Diabetic homecare notes

The following notes have been prepared to help you cope with the after care required to maximise the quality and quantity of a diabetic pets life.

Background

The principle signs of diabetes in the cat and dog are:

Weight loss
A period of excessive appetite (with paradoxical weight loss)
A great thirst

We often use these three signs to gain an idea how our patients are responding to treatment.

In humans, diabetes is either type I or type II. Type II patients (the common form in humans) can get buy with dietary control, tablets etc. Type I suffers require daily insulin by injection.

Dogs are all type I and require insulin (just about all require it twice daily).

Cats on the other hand are a mixture of type I (60%) and type II (40%), but best results are obtained in both situations with daily insulin injections.

Some cats can get by with once daily insulin, but the majority requires twice daily insulin injections.)

The problem of diabetes relates to the pancreas. Special cells (beta cells) fail to produce sufficient insulin for the animal's requirement. Insulin allows blood sugars to get inside and feed cells. Without it, body cells are bathed in "food" but can't eat! So the animal essentially starves to death despite eating a lot! During starvation, fats are metabolised. The waste products of this metabolism if in excess are toxic and make the animal feel ill and can even lead to death.

The discharge appointment

When discharged the vet will show you how we perform insulin injections
How to draw up the correct amount
Where to inject
How to inject (the vet may demonstrate this using sterile water. They will then give you a go and check your technique)
How often to inject (once daily or twice daily)

It is a very easy technique to master. Before long you will find it all very easy.

Revisits

You will make weekly revisits until the patient is stable:
5-6 hours after morning insulin injection (if twice daily dosing)
9-10 hours after morning insulin injection (if once daily dosing)

Feeding

What to feed? Diabetic animals are best fed the following diets:
Obese - Hill's r/d diet (m/d available for cats)
Normal - Hill's w/d diet
Under weight - just feed normal diets until weigh back to normal the feed w/d.
Reason:

High fibre diets
Reduce insulin requirements

Reduce post feeding blood glucose peaks
When to feed: Idea = Give insulin something to work on!

Dogs:

Feed a small amount of daily ration before you inject the morning insulin
If eaten, then inject insulin and feed 1/2 of daily ration.
Feed the other 1/2 of diet after the 2nd injection later in the day.

Cats:
In principle should feed cats as above. Do so if possible, however cats are often grazers, if this is the case just leaving sufficient food down all day long.

Water must be available ad lib at all times.

Potential Complications of Diabetes

Don't worry, we do not imply all the following will happen, but some could happen and it is best you are aware of it.

Hypoglycaemia
This is where the blood glucose levels drop too low.
This is easy to spot, as the signs are very distinctive:

Very strange behaviour ("spaced out")
Collapse
Staggering

Cause - Insulin overdose
Solution - Give concentrated glucose solution by mouth (honey is a second best choice). Keep a saturated solution of glucose in your fridge with a syringe attached. (Purchase Glucodin powder from your local chemist). The amount you give should give is not fixed. Don't worry you cannot really overdo it. After this dosing it is best you bring your pet into the surgery for a blood glucose test and discuss why things may have gone wrong.

Kidney Failure

Kidney failure can follow on from diabetes. So we might also want to occasionally monitor blood urea / Creatinine levels. Indicators of renal function.

Cataracts

100% of dogs with diabetes will develop cataracts at some stage. Onset is usually quite rapid. Cataracts can occasionally go clear when they age, but there is no guarantee of this. A veterinary ophthalmologist can remove cataracts surgically and vision is restored.

Chronic Skin infections

Especially seen in dogs. This is easily controlled with antiseptic shampoos and antibiotics when necessary.

Cystitis

Cats and dogs with diabetes (esp. cats) are prone to bladder infections. Treatment is normally by antibiotics +/- analgesia.

Further blood testing?