor and record daily water and food consumption.
- Owner should monitor and record daily urine glucose and ketone bodies.
- Owner should maintain starting dose and frequency of administration for the entire week.
- Owner should watch for signs of hypoglycemia.
After 1 week: In-clinic re-evaluation:
- Verify adequate injection technique.
- Evaluate dog owner's monitoring of clinical signs and glucosuria.
- Weigh the patient.
- Evaluate glycemia via glucose curve or punctual blood glucose evaluations.
- Increase insulin dose if necessary, according to clinical signs and/or glycemia values. An interval of 5 to 7 days between dosage increments is ideal. Less than that can lead to Somogyi overswing.
- Repeat procedures listed above at regular intervals until clinical signs and body weight are satisfactory.
- When regulation is achieved (no clinical signs; satisfied owners), it is suggested to schedule rechecks every 2 to 4 months:
- Perform a complete physical examination.
- Revise home monitoring if necessary.
- Evaluate glycemia if necessary (eg, glucose curve, fructosamine).
If there is a problem:
If clinical signs resume, fructosamine levels are not satisfactory, and/or there is deterioration of overall health, causes must be identified.
- Perform a complete physical exam.
- Injection technique and insulin quality control.
- Feeding and exercise.
- Environment of the patient (recent changes).
- Perform a glucose curve.
- Evaluate complete blood count, urinalysis (including sediment examination) and serum biochemistry profile (including T4).
- Additional testing procedures may be required. Diabetic dogs may develop other concurrent diseases or infections that will interfere with insulin effect.