Veterinary Medicine - September 2007 - (Page 608)

Diabetes management O P E E R - R E V I E W E D FIGURE 2 Protocol for initiating insulin therapy in nonketotic diabetic dogs If the dog is stable and nonketotic, use either Vetsulin or NPH at a starting dose of 0.5 U/kg subcutaneously. Give the first dose in the clinic, and check the blood glucose concentration every two hours. If the glucose concentration drops below 120 mg/dl, decrease the insulin dose by 10% to 25%. If the glucose nadir is between 120 and 300 mg/dl, continue the present insulin dose. If the glucose concentration stays above 300 mg/dl, increase the insulin dose by 10%. Evaluate the duration of effect. If the glucose concentration is increasing 10 hours after insulin administration, give the insulin every 12 hours. If the glucose concentration is decreasing 10 hours after insulin administration, give the insulin every 24 hours. Repeat the glucose curve in seven days. and 2 for detailed insulin therapy initiation protocols. At-home monitoring A veterinary-specific glucose monitor (AlphaTRAK—Abbott Laboratories) is now available and provides rapid glucose measurement with a single drop of blood. A 22-ga needle or a lancet device is used to puncture the skin, generally on the pinna or lip, and the capillary action strip draws the sample into the machine. Many clients can easily learn to do this at home and are able to check their pets’ blood glucose concentrations without the inconvenience and expense of a visit to the veterinarian’s office. Cats particularly benefit from at-home monitoring, as stress hyperglycemia is avoided. Even if clients are reluctant to check glucose concentrations on a regular basis, the ability to measure a glucose concentration if the pet is unwell or acting strangely can be a lifesaver. I do not encourage owners to change insulin doses based solely on at-home glucose measurements. Rather, the results should be added to other informa- Follow-up care It may take a few weeks to find the appropriate dose for a patient, and even well-controlled diabetics usually need periodic adjustments. For dogs, I recommend a recheck after the first seven days of insulin therapy and then every six to eight weeks. Any time the insulin dose is changed, reevaluate the patient within two weeks. Cats, particularly those receiving glargine, may go into remission within the first month of therapy, so close monitoring is needed to identify the return of endogenous insulin production. Check the glucose concentrations (both pre-insulin and nadir) on a weekly basis for the first month; decrease the insulin dose or discontinue therapy if hypoglycemia (glucose < 70 mg/dl) is identified or if the pre-insulin glucose concentration is < 180 mg/dl (see Figure 3). tion such as weight, thirst, hunger, urine output, and energy levels before dose adjustments are made. If owners are unwilling or unable to measure blood glucose concentrations at home, they can purchase urine dipsticks for glucose and ketone detection. If ketones are frequently noted, the patient should be rechecked by the veterinarian. Most dogs with well-regulated diabetes have mild glycosuria most of the day; any patient with persistently high urine glucose concentrations or negative urine glucose concentrations is probably receiving an inappropriate insulin dose and should be examined. Do not instruct owners to increase the insulin dose if substantial glycosuria is noted, as many patients that are receiving too much insulin have periods of rebound hyperglycemia with subsequent spillage of glucose into the urine. Instead, owners should regard this as an indication for a visit to the hospital and a full evaluation. 608 September 2007 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - September 2007

Contents Letters Leading Off The Veterinary Medicine Interview: Dr. William J. Kay Idea Exchange Practical Matters Salivary Mucoceles in Cates: A Retropspective Study of Seven Cases Hyperlipidemia in Dogs and Cats Purina Insert The Latest Management Recommendations for Cats and Dogs with Nonketotic Diabetes Mellitus CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - September 2007

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