My Pet’s Diabetes Is Not Controlled — What Now?

  • Insulin must be administered frequently enough. Most pets will require twice-daily insulin injections for adequate control of diabetes.
  • Insulin injections must be timed properly. Some experts suggest administering insulin up to 30 minutes before meals in order to combat the large fluctuations in blood sugar that happen after a meal.
  • Insulin must be replaced regularly. Insulin can become outdated or contaminated and stop working well enough to control blood sugar. Ask your vet how often you should replace your pet’s insulin.
  • Insulin underdosage — insulin is dosed over a very large range, and sometimes pets are simply not receiving enough for their body weight or the severity of their blood sugar elevation. Your vet may recommend increasing the insulin dosage slowly based on serial blood sugar measurements (called a blood glucose curve) done every week until your pet is controlled or is receiving insulin dosages that support true insulin resistance.
  • Insulin overdosage — when excessive amounts of insulin are given, low blood sugar results, which then causes a rebound high blood sugar state. This can appear as poor blood sugar regulation. If your pet is on high dosages of insulin and still looks poorly controlled, your vet may be suspicious of this issue and recommend decreasing your pet’s dosage. This usually requires your vet to perform several blood sugar curves to diagnose.
  • Consider changing to a different type of insulin. Some dogs and cats metabolize insulin quickly, so it doesn’t last long enough to control blood sugars throughout the entire day. These pets may require longer-acting insulin preparations.

Sometimes, if these potential issues aren’t addressed or your pet’s condition is refractory, your pet may continue to require high insulin dosages. This condition is called insulin resistance. Insulin resistance occurs when a pet’s body fails to respond to the normal actions of the administered insulin. Dosages of insulin that suggest insulin resistance are greater than one unit of insulin per pound of body weight per injection for a dog and greater than six to eight units of insulin per injection for a cat. If insulin resistance is present, a further investigation for additional medical conditions is warranted.
Whether you and your pet are managing diabetes well or if you are dealing with some of the issues outlined above, the most important thing is to stay in close contact with your veterinarian. He or she will make sure you have all the information and tools necessary in order to optimally manage your pet’s diabetes. While diabetes can seem like a daunting disease to manage at home, with the proper support, you can do it!

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