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Long-term management

Once the maintenance dose has been established and the dog is stable, a long-term management program must be implemented. The aim is to minimize variations in insulin requirement. This includes monitoring to detect underdosage or overdosage of insulin, and adjustment of dose, if required. Careful monitoring during maintenance will help limit the chronic problems associated with diabetes, including cataracts, etc.

Various approaches to maintenance have been described. The most clinically accepted approach is to have the owner monitor and record the dog’s general health (including well-being, thirst, and appetite) and check urine glucose daily. Dogs should be checked every 2 to 4 months (more often if there are problems) for general health, urine glucose, and blood glucose level. Adjustments to the insulin dose must be based on full analysis of clinical data and the blood glucose measurement.

The use of progestogens in dogs suffering from diabetes mellitus should be avoided. Ovariohysterectomy should be considered for intact bitches. Stress and irregular exercise must be avoided. Care must be taken with the use of corticosteroids. It is important to establish a strict feeding schedule in consultation with the owner that will include a minimum of fluctuations and changes.

It is extremely important that owners are able to recognize the signs of hypo- or hyperglycemia and respond appropriately. Polyuria, polydipsia, and polyphagia in combination with weight loss, general bad condition, loss of hair or abnormal furry coat, and lethargy are the most common clinical signs of hyperglycemia, and require administration of insulin to restore blood glucose levels to an acceptable range.

However, these clinical signs may also be present due to a rebound hyperglycemia secondary to a hypoglycemic episode (Somogyi overswing). While a blood glucose curve can help differentiate between insufficient insulin dosing and Somogyi overswing, the results can be confusing if the rebound hyperglycemia persists for a few days. Evaluating weight changes in the patient can help shed some light. If the dog is losing weight and exhibiting clinical signs of diabetes mellitus, the insulin dose may be insufficient. If the dog is gaining weight, but continues to have clinical signs consistent with diabetes mellitus, the insulin dose may be excessive, and causing Somogyi overswing.

Owners should also understand that their dogs can live healthy, active lives when their dog’s diabetes is properly regulated.