Written by: Alexa Waltz
The diagnosis of canine diabetes can be overwhelming and scary for pet parents. Daily shots? Expensive insulin? Blood glucose testing??? It sounds like a lot, but thankfully pet owners learn quickly what it takes to keep their diabetic dog healthy and happy! You’ll be relieved to know that once some of the details are ironed out, the management of diabetes in dogs can become fairly routine. It does involve a devoted and observant pet parent, as diabetes will always be a serious but manageable health condition for your dog.
The ABCs of Treating Diabetes in Dogs
Did you know that managing diabetes in humans closely resembles our approach to diabetic dogs? Since dogs typically have insulin-dependent diabetes mellitus, similar to Type 1 (“juvenile”) diabetes in people, there are many crossovers! Check our other blog post to become familiar with the symptoms of diabetes in dogs . The main differences with diabetes management in people versus dogs are that we do not have to strive for perfection with blood glucose regulation as we do in people, and dogs tend to not develop the other chronic conditions associated with diabetes since people live much longer!
Just as a quick review, when an animal becomes diabetic, the pancreas is no longer able to sense glucose levels in the blood nor secrete insulin. Without insulin, the glucose floating around in the bloodstream is unable to enter and provide energy for cells in the body. Body organs begin to starve due to a lack of usable energy despite the rising glucose levels in the blood. How do you fix that? It’s simple — supply the insulin for them!
We, as the pet parent, need to step in and take over for that damaged pancreas in order to supply the insulin needed for cells to access that glucose. We also need to monitor the glucose level for highs and lows during a given day since these fluctuations can reach some dangerous thresholds. It is a delicate balance between insulin delivery, food consumption, and exercise to maintain your dog’s glucose in a healthy range 24/7.
Insulin Therapy
Unfortunately, diabetes in dogs is a lifelong disease. Researchers have been studying canine diabetes for decades, and although advancements in treatments and monitoring have fine-tuned some of the clunkier points of living with diabetes, we still do not have a “cure” or a replacement for the pancreas. We are left managing our diabetic dogs with daily insulin injections, typically given twice a day at mealtime. Insulin must be delivered by injections under the skin, and there are no effective diabetes medications that can be given by mouth in our canine patients. By giving injections, the active insulin molecules can find their way into the bloodstream, circulate around the body, and do their job to maintain your dog’s health.
When a dog is initially diagnosed with diabetes, they may be very sick and require several days of hospitalization, especially if they have diabetic ketoacidosis. These dogs need some close monitoring, intravenous fluids (IV), special insulin, and blood glucose monitoring for some time before we can think about starting daily home care.
However, some dogs are much more fortunate and are not as sick when they are first diagnosed. Dogs that are eating, drinking, and have a reasonable amount of energy may do just fine without hospitalization. Instead, they are healthy enough to start with a maintenance dose of insulin twice daily at home! When your dog is healthy enough to receive treatment at home, your vet will start with a standard dose of insulin that is effective for most dogs and see how it is tolerated by your buddy. Two weeks later, your vet will recheck your dog’s symptoms and consider some glucose monitoring in the clinic (see discussion later). It may take about 6 weeks before the perfect balance of insulin and glucose is reached so being patient, consistent, and observant is essential!
We are so fortunate to have several different safe and effective insulin options available for dogs! Each type of insulin has a slightly different duration of action (how long the insulin lasts) and time to effect (how quickly the insulin kicks in to lower blood sugar levels). The type of insulin that may be best for your dog is determined by financial limitations, desired ease of administration (syringe vs injection pen), and how well your dog’s body responds to it. The most common brands of insulin for dogs are Vetsulin, Novolin-N, Humulin- N, Glargine/Lantus, Detemir/Levemir, and Prozinc. Most of these options are twice-daily dosing using special insulin syringes or a convenient injection pen. Once your dog starts their twice daily insulin dosing, you may see a decrease in their original symptoms immediately, although it could take up to 6 weeks for their bodies to adjust to the insulin injections you are providing.
AskVet Tip: Need some additional coaching for giving those insulin shots or handling the insulin bottles and syringes? Luckily there are lots of accessible resources available to put your fears at ease! Before you and your dog are sent home, your vet will provide a tutorial on how to handle the insulin, syringes, and give injections. If you are overwhelmed and need more support at home, YouTube can come to the rescue! Many veterinarians have made educational videos for pet owners on how to give insulin, basics of handling and storing insulin bottles, as well as some details about blood glucose testing. Your vet staff is happy to go over things as often as you need to as well, so give them a call!
Diet
Changing your dog’s diet to a high fiber/low carbohydrate dog food is another approach that may stabilize daily glucose levels and insulin needs. A high fiber diet will slow glucose absorption in the intestines allowing for a steadier level of glucose available over a longer period of time. Your vet may recommend prescription diets like Royal Canin Glycobalance, and Hill’s Metabolic or W/D. Even if you do not choose to change your diabetic dog’s diet, it is essential to pick a dog food and feed a consistent volume twice a day without much variation or excessive treats – both which may spike blood glucose levels. It is recommended to give insulin while your pup is eating or soon after, and consistency in the timing of injections is key!
AskVet Tip: Although you do need to keep your diabetic dog’s diet as steady as possible, it does not mean you need to sacrifice treats forever! A daily small midday snack that is less than 10% of the total daily caloric intake may be tolerated by your pup! Some healthy options include apples, carrots, green beans, sweet potato, small lean chicken and protein pieces. Be sure to discuss your dog’s diet and treats with your vet.
Exercise
Another pillar of good diabetes management for dogs is keeping up with moderate and regular daily activity and maintaining your pup in an overall good body condition. Overexertion could result in very low blood glucose levels (due to the extra energy needed during exercise), so try to keep the activity level as regular as possible and monitor your dog closely on days that he has completed more activity than usual. Consult with your veterinarian for any special changes needed should an increase in exercise be desired (hikes, beach days, agility classes, etc). Along with a regular diet, consistent exercise will help keep their glucose and insulin balance steady and more predictable!
Treat Concurrent Diseases
Since diabetes mostly affects senior dogs, there is a good chance they are experiencing some other health issues too. Through additional lab testing, your vet will check for evidence of Cushing’s disease, low thyroid, kidney disease, periodontal disease, pancreatitis, and urinary tract infections, just to be sure none of these common conditions are interfering with glucose control. The presence of several medical conditions at the same time will definitely complicate diabetes management and likely require close monitoring for all medications needed to stabilize each health condition as best as possible.
AskVet Tip: A severe health condition called “diabetic ketoacidosis” is a life-threatening condition that sometimes occurs in dogs just before they are formally diagnosed with diabetes. This condition develops due to the presence of the acidic byproducts of fat breakdown for energy due to the lack of insulin and accessible glucose. This condition will require several days of hospitalization, IV fluids and electrolyte corrections, and emergency care before they can be stabilized and started on maintenance insulin. Once they are eating, drinking, and feeling good again, they can start regular diabetes management and be sent home with you!
Monitoring Diabetes
When your dog is diagnosed with diabetes, next comes the commitment from the pet parent to closely monitor her response to insulin for the length of her life. Unlike in human diabetes control, we do not strive for perfection with dogs! We try to maintain a blood glucose within a reasonable range, and most of all try to eliminate the symptoms you were seeing when your dog was first diagnosed.
Goal #1: Reduce the Symptoms
The easiest and most reliable way to gauge the overall glucose control in your diabetic dog is observing the return of water consumption and urination to a normal level! They should also have a steady appetite, feel good, and have some energy. A well-controlled diabetic dog will gain weight and muscle mass in the weeks/months following the introduction of insulin.
AskVet Tip: A great way to monitor dogs at home is to keep a journal for urination, water consumption, appetite, insulin, and weight (when possible). This will help you detect big and little changes in your pup and provide an easy way for you and your vet to monitor how your diabetes management is going at home!
Even after your pup seems well-regulated, always be on the lookout for changes in urination and drinking habits. Changes from the norm may indicate that your pup needs an adjustment to the insulin dosage or possibly the development of another problem (such as a urinary tract infection). A recheck with your vet is appropriate if you notice any sudden increase in your diabetic dog’s thirst and urination.
Glucose Curves at the Vet Clinic
The “glucose curve” is a traditional method of blood glucose testing that your veterinarian may recommend in order to see a day-long snapshot of the response to your dog’s current dose of insulin. The glucose curve uses serial blood samples taken from your dog every two hours to see how high your dog’s glucose levels go before the insulin takes effect and starts lowering it, how low the glucose goes when responding to the dose of insulin, and how long the insulin dose works to lower blood sugar levels. Random individual “spot” glucose checks throughout the day have some value, but are not good indicators of overall glucose control. Glucose levels are always in flux depending on the time of day, the insulin activity, digestion of food, and physical activity. Fine-tuning insulin dosing is best determined by glucose monitoring and observing physical signs that your dog is showing. It is common for your vet to start your pup at one insulin dose and then increase or decrease it a few weeks later after glucose levels are measured.
AskVet Tip: What does the actual glucose curve entail? After feeding your dog her usual morning meal and giving the usual insulin dose, you will drop her off at your vet clinic for the day. They will collect a tiny blood sample at drop-off and every two hours to measure glucose levels on a glucometer for a 8 hour period of time. The highs and lows may be within a healthy range or may call for the insulin dose to be altered. Any changes in the dose of insulin should be followed two weeks later by glucose monitoring just to recheck those highs and lows.
Continuous Glucose Monitoring Devices
More recently, veterinarians adapted the “continuous glucose monitoring” (CGM) devices from the human world to the animal! Using implantable devices like the Abbott “Freestyle Libre” and Medtronic “iPro2” gives pet parents an option to skip the glucose curve in the vet clinic and monitor glucose levels over a period of days, in the comfort of their own homes. This eliminates the labor-intensive glucose curve, decreases stress for your dog, and gives a great picture of the daily variation of glucose control in real life. Using an app and smartphone, pet parents can see real-time blood glucose levels, and share the results to be analyzed by the veterinarian.
What is the process involved for using this monitor? Typically, your vet will write a prescription for you to pick up a device at a human pharmacy at the cost of around $50-$80. Bring the device in for an appointment with your dog. Your vet will shave a small area of fur from your dog’s chest or back area and implant the sensor probe into the skin as securely as possible. The device will take glucose measurements every minute and record them into a rolling log, available to your veterinarian via the cloud. The device app enables you to scan the sensor, and both you and your vet can access glucose readings as long as the sensor is in place!
Although this has proven as a wonderfully accurate and convenient way to measure blood glucose over a period of time there are some downfalls of the CGMs … one of these is that they are made for human skin and not haired skin! They sometimes do not stick as well or last long on animal skin due to body movements and anatomical features. Vets desire to get at least 1-2 days of readings before it falls off! This can be avoided with some glue applied to the device, dressing your dog in a t-shirt or sweater to help the sensor stay in place, and also by keeping movement and activities controlled in the hopes that it does not dislodge prematurely! If the CGM device is a good option for your dog, your vet will likely want to use this method for checking glucose control instead of the glucose curve.
Home Glucose Testing
At-home spot checks for glucose testing can be a useful tool so it is good for pet parents to have the ability to check glucose at home! Veterinarians recommend the purchase of an Alpha-Trak2 monitor and test strips for dogs and cats, along with some small lancets (needles) and a spring-loaded device to puncture the skin for a blood sample. It is recommended to take a small blood sample at about 4 hours after the insulin dose, and again at 8 hours, to see what the lowest and highest glucose levels may reach. Also, if your dog is showing signs of hypoglycemia (see discussion below) you can use this device to decide if your dog is dangerously low and needs a snack or some sugar. At home, we do not want the glucose reading to ever go much below 100, as that could lead to hypoglycemia. If you are getting extremely low readings or high readings (400-500+) at home, a recheck with your vet is recommended.
AskVet Tip: How do you get a blood sample at home?!?!?! YouTube to the rescue! There are many videos made by veterinarians and vet techs showing how to painlessly get a nice bleb of blood and run it on your glucometer at home. Some great sites to collect blood on dogs are the ear flap, paw pad, or even on the gums inside the mouth. Use the spring-loaded lancet device and hold it flat against the skin, and press the button for a quick poke. Gently squeeze around the area and a small bleb of blood will form, perfect for the glucose strip!
Home Urine Test Strips (Ketones and Glucose)
Another at-home screening test that pet parents may want to use are urine glucose and ketone test strips. These can help owners monitor levels of glucose and ketones in the urine and may provide some information about overall diabetes control. These have some value, but since the blood glucose levels do fluctuate throughout the day it can be difficult to provide detailed information with just these test strips. The presence of ketones, or an increase in glucose detected could indicate an insulin dosing issue and should be followed up with a visit to the vet.
Routine Follow Up Care
Like we discussed earlier, taking care of your diabetic dog is a long-term commitment – both for their daily care as well as a financial commitment for treatment and follow-ups. It is important that any insulin dose change is followed by a two week recheck, and most veterinarians will also recommend general follow-up appointments every 6-12 months thereafter. At these appointments, your dog will be assessed for weight gain or loss, appetite, the control of symptoms like drinking and urinating, and some baseline blood and urine testing will be performed. A fructosamine test may be helpful too, in that it gives a sense of the average blood glucose over the previous couple of weeks. Urine cultures (growing bacteria from a urine sample) are also an important aspect of monitoring diabetics … bacteria love to grow in urine with glucose present! It is also important to keep teeth clean as well as monitor vision for the formation of diabetic cataracts within the lenses.
Complications of Diabetes in Dogs
Unfortunately, even the most excellent glucose control and insulin dosing does not guarantee that your dog will be free of complications nor struggle with their diabetes from time to time. Always keep an eye on their appetite, urine habits, water consumption, mood, and activity level for subtle changes needing to be checked out. Any diabetic dog that is vomiting, not eating or having diarrhea should be more urgently seen by their vet. Insulin dosing is highly dependent on food intake and digestion! For insulin-dependent dogs, efforts to remedy health issues should be taken as soon as possible, so call your vet right away.
The following are some common medical conditions related to diabetes:
– Hypoglycemia, blood sugar too low You may observe your dog walking wobbly, acting depressed or tired, vomiting, not responding to you like normal, or they may have a seizure if their blood sugar falls too low (usually due to lack of eating or the insulin dose being too high). This is an emergency! Immediately apply honey, karo corn syrup, maple syrup, or sugar water on their gums (do not make them drink anything as they may not be able to swallow). Seek veterinary care immediately.
– Cataracts The lens is located inside the eyeball and high glucose levels will cause cataracts to form and your dog’s vision to be impaired. This can be very painful and will need some treatment and monitoring as well.
– Urinary Tract Infections Bacteria love to grow in urine with glucose in it! Urinary tract infections are uncomfortable and can also lead to bladder stone formation. Routine urine tests and cultures are recommended to be sure to avoid these issues.
– Polyneuropathy Some diabetic dogs may develop weakness and difficulty walking
– Kidney Failure Prolonged hyperglycemia (high glucose in the blood) can damage the fragile nephrons in the kidney leading to chronic kidney failure.
– Difficult Regulation/Hyperglycemia Some dogs are very difficult to regulate with insulin and may continue to have hyperglycemia. Changing dosing and trying different types of insulins can help some dogs find what works best for them. Dogs with multiple disease conditions will have a more difficult time regulating their glucose.
– Ketoacidosis Dogs with undiagnosed diabetes, known diabetics with poor glucose control, or ineffective insulin delivery may experience diabetic ketoacidosis. Ketoacidosis occurs when the tissues are starving for glucose, but insulin is not available to facilitate getting it into cells. The body begins to break down fat as the ketone bodies can be used as an alternative fuel source. Unfortunately, over time the metabolites are harmful to the body and the dog will get very very sick. They will need immediate treatment and hospitalization with IV fluids to reverse dehydration and insulin to get glucose into the cells.
Prognosis
Dogs respond to diabetes and treatment in their own special way. Some are not very sick at the outset and quickly become managed with insulin and diet. Others are very sick when they are first diagnosed, and unfortunately, some are very difficult to control with insulin too. Your dog’s journey with diabetes will be her own and as her pet parent, just do your best to feed a constant diet, give insulin consistently, keep a journal for daily habits, maintain the necessary follow-up appointments, and consult with your vet when you notice anything concerning. Your dog can live a good quality and long life even with diabetes!
For questions and further discussion on diabetes in dogs, your AskVet veterinarians are here to help! If you have any questions about your dog’s medical condition or are wondering whether your dog’s symptoms are an urgent issue, then all you have to do is AskVet. We are here 24/7 to help you and your dog!
Written by:
Alexa Waltz, DVM
Dr. Waltz was raised near the beaches of Southern California but has spent her adult life living all over the beautiful United States while serving in the military and as a military spouse. She left California for the first time to pursue a career as a veterinarian at Louisiana State University School of Veterinary Medicine and graduated as a Doctor of Veterinary Medicine in 2006. She was accepted into the US Army Health Professionals Scholarship Program during vet school and upon graduation spent her military years as a veterinarian in San Diego working for the US Marine Corps and US Navy Military Working Dog programs as well as caring for pets of service members. After her military service, she became a civilian veterinarian and continued as a small animal general practitioner at clinics in California, Rhode Island, Colorado, and Maryland. Dr Waltz loves to see her “in person” patients just as much as communicating with and assisting pet parents virtually on AskVet. Dr Waltz is also a Mom to 3 humans, 2 guinea pigs, and 1 Australian Shepherd and in her spare time she loves traveling, adventures, exercising, and doing just about anything out in nature!
