My Dog Has Diabetes!

Now what?

By Jacquelyn H. Burns, DVM © 2012 Jacquelyn H. Burns All rights reserved.

Is intended to educate you and inform you about Dr. Burns’ and Holmes Veterinary Hospital’s approach to the diagnosis, monitoring and treatment of diabetic dogs. It is not intended to substitute for information, diagnostics and treatment provided for your pet by your veterinarian.

Material in this presentation

Diabetes mellitus is also know as sugar diabetes.

It is caused by a deficiency of insulin, a hormone produced by the pancreas.

Without insulin, glucose cannot be taken up into the body’s cells, so it stays in the blood stream, causingHigh blood sugar (hyperglycemia)

What is Diabetes?

Increased thirst Drinking excessive amounts of

water Drinking the bowl dry Begging for water

Increased urination Increase in urine volume Accidents in the house Asking to go outside more often

Weight loss

Signs of Diabetes

Cataracts and blindness

Anorexia Vomiting Depression

Advanced disease may present with different signs

History Increased thirst, increased urination, urinating in house

Physical exam Often documentable weight loss

Fasted blood glucose test Normal is 60-110 Most diabetics are over 300 at time of diagnosis

Urinalysis Glucose in urine Often also have urinary tract infection

How does my vet diagnose diabetes?

Additional tests such as a CBC and Serum Chemistry Profile, insulin levels and/or serum

fructosamine may be recommended to establish a baseline

for the function of organs

Many people with diabetes can be

managed with oral medications, diet and

exercise. Some cats can be managed with a

special diet.

Dogs have to have insulin injections.

You want me to give my dog a shot twice a

day?

It really isn’t as hard as you think it is

Insulin needles are superfine and don’t hurt much

Most dogs don’t seem to mind and can be trained to come and sit quietly for their shot and then they get a treat

The type of insulin we use in dogs is a u-100 Strength human insulin readily available at the drugstore and not horribly expensive

There are different types of insulins—some short-duration, some long-lasting and some medium duration

Insulin comes in different strengths Syringes come calibrated for a specific

strength of insulin Insulin strength MUST MATCH the syringes

with which you are giving it. Using U-100 strength insulin in a U-40 syringe or using U-40 strength insulin in a U-100 syringe could be disastrous!

INSULINS & Syringes ARE NOT INTERCHANGEABLE!!!!!!!!!

Decrease thirst Decrease urination Stabilize weight Control secondary urinary tract infections that

often occur Keep patient happy and feeling well Keep blood glucose in the neighborhood of 180-

225 Avoid low blood sugar (hypoglycemia)

Goals of Treatment

Your dog did not become diabetic overnight, and we won’t be in a huge hurry to get it “regulated.”

We’ll go slowly because it is much more dangerous to get the blood sugar too low than it is for it to be too high.

It may take several weeks to get the blood glucose levels where we want them. Don’t be discouraged.

We don’t micromanage diabetes at Holmes Veterinary Hospital. We are more concerned with how your pet feels than his or her actual blood sugar level.

Dr. Burns’ philosophy and approach to diabetes in non-sick dogs

• Typically, Dr. Burns starts small dogs at 0.25 units insulin per kg twice daily—in the morning and again about 12 hours later.

• She checks a blood glucose once a week. Your dog should not be fasted for this test.

• As long as the blood glucose is very high, she has you increase the amount of insulin by 1 unit a week until we reach what she considers the endpoint.

• When the blood glucose gets down to around 180-225, we consider that an endpoint and hold at that dosage of insulin. This may take 4 to 12 weeks.

• If the blood glucose gets below 150, Dr. Burns is likely to decrease the amount of insulin you are giving.

• After a few weeks at the endpoint dosage, Dr. Burns may want to check a serum fructosamine, which tells her how well regulated your dog is.

Usual Regimen of Diabetes Care

Give morning insulin dose

Feed breakfast, about half of your dog’s usual daily calorie intake

Give afternoon insulin dose

Feed supper, about half of your dog’s usual daily calorie intake

10 to 12 hours later

See Dr. Burns in the afternoon every 7 days until near the endpoint. Then she may recommend a curve or a

mid-day blood glucose test to see what your pet’s nadir (lowest blood glucose) is. Also, see her for

testing If there is a dramatic change in water intake/urine output.

Play a large role in diabetes management, but Dr. Burns does not like to change your dog’s diet during initial treatment. It is important that your dog eats his or her normal food during this time.

Later on, we may consider an increased fiber, decreased calorie food.

Diet and Exercise

It is important for your dog to have some insulin twice day, even if he or she does not eat or doesn’t consume a full meal.

If your dog does not eat or eats much less than her usual ration—for whatever reason—give one-half of your usual insulin dose.

What if my dog does not eat?

Low blood sugar (under 60) Causes can include:

Did not eat enough Too much insulin was given Unusual amount of exercise Or a combination of the above

It is very dangerous, much more dangerous than high blood sugar.

What is hypoglycemia?

Droopy or listless Acting different

Woozy, wobbly, impaired or drunk-acting Abnormal vocalization Staggering, falling, circling Running into things as though blind

Seizures/convulsions Coma Death

Signs of low blood sugar

If your dog is conscious and able, feed him or her

If not able or willing to eat, give an ounce or two of white Karo syrup or honey. Even sugar water, maple syrup or molasses will do in a pinch. Do not give artificial sweeteners.

If unconscious and unable to swallow, massage the Karo or honey onto your dog’s gums before leaving home and/or while en route to your primary care veterinarian or after hours emergency clinic.

What to do if hypoglycemic

DON’T

If you give food or some Karo syrup to your dog and if your dog

does not respond by becoming more lucid within 10 to 15

minutes, you should take him or her to your primary care

veterinarian or to an after hours emergency clinic.

Most pets respond to the Karo syrup or honey, but if yours does not, go to the nearest veterinary clinic that is open. This will be your primary care veterinarian during

his or her office hours At night, holiday or weekend, you may have to go

to a pet emergency clinic. They can check your dog’s blood glucose and

give intravenous dextrose until he or she is stable

Keep emergency numbers written down and/or stored on

your cell phone for quick access.

Yes, there are pet owners who want to learn to do home blood glucose testing!

There are specially calibrated glucometers for animals

Blood samples can be taken by sticking near the ear margin, on the carpal pad of the foot or on elbow calluses on dogs

There are videos online that show you how to do it

Allows more exact control of hyperglycemia and avoidance of hypoglycemia

You may be able to reach your pet’s “endpoint” faster

Home Blood Glucose Testing?

If you are committed, we will be glad to order you a pet glucometer and help show you how to use it.

We also have other resource material,

including forms for you to chart your pet’s progress

#1 Good quality of life for your pet!!!!!

Decreased thirst Decreased urine output/urination No going pee-pee in the house Maintaining normal weight Control of urinary tract infections

Remember Our Goals

Unfortunately the majority of dogs with diabetes develop cataracts and eventual blindness.

Diabetics that ping around from low blood sugar to high and often don’t eat well and don’t feel well

These dogs are much more difficult to manage Some have mitigating concomitant diseases such as

Cushing’s Syndrome that make them more difficult to treat.

Certain breeds seem to be more difficult to treat (in this practice, it’s miniature Schnauzers).

Obese and inactive dogs can be more difficult to manage

“Brittle” Diabetics

Veterinarians may want to admit the patient for the day and do a blood glucose “curve” This means taking several samples during the day These are sometimes plotted on a graph called a curve

Veterinarians may want to test Serum Fructosamine, which gives an “average” of what your dog’s blood glucose has been doing for the past couple of weeks

Veterinarians may want to test (or retest) for other diseases

To better assess what the patient’s blood sugar is doing…

Feeding your dog an increased fiber/reduced fat and calorie food makes them easier to manage

Getting a consistent amount of exercise each day helps because exercise builds muscle mass which lowers the body’s requirement for insulin

Diet & Exercise

Diabetic Complications

Life-Threatening Complication! Dogs are very sick

Anorexia Vomiting Depression Death

Requires intensive care hospitalization 24 hour care facility We refer to an AAHA-

accredited 24 hour hospital

Diabetic Ketoacidosis

Cataracts cause the lens in the eye to turn an opaque white color and eventually cause blindness

Cataracts are usually not painful Dogs losing vision gradually will

learn to navigate around your house As long as you don’t move the

furniture around, most do just fine Going outside in a fenced yard is ok Going outside and being allowed to

run free is not ok Dogs losing vision suddenly may

have an adjustment period

About Diabetic Cataracts

Lens-induced uveitis Eye becomes reactive to a protein that leaks

from the lens Red, uncomfortable eye requiring treatment

Lens luxation Lens tips forward or backward Can lead to glaucoma

Retinal deterioration Such patients can go blind even if cataracts

are surgically removed

Complications of Cataracts

A highly specialized procedure Cannot be done in primary care veterinary

practices Patients must be referred to a Board-

Certified Veterinary Ophthalmologist Ideally done early in the course of the

disease Before complications develop!

Cataract Surgery

Jacquelyn H. Burns, DVM Holmes Veterinary Hospital 1001 Church Street Laurens, SC 29360 www.holmesvethospital.co

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© 2012 Jacquelyn H. BurnsAll rights reserved