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Healing & Alternative Health
Dr. Carson's Holistic Animal Care:
SIGNS OF AGING IN THE DOG AND CAT, PART XXIII:
Organs of the Abdomen: Diseases of the Pancreas: Diabetes Mellitus - Maintenance Insulin Treatment
by Kathleen M. Carson, D.V.M
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I wrote in last month’s column about how, when your diabetic cat or dog is first diagnosed with Type I diabetes mellitus (insulin dependent diabetes mellitus or IDDM) she is hospitalized, her very high blood glucose (BG) is brought closer to normal, and her initial dose of insulin is determined. I ended my September column with your animal’s discharge from the hospital with insulin, insulin syringes, and, most probably, a new diet.
For you, the initial days/weeks following the diagnosis of diabetes mellitus (DM) involves coming to terms with the fact that your animal has a chronic, probably lifelong disease; getting used to giving him insulin injections; probably changing his diet; feeding him only a given amount and, for dogs, at specific times in the day; watching the amount of exercise he gets; and carefully observing him for signs of increased/decreased appetite or thirst, how much urine he’s peeing, and whether his weight is changing. For many people, this seems overwhelming at first, but, with time, the vast majority will learn to take it in stride. This is hard to believe at first, but I promise you it is true.
Your veterinarian will probably not schedule your animal’s first recheck for at least 4 - 7 days after she goes home from the hospital. It takes at least this much time for your animal’s body to equilibrate or adjust to the initial dose of insulin, a new diet and feeding schedule, etc.
To insure a more even level of blood glucose over the day for your diabetic dog, your veterinarian will tell you to feed her on a schedule: if your dog is being given insulin only once a day, you will be told to feed her half the determined amount of food at the time of the injection and the other half 8-10 hours later. If your dog is being given insulin twice daily, then you will feed her half the determined amount with each injection (as close to 12 hours apart as is feasible for you).
Since cats tend to be nibblers, they can be given the recommended amount of food all at once; they will finish it off through eating multiple small meals during the day.
It is always best to hold off on giving your animal his insulin injection(s) until you’re sure he’s going to eat the food you’ve just given him. If he doesn’t eat the food, or eats only part, you will be told to skip the injection (for the former) or reduce the dose (for the latter).
It is rare for the initial dose of insulin to be the one that ends up being the ideal, final one for your dog or cat, but you still should see some signs of improvement when your animal first goes on insulin: your animal’s previous ravenous appetite and extreme thirst should begin to decrease, he should urinate smaller amounts of urine, and he should begin to gain back at least some of the weight he had lost.
A potential problem which could develop with insulin treatment for your diabetic animal is blood sugar which is too low (hypoglycemia). This is more likely to happen when your animal is first put on insulin, when/if his dose is increased, or if your animal exercises a lot more than normal. Hypoglycemia can cause problems, some very serious, ranging from mild muscle twitching to weakness/wobbliness to loss of consciousness or a seizure. Your veterinarian will recommend that you always keep handy a supply of either honey or karo syrup. If you see any of these symptoms, he’ll tell you to give your animal the honey/karo syrup; this will give her body a rapidly absorbed source of sugar, which will start to bring her BG back up to a more normal level. Even if your animal is unconscious, you can rub small amounts of the honey or karo syrup into her gums, and it’ll be absorbed that way. If she can swallow, you can give her multiple small doses, but don’t give her so much at one time that she chokes. Also, if your animal is seizuring wait until she stops to give her the honey/karo syrup; you could be badly bitten if you attempt to do so during a seizure, and/or she could inhale some of the honey/karo syrup into her lungs. Unless your animal’s BG is extremely low, the honey/karo syrup should bring her around slowly. When she’s conscious again, offer her some of her regular food or even babyfood or pieces of chicken or beef. Of course, you should bring your animal to your veterinarian or local emergency clinic as soon as possible after a hypoglycemic episode.
About 4-7 days after your animal first goes home, you’ll bring her back to your vet for a weight check and physical exam. Your veterinarian will question you about her water and food intake and urine output. He’ll probably ask you to feed your animal at home and wait to give her injection until you can do so under his observation (so he can check to make sure you do it correctly). He’ll answer any questions which have come up for you in the time since your animal went home. Then your animal will probably stay at the hospital for 12-24 hours so he can do another BG curve (where BG levels are checked every 2 - 4 hours to see how the BG levels change over time in response to the insulin).
Depending on the results of the BG curve, your animal’s initial dose will probably be changed - either up or down. The former is much more likely on the first recheck.
From then on, followup exams and BG curves will be done every 7-10 days or so until your animal’s ideal insulin dose is determined. He or she will be said to be regulated at this point. A dose of insulin is determined to be ideal when it can maintain BG levels between 80 - 200 mg/dl for 18 - 24 hours/day. [The goal is not to keep BG consistently within the normal range (80-120 mg/dl); this is unrealistic. It’s better to let it go a little above the top normal for part of the day rather than risk it going too low.]
Cats’ BG levels can go up with stress (like being in the hospital and having blood taken several times!). This will be taken into consideration when your veterinarian interprets the results of your cat’s BG curve. If your cat is responding clinically (weight gain, reduction of her previously excessive thirst/appetite/urination, she will not be terribly worried if the BG levels are somewhat higher than might be expected.
The frequency of followup exams/labwork will be decreased after your animal has become regulated. You’ll probably be asked to return every 2 - 4 months (sooner if you notice an increase in your animal’s food or water intake, excessive urination, or weight loss - or, of course, any signs of hypoglycemia).
These followup visits will entail a detailed history, physical exam, and a new kind of blood test: either fructosamine or glycosylated hemoglobin (GHb). The latter two tests reflect the average BG over the previous several weeks (fructosamine) or months (GHb).
If clinical signs or elevated fructosamine or GHB levels are present, then a BG curve will be scheduled. Your veterinarian will possibly also run more comprehensive blood tests and a urinalysis/urine culture to see if any other condition/disease is complicating the picture. If any are found, they need to be addressed along with treatment of the diabetes.
Next month I’ll write about diabetic ketoacidosis. |
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Dr. Kathleen Carson, DVM
Veterinarian & Author
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Dr. Carson received her Doctor of Veterinary Medicine degree from the University of California at Davis in 1968. She's been a small animal practitioner (dogs and cats ) for all the years since, except for a short stint at the San Diego Zoo when she first graduated.
She belongs to the American Veterinary Medical Association and the American Holistic Veterinary Medical Association.
Since 1974 she's lived and practiced in the South Bay Area near Los Angeles. She started the area's first house call practice in 1976 and the first pet crisis/loss group in 1989. The human-animal bond is of special interest to her.
She started exploring complementary veterinary medicine in 1987. Her practice became 100% holistic in 1996. She utilizes acupuncture, herbs, supplements, Bach Flower Remedies, homeopathic remedies, nutrition and medications for her patients in her practice.
She's currently taking a leave of absence from her house call practice due to health reasons but continues to do phone consultations and to write.
E-mail:
Critterhlr@aol.com
website:
http://www.holistic
vetconsult.com
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