Stabilisation Options
Initial stabilisation of otherwise healthy Diabetic dogs is usually achieved
by either blood or urine glucose monitoring. Selection of the appropriate
method should involve discussion with the owner regarding financial and
time-commitment constraints. It is a widely held myth that Diabetics should
routinely be stabilised with blood glucose curves. As a general rule, curves
can be reserved for evaluation of complicated cases. Dogs can be hospitalised
for stabilisation for convenience but ideally they should be kept in their
home environment and subjected to their usual exercise and dietary regimes.
This assists ensuring stability on return to their normal home environment.
Day to day consistency is essential to success.
Stabilisation involves the following steps:
A consistent
dietary regime is planned with the owner
A consistent
exercise regime is planned with the owner
A method
of monitoring (blood or urinalysis: see below) is selected with the
owner
Insulin
therapy is started at approx 0.5 iu / kg usually with a lente insulin
Based
on monitoring results insulin dose is changed every 2-3 days as necessary
This
procedure is constantly repeated every 2-3 days until either then dog stabilises
or insulin resistance is demonstrated (> 2iu insulin per kg bodyweight
per injection).
| Urinalysis |
| Advantages |
cheap, easy, suitable for at-home stabilisation |
| Disadvantages |
slow, somogyi over-swing can cause confusion |
| Procedure |
|
| Urine collected first thing each morning and tested
for glucose |
| If result is: negative |
insulin dose is decreased |
| Slight positive |
no change in dose |
| Strong positive |
insulin dose increased |
| Blood Glucose Analysis |
| Advantages |
quick and accurate method |
| Disadvantages |
more expensive, strict sample timing protocol |
| The timing of sample collection is crucially important in
interpretation. Samples should aim to identify the nadir blood glucose concentration
(lowest point of the day) using any given dose of insulin. In most
cases this means sampling approximately six hours post-insulin administration. |
| Procedure: |
Collect blood for glucose estimation six hours after administering
insulin
If blood glucose is: <3.5 mmol/L decrease insulin dose
3.5-7.5 mmol/L leave insulin unchanged
>7.5mmol/L increase insulin dose |
Clinical Reminders
Leave 2-3 days between insulin dose changes to allow new dose to have full
effect
For small insulin increases/decreases, a change of approximately 5-10% total
dose is often appropriate.
If larger changes are required 10-20% may be appropriate.
If insulin dose exceeds 2iu/kg bodyweight per injection "insensitivity
is confirmed. (See Axiom Fact sheet 4.2 for advice).
Ensure owner has knowledge of the signs and emergency treatment of hypoglycaemia
should it develop during stabilisation. |