Treatment of clinical DM in the dog always requires exogenous insulin therapy.

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The Task Force’s first-choice recommendation for dogs is lente (Vetsulin) using a starting dose of 0.25 U/kg q 12 hr, rounded to the nearest whole U.

• Most dogs are well controlled on insulin at an average dose of 0.5 U/kg q 12 hr with a range of 0.2–1.0 U/kg.The duration of action is close to 12 hr in most dogs, and the amorphous component of the insulin helps to minimize postprandial hyperglycemia.
• The duration of action is close to 12 hr in most dogs, and the amorphous component of the insulin helps to minimize postprandial hyperglycemia.

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A critical initial goal of treatment is avoidance of symptomatic hypoglycemia, which may occur if the insulin dose is increased too aggressively. Feed equal-sized meals twice daily at the time of each insulin injection.

In contrast to cats, diabetic remission occurs only rarely in dogs with naturally acquired DM.

Performing an ovariohysterectomy in intact diabetic dogs will support remission, regardless of the underlying cause of the diabetes.

As with cats, a clinically sick, diabetic, ketotic dog should be admitted for 24 hr care for aggressive therapy of the ketosis and other underlying illnesses.

In dogs with subclinical DM, investigate and address causes of insulin resistance, including obesity, medications, hyperadrenocorticism and diestrus in intact females. Initiate dietary therapy to limit postprandial hyperglycemia (see “Dietary Therapy Goals and Management” for additional information.) Evaluate the dog closely for progression to clinical DM. Subclinical DM is not commonly identified in the dog. Most dogs in the early stages of naturally acquired diabetes (i.e., not induced by insulin resistance) quickly progress to clinical DM and should be managed using insulin.