Managing Uncomplicated Diabetes

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Appearance & Management of Uncomplicated Diabetes

Two Types of Patients can be Categorized as Uncomplicated:

1. 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.
2. Dogs that, after initial presentation with DKA and successful treatment, are generally stable and without ketonuria.

During Consultation:

• 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 3 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^®

Steps in Clinic

• 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.

Tasks for Clients at Home

• Monitor and record daily water and food consumption.
• Monitor and record daily urine glucose and ketone bodies.
• Maintain starting dose and frequency of administration for the entire week.
• Watch for signs of hypoglycemia.

Hospital Re-Evaluation After One Week

• Verify adequate injection technique.
• Evaluate blood glucose status via blood glucose curve or spot glucose measurement.
• Weigh the patient.
• Increase insulin dose only if clinical signs and monitoring confirm it is indicated. An interval of 5 to 7 days between dosage increments is ideal. Less than that can lead to Somogyi overswing.
• Decrease insulin dose if hypoglycemia is documented

Ongoing Regulation

• 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, serum, fructosamine).

Problems

If a patient experiences a change in regulation as evidenced by a change in clinical signs or blood glucose, a cause must be identified. Both product and patient sources should be considered.

• Perform a complete physical exam.
• Recheck:
  • Injection technique and insulin quality control.
  • Feeding and exercise.
  • Environment of the patient (recent changes).
  • Confirm proper storage and handling.
• Perform a glucose curve.
• If no product issues are identified, evaluate complete blood count, urinalysis (including sediment examination if indicated) and serum biochemistry profile (including T4).
• Additional testing procedures may be required if indicated. Dogs with diabetes may develop other concurrent diseases or infections that will interfere with insulin effect.

Help Your Practice Manage Diabetes Mellitus

View and download resources and tools that will assist your hospital, inform your team, and help with clients.

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Important Safety Information:

Vetsulin^® should not be used in dogs known to have a systemic allergy to pork or pork products. Vetsulin is contraindicated during periods of hypoglycemia. Keep out of reach of children. As with all insulin products, careful patient monitoring for hypoglycemia and hyperglycemia is essential to attain and maintain adequate glycemic control and prevent associated complications. Overdosage can result in profound hypoglycemia and death. The safety and effectiveness of Vetsulin in puppies, breeding, pregnant, and lactating dogs has not been evaluated. See package insert for full information regarding contraindications, warnings, and precautions.

References:

1. Martin GJ, Rand JS. Pharmacology of a 40 IU/ml porcine lente insulin preparation in diabetic cats: findings during the first week and after 5 or 9 weeks of therapy. J Feline Med Surg. 2001;3(1):23–30. 2. Vetsulin^® (porcine insulin zinc suspension) [Freedom of Information Summary]. Millsboro, DE: Intervet Inc.; 2008. 3. Data on file, Merck Animal Health. 4. Graham PA, Nash AS, McKellar QA. Pharmacokinetics of porcine insulin zinc suspension in diabetic dogs. J Small Anim Pract. 1997;38(10):434–438. 5. Martin GJ, Rand JS. Pharmacokinetic and Pharmacodynamic Study of Caninsulin in Cats with Diabetes Mellitus. 2000: Internal Study Report. 6. Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. 3rd ed. St. Louis, MO: Saunders; 2004:539–579. 7. Tennant B, ed. BSAVA Small Animal Formulary. 4th ed. Gloucestershire, UK: British Small Animal Veterinary Association; 2002. 8. Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. 3rd ed. St. Louis, MO: Saunders; 2004:486–538. 9. Reusch C. Feline diabetes mellitus. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, MO: Saunders; 2010:1796–1816. 10. Nelson RW. Canine diabetes mellitus. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, MO: Saunders; 2010:1782–1796. 11. Burgaud S, Riant S, Piau N. Comparative laboratory evaluation of dose delivery using a veterinary insulin pen. In: Proceedings of the WSAVA/FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 121. 12. Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic dogs. In: Proceedings of the WSAVA/ FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 122. 13. Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic cats. In: Proceedings of the WSAVA/FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 45. 14. Davison LJ, Walding B, Herrtage ME, Catchpole B. Anti-insulin antibodies in diabetic dogs before and after treatment with different insulin preparations. J Vet Intern Med. 2008;22:1317-1325. 15. Banfield State of Pet Health 2016 Report. p 12-13.