Starting regulation with Vetsulin
Presentation of the uncomplicated diabetic dog:
Two types of dogs can be categorized as uncomplicated:
- Dogs presented to the veterinarian after the owner has noted the appearance of clinical signs without general deterioration—that is, no diabetic ketoacidosis (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 its successful treatment, are generally stable and without ketonuria.
- Perform a thorough physical examination and weigh the dog.
- Conduct laboratory testing including complete blood count, urinalysis (including sediment examination), and serum biochemistry profile.
- Rule out hypothyroidism, renal failure, inflammatory bowel disease, pancreatitis, exocrine pancreatic insufficiency, hyperadrenocorticism, growth hormone excess or acromegaly, neoplasia, and hepatic disease.
When health status is known and diabetes mellitus confirmed:
- Explain thoroughly what diabetes mellitus is, that achieving regulation may take time (up to 1 to 2 months), and what the implications are for the family. Make sure the dog 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 management.
- Treat existing infections or other medical conditions. Many diseases will affect insulin metabolism.
- Introduce appropriate diet.
- Begin therapy with Vetsulin® (porcine insulin zinc suspension).
- Weigh the dog. In the event of a fraction of a kilogram, round the body weight down rather than up. For example, a 12.9-kg dog should be dosed as a 12-kg dog. If the dog is grossly overweight, utilize the optimal body weight for calculating the starting dosage of Vetsulin.
- Establish a starting dose based on the labeled dosage of 0.5 IU insulin/kg of body weight. This initial dose should be given once daily concurrently with or right after a meal.
- Begin with once-daily injections, then evaluate.
- Some dog owners may do best by easing into the routine of diabetes management with once-daily injections. This is preferable to having an overwhelmed client who sees euthanasia as the only viable option. After acclimating to the ease of giving injections, the client is more likely to willingly accept twice-daily injections, if needed.
- Remember that hyperglycemia does not kill dogs; hypoglycemia can.
- The majority of dogs (two-thirds) will require twice-daily Vetsulin injections.
- Keep the dog hospitalized for the day to verify that the starting dose does not cause hypoglycemia.
- Instruct the owner:
- The majority of dogs (two-thirds) will require twice-daily Vetsulin injections
- How to administer injections
- How to identify and treat hypoglycemia
- Parameters to monitor at home
- Preferred diet and frequency of meals
- Exercise recommendations
- Discharge dog to owner’s care for 1 week. This allows the dog and owner to acclimate to the injections.
At home, have the owner:
- Monitor and record water and food consumption.
- Monitor and record urine glucose and/or ketone bodies.
- Maintain starting dose and frequency of administration for the entire week.
- Watch for signs of hypoglycemia. If so, they should contact their veterinarian immediately.