Diabetes Mellitus Management for Dogs and Cats: Page 2 of 3

Home Care

Typically two daily injections of insulin twice daily will be required for the rest of your pet's life. Though with some cats, once the blood sugar has been lowered, the dose of insulin may be reduced or eliminated. However, cats may become insulin dependent again later in life. Oral medication may be effective for some diabetic cats. It is also important that the injections are given at the same times each day, usually every 12 hours. In sporadic occasions if the 12 hour time frame cannot be met, insulin may be given 10-14 hours apart. The injection is given just under the skin (subcutaneous) and is not painful to your pet. Insulin should be given behind the region of the shoulder blades, along the back, changing the site of administration at each administration. Your veterinary technician will show you how to administer the insulin injection.

The Insulin Dose

The type of insulin and the daily dose are tailored to meet the needs of each pet. Other medications may be prescribed, depending on any concurrent illnesses.

Your veterinarian will determine the initial dose of insulin while your pet is in the hospital. This dose will likely need adjustment once your pet has been home for 7-14 days because the food and exercise your pet receives at home are different from that received in the hospital. To regulate any changes in the insulin dose needed by your pet, your veterinarian will continue to monitor your pet with blood testing.

Handling Insulin and Insulin Syringes

The insulin needs to be kept cool and out of light, most people prefer to keep it in the refrigerator. The bottle should be mixed by rolling or swirling before withdrawal of the insulin into the syringe. The bottle should never be shaken to mix the insulin.

The syringe and needle should be stored in protective wrappers to keep them sterile. Syringes and needles have four parts consisting of the syringe barrel, the plunger, the needle, and the needle guard. Various syringes are available for injecting insulin. Ultralow dose (1/3 cc) insulin syringes are preferred because they are designed for ease in measuring small amounts of insulin. These syringes and needles are disposable or "single use" only. THEY SHOULD NOT BE REUSED! After injecting your pet with insulin, place the needle and the needle guard in a suitable disposal container. DO NOT recap the needle, you could inadvertently stick the needle into your hand or finger. For their safety, it is important that children not have access to the used syringes and needles.

Drawing up the Insulin

Set out the syringe and needle, insulin bottle and have your pet ready.

1. Remove the needle guard from the needle; draw back the plunger to the desired dose level.

2. Insert the needle into the insulin bottle.

3. Inject the air in the syringe into the bottle to prevent a vacuum from forming in the insulin bottle.

4. Pull back on the plunger, filling the syringe with insulin to the correct level.

Before withdrawing the needle from the bottle check to see that there are no air bubbles in the syringe. If you see an air bubble, draw up slightly more insulin into the syringe and gently tap the barrel with your finger to move the air bubble to the nozzle of the syringe, then gently expel the bubble by pushing the plunger upwards towards the bottle. Now check to see that you have the correct amount of insulin in the syringe. The correct dose of insulin is measured from the needle end, or "0" on the syringe barrel, to the end of the plunger closest to the needle.

How to Give an Injection

1. Hold the syringe in your right hand (or your left, if left-handed). There are many ways to hold the syringe. With time you will develop the one easiest for you. You may find it helpful to begin practicing with a syringe filled with water and injecting it into an orange.

2. Have a friend or member of your family hold your pet as you pick up a fold of skin along the back with your free hand. Be sure to pick a different spot for each injection. Insulin injections should not be given between the shoulder blades because insulin absorption is erratic or unpredictable in this area.

3. Push the very sharp, very thin needle through the animal's skin quickly. This should be easy and painless using the insulin needle. Take care to push the needle through only one fold of the skin, not into your finger, your pet's underlying muscle, or through both layers of skin.

4. Pull back gently on the plunger (aspirate) to make sure that no blood fills the syringe. If this happens, remove the syringe from this site, and proceed in another location. You may have just hit a skin blood vessel.

5. With your thumb on the plunger, push the plunger into the syringe until it will not go in any farther.

6. Withdraw the needle from the pet's skin, immediately dispose of the syringe and needle guard.

7. Pat your pet to reward it for sitting quietly for the injection.

"Sterilizing" the skin with alcohol is not necessary, and may be counterproductive if it stings and causes your pet to avoid the injections.

Sometimes your pet may have an insulin "reaction" caused by a sudden decrease in blood sugar (insulin-induced hypoglycemia). This usually occurs 2-6 hours after the injection. The earliest signs resemble a drunken state; that is your pet will be weak and walk with a wobbly, uncoordinated gait. This stage may progress to seizure or coma. Should hypoglycemia occur, give 1-2 teaspoons of Karo syrup by mouth, and call the hospital immediately. A blood sugar level significantly below normal is an immediate threat to life, and needs to be dealt with urgently. INSULIN- INDUCED HYPOGLYCEMIA IS OFTEN AN INDICATION OF EXCESSIVE INSULIN ADMINISTRATION. IMMEDIATE REASSESMENT OF INSULIN REQUIREMENTS BY YOUR VETERINARIAN IS REQUIRED.

When to Feed

When you feed your pet is as important as what you feed your pet. Your pet must be fed the recommended diet in the correct quantity at a regular time each day in conjunction with the insulin injection. Correct dietary management is a critical part of the successful management of the diabetic animal. As a general rule of thumb, the diabetic animal should be fed 2-3 times daily. Ensure that your pet is eating well before giving each insulin injection. If the insulin is given first and the animal refuses to eat, this could lead to hypoglycemia. Cats that are fed free-choice (i.e., food available all time) require no changes in their life style as long as you are certain that they are eating normally.