Certain fundamentals apply to every diabetic pet, dog or cat, young or old. These are the things you need to know about the insulin you administer to control his diabetes mellitus.
- Pick two times of day, exactly 12 hours apart, that you can administer your pet’s insulin. Be consistent, and stick to that schedule as closely as you possibly can. It is important for your pet to have consistency in scheduling, eating, everything.
- Feed your pet at the time of the injection, then again 2-4 hours later, which is about the time the insulin’s effect peaks.
- Divide your pet’s thorax (the part of the body where the ribs are) into 7 parts. Sunday’s injections go at the front of the thorax, and each day moves back a little further. Injections administered in the neck area are poorly absorbed and the back end of the body is more sensitive to pain.
- Give the morning injection on the left side, the evening injection on the right side.
- Use the three-fingered, pyramid technique to lift the skin, then put the needle into the base of the pyramid. Using a two-fingered technique, or letting your two fingers get too close to each other, creates a wall instead of a pyramid, and makes it more likely that you might go all the way through, spraying your pet’s fur with insulin.
- Put the needle in all at once and get it over with. Dilly-dallying just allows a greater risk of pain.
- If you do perform a “fur shot,” do not repeat the insulin injection unless you are absolutely sure that none of the dose went into his body.
- Insulin must not be allowed to become warm, so be sure to put it back in the refrigerator (top shelf, which is not too cool) as soon as you finish drawing up each dose. When traveling, keep the insulin in a cool ice chest, but do not allow it to come in contact with the ice or refreezable cold pack. Insulating with a brown paper grocery bag is good, as is the inside of a wad of newspaper.
- Levimir® (detimir) and Lantus® (glargine) insulins can usually and infrequently withstand an overnight stay out of the refrigerator in a cool, dark room. Other types of insulin cannot. If you are using insulin other than detimir or glargine, you must discard the bottle if it is left out. Regardless of the type of insulin, if you observe that your pet’s appetite and/or water intake change after such an incident, it usually means that he is no longer regulated. Contact your pet’s doctor and be sure to mention leaving the insulin out of the refrigerator. Of course, there are many other potential causes of disregulation.
- If your previously-regulated pet begins to drink excessively, urinate excessively, eat too much or eat too little, call his veterinarian. Some common causes of disregulation include urinary tract infection (extremely common in diabetic patients), insulin gone bad, poor insulin injection technique, excess fat in the diet, excess fat in the bloodstream, development of Cushing’s disease, any illness, infectious or otherwise, allergy flareups, corticosteroid administration.
- Get used to speaking the lingo of diabetes. Insulin is measured in units. If someone needs to care for your pet in your absence, they may become confused if you give them a dosage in terms of lines on a syringe. Yes, I have seen it happen repeatedly.
- Properly cared for, detimir and glargine insulins can be used for about six months. Proper care means never reusing syringes, never allowing contamination of the vial or its top, never letting a contaminated needle enter the bottle (or even a potentially-contaminated needle…if in doubt, throw it out), never allowing the insulin to become too warm. Neither of these insulins contains a preservative or germ-fighting ingredient. When used in people, they are discarded after 30 days. So, in order to allow use for a longer time, strictly to control cost, extreme care must be practiced.
- Your pet must eat a low-carbohydrate diet, usually Hill’s Pet Nutrition Prescription Diet w/d for dogs and Purina Veterinary Diets DM Diabetic Management for cats. Avoid variances from these foods. Avoid unapproved treats (which means most treats!).
- Moderate exercise is good for diabetes regulation, and taking your dog on a long walk one or more times each day is usually encouraged, with your pet’s doctor’s approval, of course.
- Low blood sugar is relatively uncommon in canine and feline diabetes. It is most likely to occur when someone in the household administers a dose of insulin after someone else has already given one. It may also occur when a diabetic cat “reverts,” and begins creating insulin on his own again. Low blood sugar can be deadly in minutes, so if your pet exhibits lethargy, loss of consciousness and/or seizures, he may need supplemental sugar to reverse the process. If he is awake, give him a small amount of honey or Karo syrup. If he is not conscious, you can carefully rub honey or Karo onto his gums, but be careful that he does not inadvertently bite you. Also, call your pet’s doctor and see if he is available to see your pet on an emergency basis. Do not just get in the car and begin driving around with an emergency patient. Know where you are going first.
Special considerations for patients receiving crystalline insulin:
- Crystalline insulin may be known to you as Vetsulin, ProZinc, Velosulin, Humulin, Novolin, Lente Insulin; ultralente insulin. Detimir and glargine are not crystalline insulins, therefore the following comments do not apply to them.
- Heat kills. Crystalline insulin does not tolerate heat. Or even warmth, such as room temperature. If you leave it out of the refrigerator all day or all night, throw it away.
- Crystalline insulin does not tolerate trauma. When mixing, you must roll the bottle gently in your hand. If it is shaken, throw it away. If you inadvertently drop the bottle, watch carefully for signs of disregulation, and, if they occur, purchase a new bottle of insulin.
You may wish to print out these basics so that you have them handy.
See you tomorrow, Dr. Randolph.