For specific monitoring recommendations based on blood glucose nadirs, see the algorithm for monitoring blood glucose levels in dogs and cats.

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Monitoring on the initial day of treatment

• Initiate insulin therapy.
• Measure fructosamine.
• Perform a BGC to ensure that hypoglycemia does not occur.
• If BG is <150 mg/dL at any time:
  • Decrease dose by 10–50% in dogs.
  • Decrease dose by 0.5 U in cats.
  • In both species, re-curve the next day and daily thereafter until a nadir >150 mg/dL is reached.
• If BG is >150 mg/dL, discharge the patient and re-evaluate in 7–14 days (sooner if concerns for hypoglycemia arise). The insulin dose should not be increased on day 1 no matter how high BG may be.

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Monitoring until control is attained

• In a new diabetic, have owner administer insulin in hospital to observe technique.
• BGC will need to be performed q 7–14 days until acceptable dose is found.
• Review owner log.
• Perform a physical examination, including measurement of body weight.
• Perform a BGC and measure fructosamine.

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Ongoing monitoring

• Review owner log.
• Perform a physical examination, including measurement of bodyweight.
• Perform a BGC and measure fructosamine.
• Semiannually, perform full laboratory work including urinalysis, urine culture, triglycerides, thyroid levels (cats), and BP.
• Any time an insulin dose is changed, a BGC should be performed in 7–14 days.
• Utilizing “spot checks” or isolated BG values by themselves is not recommended as a sole reason to increase an insulin dose, but can sometimes be used to decrease the dose (if verified).

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Ongoing home monitoring

• Log food and water intake and appetite daily.
• Log insulin doses daily.
• Note any signs suggestive of hypoglycemia; contact veterinarian if persistent.
• Periodically test urine; record glucose level and ketones. If ketones are present, contact veterinarian.

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Treatment adjustments based on nadirs

See “Monitoring” Algorithm

Insulin adjustments if the nadir is <80 mg/dL

See “Hypoglycemia” Algorithm.

• If clinical signs of hypoglycemia are present, treat as necessary.
• Once the BG becomes >250 mg/dL, reinitiate therapy.
  • Decrease the dose 10–25% in dogs depending on the BG level and if there are no clinical signs of hypoglycemia.
  • Decrease the dose 50% in dogs if there are clinical signs of hypoglycemia.
  • Decrease the dose 0.5–1 U in cats depending on BG and if there are clinical signs of hypoglycemia.
  • A BGC should be obtained after the next dose to ensure hypoglycemia does not recur. If hypoglycemia recurs with the lower dose, continue to decrease dose and obtain a BGC until hypoglycemia is not seen. Obtain a BGC in 7–14 days.
• If BG never returns to >250 mg/dL, consider remission, especially in cats. Monitor for hyperglycemia recurrence, in which case reinitiate insulin therapy as for new patient.

Insulin adjustments if the nadir is >150 mg/dL

• If clinical signs are present:
  • Increase the dose 10–25% in dogs depending on the size of the patient and the degree of hyperglycemia.
  • Increase the dose 0.5–1 U in cats depending on the size of the patient and the degree of hyperglycemia.
  • If giving insulin once daily, consider q 12 hr therapy.
• If clinical signs are not reported:
  • Consider stress hyperglycemia OR placebo effect.
  • If weight is stable, leave dose unchanged and recheck in 1–3 mo.
  • If weight is decreasing, consider dose increase and recheck in 14 days.
• Consider the presence of insulin resistance if:
  • In dogs, insulin dose >1 U/kg/dose with no response or >1.5 U/kg fails to bring BG below 300 mg/dL.
  • In cats, insulin dose >5 U/dose.

Insulin adjustments if the nadir is 80–150 mg/dL

• If clinical signs are controlled, no adjustment needed.
• If clinical signs are not controlled, do not adjust the insulin dose. Consider the following possibilities:
  • BGC is not reflective of overall control; BGC varies day to day.
  • There is inappropriate insulin duration of action. If giving insulin once a day, consider q 12 hr therapy. If giving q 12 hr, may need to consider changing insulin.
  • There is overlap of insulin action. If BG is still decreasing at end of day, the subsequent dose may cause hypoglycemia. May need to give a lower dose in the evening.
  • Presence of another disease is causing the clinical signs.