Nov
1
2017

Blood glucose regulation is a dynamic process. The art of successful management of diabetic pets is to use exogenous insulin to mimic this dynamic process of blood glucose regulation.

Human labeled insulin has evolved from animal to recombinant to synthetic sourced insulins with variable potency and duration of action.  This allows the physician to deliver insulin more precisely and manage diabetes more intensely.

Animal patients may tolerate extremes in blood glucose better than humans and are unable to signal when their blood glucose is low.  Veterinarians have the flexibility to manage their patients’ disease tightly with the goal of achieving normal blood glucose or more loosely with the goal of managing clinical signs and reducing the risk of diabetic ketoacidosis.

To successfully manage the diabetic dog or cat:

Establish a Goal for Therapy:

Veterinarians and their patients are dependent on pet owners’ participation in treatment. Clients’ ability to care for pets can be constrained by budget, time and commitment level. Thus it is imperative to establish a goal for treatment which meets clients’ expectations as well as patients’ medical needs.  Realistic treatment goals are to eliminate clinical signs and stabilize body weight while avoiding hypoglycemia.

It is well established that it is possible to induce remission in cats with diabetes with a combination of insulin therapy, diet change and aggressive monitoring. Attempting to induce remission of diabetes in a feline patient is academic at best; if the client does not have the time or resources to monitor blood glucose levels frequently at home.  Conversely, the highly motivated cat owner may be left dissatisfied and turn to the internet if she is not offered induction of remission as a treatment option.  Make the client an ally in disease management by asking lifestyle questions and offering treatment options.

Know Insulin Types:

Duration of insulin activity varies by type. Insulin is categorized as short, intermediate and long acting. In general, dogs tend to respond most consistently to intermediate insulins. Rarely is a dog better managed using long acting insulin.  Cats can be regulated using long acting and intermediate insulin.  Goal for therapy (i.e. tight vs. loose regulation), budget and individual patient response should be considered when choosing insulin type.

Use the Right Test:

Patient response to insulin varies individually and over time. Thus, routine monitoring of response to therapy is necessary. While physical exam and history taking are most important, testing aids in troubleshooting and regulation.

Blood glucose curves can be used to guide changes in insulin type and dose in the initial phase of diabetic regulation and when troubleshooting dysregulation.  Ideally, use blood glucose nadir to change insulin dose.  Establish duration of insulin activity when determining frequency of insulin administration or considering insulin type.

Serum fructosamine or A1C can be used as an aid in the diagnosis of diabetes or as a tool to monitor blood glucose over time. Given both are an average of blood glucose levels over several weeks, it may not be advisable to use them as the only tool for changing insulin dose, frequency or type.

When hospital acquired blood glucose curves and / or serum fructosamine fail to provide data to guide patient care consider teaching the pet owner to monitor blood glucose at home or refer for continuous blood glucose monitoring.

In conclusion, managing diabetic pets can be challenging but rewarding. Establishing treatment and monitoring protocols that meet the client’s budget and lifestyle can improve the patient’s lifespan.

Author: Dr. Bonnie Bragdon earned her Doctor of Veterinary Medicine and her Master of Veterinary Clinical sciences from The Ohio State University. Dr. Bragdon is a Veterinary Professional Services Manager for Merck Animal Health’s US Companion Animal business, where she helps veterinary teams help pets by providing technical support.

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