Insulin, Diet and Exercice : the Three Cornerstones of Dog Diabetes Treatment
Dog diabetes cannot be cured except in the case of gestational diabetes or when diabetes is caused by Cushing’s disease. Diabetes is therefore a chronic disease that will need lifelong treatment. The goal of the treatment is to eliminate or limit the symptoms by lowering blood glucose. It prevents the onset of complications that often turn out to be dangerous for your dog’s health.
In practice, diabetic dogs, if well treated, can live a long and happy life.
The treatment strategy is based on the injection of insulin that lowers back the blood glucose to near-normal levels, which limits or suppresses the symptoms of the diabetic animal. Nevertheless, the owner must be warned against the complications of the treatment itself. Reducing too much blood glucose results in hypoglycemia, which is a serious condition and which may be fatal.
The treatment consists in one or two daily injections of insulin accompanied by a proper diet. Both injections and diets have to be given by the owner at very precise times of the day and in precise doses/amounts.
Insulin is injected under the skin (subcutaneous injection), usually in the back of the neck, or in the flank.
Veterinarians can choose between different types of insulin. Insulin preparations differ by their speed of action, their duration of action and their peak concentration (=maximum insulin blood concentration they can attain). This effect is due to the chemical form of the insulin. In pharmaceutical preparations, insulin is not pure. It is bound to crystals. The crystal slows down the absorption of insulin from the layer under the skin into the blood. The bigger the crystal, the slower the insulin absorption in the blood. Slower insulins are also longer acting insulins.
The insulin preparations may be classified according to three criteria:
- The onset of action: the time between the injection and the beginning of the effect. It ranges from 10 minutes to 1.5 hours
- Maximum effect: the period of time when insulin is really effective for limiting blood glucose. It ranges from 1-3 hours to 3-22 hours after injection.
- Duration: period of time when the injected insulin remains present in the blood. It ranges from 1 to 24 hours.
Your vet will probably choose among Regular, NPH, Lente or Ultralente insulin. All these medications come from the human medicine. There is only one registered product for dogs and cats: Vetsulin®, a porcine zinc insulin suspension (Caninsulin® in Europe).
Condition of storage: insulin is sensitive to sunlight and high temperature. It should therefore be kept in a fridge but should not be frozen.
The other important aspect of diabetes treatment is dog’s nutrition. Injected insulin compensates for the increase in blood glucose that follows food ingestion. There is a precise balance to be found between the amount and quality of food and the insulin dose. You may have noticed that human diabetic patients calculate their carbohydrate intakes for adjusting daily their insulin doses.
Diets containing large amount of fibers and giving priority to complex carbohydrates are usually prescribed to diabetic dogs. They can be made at home or purchased from manufacturers that develop special formula for diabetic dogs. Sometimes, the vet will prescribe a special low fat diet that can be used for obese dogs (see Food for diabetic dogs page).
Finding the right balance
Your vet will therefore prescribe both the dog’s treatment (insulin injections) and its diet. Full compliance is required. At the beginning of the treatment, your vet will try different options. After the initial prescription, she will perform a Blood Glucose Test to check blood glucose remain within the target limits. Ideally, the glycemia should remain along the day between 100 less and 300mg/dL. In practice, glycemia may climb higher, but is important that glycemia does not drop too low (80-100 mg/dL). The first attempt is rarely the right one, your vet will probably modify the first prescription (food and/or insulin) and run (or make you run) a new blood glucose test.
Once your dog’s glycemia has been stabilized, your vet may ask you to perform yourself a blood glucose tests regularly to check that the response to the treatment has not changed. Diabetes changes over time and your vet will change periodically her prescription.
Below 80 mg/dL your dog runs the risk to develop hypoglycemia. It is very important to emphasize that hypoglycemia is a dangerous complication of the treatment that requires immediate reaction. If your pet shows the signs of hypoglycemia (disorientation, weakness, low energy, loss of consciousness, anxiety, restlessness, tremor/shivering, coma…), feed it quickly with a highly concentrated sugar treat and call your vet or a veterinary emergency service.
When your dog exercises he uses glucose as source of energy. It impacts its glycemia. It also helps your pet lose weight when needed. In order not to lose control of your dog diabetes, you will define, with your vet, a typical set of daily exercises for your dog that will part of the treatment balance.