Diabetes Mellitus Management
At Oakview Veterinary Medical Center, we understand the importance of maintaining your pet’s health and well-being. One health issue that affects many pets is diabetes, which is a chronic condition that requires ongoing management.
If you suspect that your pet may have diabetes, you’ve come to the right place. Our team of experienced veterinarians and veterinary technicians are here to help guide you through the diagnosis, treatment, and management of your pet’s diabetes.
What is Diabetes?
Diabetes in pets is similar to diabetes in humans: the body cannot convert glucose into energy due to issues with producing or regulating the hormone insulin. While a diagnosis of diabetes in your pet may sound scary, this is something we can manage together with the right medical plan. Cats and dogs experience diabetes differently, so it’s important to understand what we’re trying to treat. Diabetic dogs lack the cells needed to produce insulin, and they will require insulin therapy either once or twice a day for life, usually along with diet changes. Their diabetes is more like type 1 diabetes in people. Cats with diabetes generally have insulin resistance, rather than the inability to produce insulin. They will usually require insulin at the beginning of treatment, but because they are still able to produce their own insulin, some will go into remission and eventually be managed using diet alone. Their diabetes more closely resembles type 2 in people.
What are the Signs of Diabetes?
The signs of diabetes in pets can vary, but some common symptoms include:
- Increased thirst and urination
- Weight loss, even though your pet may be eating more than usual
- Lethargy and decreased activity levels
- Changes in appetite
- Poor coat condition or skin infections
- Vomiting or diarrhea
If you notice any of these signs in your pet, it is important to bring them in for an examination so we can determine the underlying cause and develop a treatment plan.
How is Diabetes Treated?
We know it can be overwhelming to have to make decisions about your pet’s care when you’re feeling anxious and worried about their health, but with diabetes, it’s important to start treatment as soon as you and your veterinary team have decided on a plan. The treatment for pet diabetes involves managing your pet’s blood sugar levels with insulin injections and dietary changes. Our veterinary team will work with you to create a customized treatment plan that meets your pet’s individual needs. We will recommend regular blood sugar testing, adjustments to your pet’s diet, and regular veterinary check-ups to monitor their progress.
Diabetes Mellitus in Cats
General Information
Diabetes mellitus is a disease caused by a deficiency of insulin. Insulin is a hormone produced by the pancreas and is necessary for body tissues to use blood sugar. Without insulin the sugar remains in the blood and eventually passes into the urine. This causes increased urine production and thirst. Increased hunger and weight loss occur because the body cannot use the sugar in the blood. As the disease progresses chemicals called ketones accumulate, resulting in vomiting and dehydration. Eventually coma and then death occur in untreated animals. Diabetes is not a curable disease. With proper insulin administration, monitoring of clinical signs and periodic glucose monitoring the disease can be controlled.
Cats typically have type II diabetes. Chronic pancreatitis (inflammation of the pancreas) is the most common cause of diabetes in cats. This causes a decrease in insulin production and/or a resistance to insulin by the cells. Type II diabetes is sometimes reversible, and the disease can go into remission.
Feeding the correct diet is a very important part of diabetes management in cats. We usually recommend feeding a prescription diet made specifically for this disease. This diet is Purina Pro Plan Veterinary Diets DM. It is recommended to feed a diabetic cat mostly a canned food diet. The savory selects variety of the Purina DM is not recommended, however, because it contains more carbohydrates and can make diabetes regulation more difficult.
If a prescription diet is not an option for you or your pet, then an alternative option is to feed a high protein, low carbohydrate diet.
Feeding a diet that is less than 7% carbohydrates as listed on the chart at https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf is recommended. Please use this chart to find a food that your cat likes to eat. The information on this chart is not comparable to the information listed on the can.
General Instructions
- Feed half the daily recommended amount every 12 hours. Insulin should be given immediately after eating. If your pet eats at least 50% of their normal meal, then give the full insulin dose. If they eat less than 50% of their meal, then give half the regular insulin dose. If they do not eat two meals in a row, DO NOT administer insulin and contact us or Blue Pearl-Fox Valley Animal Referral Center when after hours. Please do not resume giving insulin without speaking with a veterinarian.
- Every 12 hours give the insulin as directed. We typically use a glargine insulin for cats. This comes in an easy to use insulin pen. To administer the insulin you attach a pen needle (a ½ inch needle is best for cats) that screws directly onto the end of the pen. Dial to the desired insulin amount. Insert the needle under the skin and push the button on the pen. Wait at least 5 seconds to remove the needle so the pen can discharge the dose. It is normal to see a small drop of insulin at the tip of the needle. After injection, place the cap back on the needle and remove it from the pen.
Insulin should be stored in the refrigerator, on a shelf near the back and not in the door (to minimize temperature fluctuations.) The pharmacist and the packaging recommend keeping at room temperature. This is not the case for animals. We recommend keeping the insulin in the refrigerator at all times.
Inspect the insulin before each use. If any color or consistency changes are noted, then do not administer.
- The starting dose of insulin is:
- Keep a record of important clinical signs such as drinking and urinating as well as appetite and any changes observed.
Potential Complications
Low blood glucose, or hypoglycemia: In general, low blood sugar is more immediately life-threatening than high blood sugar. Pets can become more sensitive to their insulin over time. Because of this insulin should not be increased any more frequently than once a week, after performing blood glucose curves or fructosamine levels. In general determining a pet’s ideal insulin dose takes about a month. Once the diabetes is well controlled, then the monitoring can become less frequent.
Symptoms of low blood sugar include: weakness, trembling, severe lethargy, confusion and seizures. If you notice any of these signs, then you should feed a meal or rub some honey, sugar water or Karo syrup on the gums and contact us or Blue Pearl-Fox Valley Referral Center if after hours. Do not give any insulin before consulting with a veterinarian.
Urinary tract infections (UTI): UTI’s are common in diabetic animals because there is always some glucose in their urine. If your pet is experiencing a sudden increase in urination or accidents, then they may have a urinary tract infection. Urine cultures are recommended every six months in diabetic animals to screen for this complication. Often there can be no symptoms present with an infection.
Diabetic ketoacidosis and/or pancreatitis: Diabetic ketoacidosis (DKA) occurs in pets when their blood glucose has been high for too long. These pets are often not eating, vomiting and dehydrated. Hospitalization for IV fluids and supportive care with diabetes management are needed to treat this condition. Pancreatitis means inflammation of the pancreas. This affects digestion and causes vomiting, inappetence and lethargy. Hospitalization is also often required to treat this condition.
Please monitor for any vomiting, diarrhea, poor appetite, lethargy, changes to thirst or urination, or any other unusual symptoms and contact us if they are seen.
Monitoring Your Pet’s Response to Treatment
Veterinary diabetic patients are monitored quite differently than human diabetic patients. Daily glucose monitoring is not necessary or recommended for diabetic pets.
We will often recommend using an interstitial glucose monitor designed for humans when starting a new diabetic. We have been using the Free Style Libre monitor. This is a sensor that is placed on the skin after clipping and cleaning the skin. These sensors can last for up to 14 days and will record glucose readings every 15 minutes. An app can be easily downloaded onto most smart phones that is used to collect the data from the sensor. This data then can easily be shared with our clinic via a website.
An important point to note about the Free Style Libre system is that it was developed for humans. There is no guarantee by the company (or our office) that the sensor will stay on a pet and they will not reimburse for any that fall off. In general we have had good luck with most cats with the sensors working well and staying on.
The Free Style Libre sensor will need to be scanned at least every 8 hours. After eight hours it starts writing over the oldest data it has collected. The easiest way to collect the data from the sensor and to share it with us is to use a smart phone. An app can be downloaded and used. Your veterinarian will email you a link to connect with us on LibreView, the software we use to view the data. It is best to scan the sensor with the same device as much as possible.
Bathing and swimming are not recommended for your pet when wearing a glucose sensor.
If the sensor is showing low glucose levels or high glucose levels that do not correlate with how your pet is acting, then it may not be working properly. Please let us know if you notice these trends.
More information on the Free Style Libre glucose monitor can be found at: www.freestyle.abbott Just a reminder that this information is for people, but is generally applicable to pets.
If a continuous glucose monitor is not an option for you or your pet, then we can show you how to collect blood glucose data with a traditional glucometer. The Alpha Trak glucometer is recommended for pets. We will give you instructions on how to collect the sample, measure the glucose and how often to do this test.
The Alpha Trak 3 is the newest glucometer. To learn more about Alpha Trak, click here: https://www.zoetispetcare.com/products/alphatrak
Goals of Treatment
Our goal is to improve the clinical signs. By doing this we help improve your pet’s, and your own, quality of life. We want your pet to be drinking and urinating normal amounts, eating well and maintaining a healthy weight. This is our main priority.
Ideally we would like to keep the blood glucose levels less than 300 mg/dL daily. The lowest levels we like to see are 80-150 mg/dL. Blood glucose levels fluctuate throughout the day depending on how well they are eating and how much exercise they get.
Diabetic cats can have a great quality of life with the correct treatment and monitoring of their diabetes.
What to bring to your first appointment
After diagnosis we will schedule an appointment with one of our Certified Veterinary Technicians to go over how to prepare the insulin, how to administer it and any questions or concerns you may have.
Please bring the following items to this appointment:
- Your diabetic pet
- Insulin pen
After your pet has been on insulin for about a week we recommend placing the Free Style Libre glucose monitor. We do this in the clinic to assure the correct placement of the sensor.
For this appointment you will need:
- A Free Style Libre sensor. We will send a prescription to the pharmacy of your choice.
- The device you wish to scan the sensor with. It is helpful to download the app for the Free Style Libre sensor prior to your arrival.
Diabetes Mellitus in Dogs
General Information
Diabetes mellitus is a disease caused by a deficiency of insulin. Insulin is a hormone produced by the pancreas and is necessary for body tissues to use blood sugar. Without insulin the sugar remains in the blood and eventually passes into the urine. This causes increased urine production and thirst. Increased hunger and weight loss occur because the body cannot use the sugar in the blood. As the disease progresses chemicals called ketones accumulate, resulting in vomiting and dehydration. Eventually coma and then death occur in untreated animals. Diabetes is not a curable disease. With proper insulin administration, monitoring of clinical signs and periodic glucose monitoring the disease can be controlled.
Dogs typically have type I diabetes. This means that they are not making insulin and rely on insulin injections. This will be a life long treatment for your pet. We usually start with a type of insulin called NPH. This is considered an intermediate duration insulin. Your dog will need injections every 12 hours.
For dogs that are obese, gradual weight reduction improves insulin sensitivity. Often we are most successful when diabetic pets are on a prescription diet specifically formulated for this disease.
General Instructions
- Feed half the daily recommended amount every 12 hours. Insulin should be given immediately after eating. If your pet eats at least 50% of their normal meal, then give the full insulin dose. If they eat less than 50% of their meal, then give half the regular insulin dose. If they do not eat two meals in a row, DO NOT administer insulin and contact us or Blue Pearl-Fox Valley Animal Referral Center when after hours. Please do not resume giving insulin without speaking with a veterinarian.
- Every 12 hours mix the insulin as directed, draw up the prescribed dose and give the insulin injection subcutaneously (under the skin.)
We typically use NPH insulin for dogs. You should gently roll the bottle between your hands a few times before drawing up the insulin.
Insulin should be stored in the refrigerator, on a shelf near the back and not in the door (to minimize temperature fluctuations.) Inspect the insulin before each use. If any color or consistency changes are noted, then do not administer.
- The starting dose of insulin is:
- Keep a record of important clinical signs such as drinking and urinating as well as appetite and any changes observed.
Potential Complications
Low blood glucose, or hypoglycemia: In general, low blood sugar is more immediately life-threatening than high blood sugar. Pets can become more sensitive to their insulin over time. Because of this insulin should not be increased any more frequently than once a week, after performing blood glucose curves or fructosamine levels. In general determining a pet’s ideal insulin dose takes about a month. Once the diabetes is well controlled, then the monitoring can become less frequent.
Symptoms of low blood sugar include: weakness, trembling, severe lethargy, confusion and seizures. If you notice any of these signs, then you should feed a meal or rub some honey, sugar water or Karo syrup on the gums and contact us or Blue Pearl-Fox Valley Referral Center if after hours. Do not give any insulin before consulting with a veterinarian.
Cataracts: These are the most common side effects of diabetes in dogs. If the blood sugar is not controlled in a timely manner, then cataracts can develop. Often this leads to decreases in vision or blindness.
Urinary tract infections (UTI): UTI’s are common in diabetic animals because there is always some glucose in their urine. If your pet is experiencing a sudden increase in urination or accidents, then they may have a urinary tract infection. Urine cultures are recommended every six months in diabetic animals to screen for this complication. Often there can be no symptoms present with an infection.
Diabetic ketoacidosis and/or pancreatitis: Diabetic ketoacidosis (DKA) occurs in pets when their blood glucose has been high for too long. These pets are often not eating, vomiting and dehydrated. Hospitalization for IV fluids and supportive care with diabetes management are needed to treat this condition. Pancreatitis means inflammation of the pancreas. This affects digestion and causes vomiting, inappetence and lethargy. Hospitalization is also often required to treat this condition.
Please monitor for any vomiting, diarrhea, poor appetite, lethargy, changes to thirst or urination, or any other unusual symptoms and contact us if they are seen.
Monitoring Your Pet’s Response to Treatment
Veterinary diabetic patients are monitored quite differently than human diabetic patients. Daily glucose monitoring is not necessary or recommended for diabetic pets.
We will often recommend using an interstitial glucose monitor designed for humans when starting a new diabetic. We have been using the Free Style Libre monitor. This is a sensor that is placed on the skin after clipping and cleaning the skin. These sensors can last for up to 14 days and will record glucose readings every 15 minutes. An app can be easily downloaded onto most smart phones that is used to collect the data from the sensor. This data then can easily be shared with our clinic via a website.
An important point to note about the Free Style Libre system is that it was developed for humans. There is no guarantee by the company (or our office) that the sensor will stay on a pet and they will not reimburse for any that fall off. In general we have had good luck with most dogs with the sensors working well and staying on.
The Free Style Libre sensor will need to be scanned at least every 8 hours. After eight hours it starts writing over the oldest data it has collected. The easiest way to collect the data from the sensor and to share it with us is to use a smart phone. An app can be downloaded and used. Your veterinarian will email you a link to connect with us on LibreView, the software we use to view the data. It is best to scan the sensor with the same device as much as possible.
Bathing and swimming are not recommended for your pet when wearing a glucose sensor.
If the sensor is showing low glucose levels or high glucose levels that do not correlate with how your pet is acting, then it may not be working properly. Please let us know if you notice these trends.
More information on the Free Style Libre glucose monitor can be found at: www.freestyle.abbott Just a reminder that this information is for people, but is generally applicable to pets.
If a continuous glucose monitor is not an option for you or your pet, then we can show you how to collect blood glucose data with a traditional glucometer. The Alpha Trak glucometer is recommended for pets. We will give you instructions on how to collect the sample, measure the glucose and how often to do this test.
The Alpha Trak 3 is the newest glucometer. To learn more about Alpha Trak, click here: https://www.zoetispetcare.com/products/alphatrak
Goals of Treatment
Our goal is to improve the clinical signs. By doing this we help improve your pet’s, and your own, quality of life. We want your pet to be drinking and urinating normal amounts, eating well and maintaining his/her weight. This is our main priority.
Ideally we would like to keep the blood glucose levels less than 300 mg/dL daily. The lowest levels we like to see are 80-150 mg/dL. Blood glucose levels fluctuate throughout the day depending on how well they are eating and how much exercise they get.
Diabetic dogs can have a great quality of life with the correct treatment and monitoring of their diabetes.
What to bring to your first appointment
After diagnosis we will schedule an appointment with one of our Certified Veterinary Technicians to go over how to prepare the insulin, how to administer it and any questions or concerns you may have.
Please bring the following items to this appointment:
- Your diabetic pet
- Insulin vial
- Insulin syringes
After your pet has been on insulin for about a week we recommend placing the Free Style Libre glucose monitor. We do this in the clinic to assure the correct placement of the sensor.
For this appointment you will need:
- A Free Style Libre sensor. We will send a prescription to the pharmacy of your choice.
- The device you wish to scan the sensor with. It is helpful to download the app for the Free Style Libre sensor prior to your arrival.
How Can Oakview Veterinary Medical Center Help?
Our experienced veterinary team at Oakview Veterinary Medical Center can help manage your pet’s diabetes and provide ongoing support. We offer blood sugar testing training, insulin injection demonstrations, dietary counseling, and regular check-ups to ensure your pet stays healthy and happy. We are also available to answer any questions you may have about your pet’s condition or treatment plan. Additional resources and information can be found here: https://www.aaha.org/aaha-guidelines/diabetes-management/client-education/. To learn more about if your pet may have diabetes, click here! If you suspect your pet may have diabetes or would like more information about how we can help manage your pet’s condition, please contact us to make an appointment. We look forward to helping your furry friend stay healthy and thrive.
