It should first be said that any disease is easier to treat when detected early in its progression. For the chronically unmanaged diabetic patient, much deterioration in the overall health has already occurred, making treatment of the disease more difficult. By the time symptoms are obvious, the disease is already well established. Routine wellness exams greatly improve early detection of diseases like diabetes.
Upon presentation of a symptomatic animal, the veterinarian will give the pet a complete physical examination and collect blood and urine for analysis. In addition to diagnosing diabetes, it is very important to rule out complicating factors that may make long-term management of the disease more difficult. A complete blood cell count and chemistry panel, along with a urinalysis is required as a baseline workup. A thyroid panel and urine culture is also commonly needed.
Elevated blood-glucose and glucosuria, or glucose present in the urine, is evidence of diabetes. Other laboratory test results that return outside of the normal range may indicate the deteriorative effects of diabetes, such as dehydration, kidney disease, pancreatitis, and ketoacidosis – a life-threatening emergency condition caused by untreated chronic diabetes.
When Diabetes Mellitus is diagnosed, insulin therapy may be started. Almost all diabetic dogs require insulin injections, as they will have Type I Diabetes – a deficiency in the production of insulin. Some cats may respond well to diet change and oral glucose-controlling drugs, at least initially. Most cats will eventually require insulin injections as well; however, cats may experience transient diabetes, where they require insulin for a period of time and suddenly reverse their diabetic status.
When insulin is given, a pre- and post-injection blood-glucose will be checked to measure the resting level and response. The veterinarian will adjust the dose until a desired effect is seen. This is called a glucose curve.
The veterinarian will then prescribe a dose of insulin for you to give at home on a once or twice daily basis. This dose may be changed frequently by the doctor as the animal shows response to the therapy and its requirements change. The staff will teach you how to properly administer the injections and help you to become comfortable with this responsibility.
A special diet is prescribed for diabetic patients. Since glucose is converted from food, animals will benefit from diets that take the body longer to break down into glucose. This will help to regulate the blood-sugar level and smooth out peaks and troughs that normally occur after and in-between meals. Also, feeding schedules should be kept consistent. The timing of insulin injections to food consumption will directly affect the blood-glucose curve throughout the day. The amount of insulin required will be difficult to assess if feeding schedules are haphazard.
For the proper long-term management of diabetes, blood-glucose is periodically monitored; and ideally, 24-hour glucose curves are established to regulate the glucose within a controlled range. Because stress may artificially elevate blood-sugar levels, your veterinarian may equip and train you to measure glucose at home. A trip to the vet may cause fluctuations in glucose that do not occur when the pet is comfortable at home and make it difficult to predict the proper dose of insulin that is needed. At home monitoring can also reduce the risk of insulin overdose – a life threatening situation that will be discussed in the following section.
In Part IV, we will discuss how to properly administer insulin injections, monitoring of blood-glucose at home, hypoglycemia – or low blood-glucose, and the symptoms of – and procedures to follow in case of insulin shock or overdose.