Diabetic Cat Eating
When you're caring for a diabetic pet, it is crucial that you know how to prevent and handle diabetic emergencies. But what do you do when your pet's diabetes is not well controlled? Fortunately, there are some simple strategies you can use to help get things back on track.

Establishing a consistent daily routine is a key to successfully managing your pet's diabetes. Feeding the same healthful diet at the same time each day, coordinated with insulin injections that are usually given twice daily, helps keep your pet's blood sugar under control. Routine exercise and regular monitoring are also essential.

Recognizing Poorly Controlled Diabetes

It can be frustrating, though, for owners who establish these appropriate routines to have pets whose diabetes seems to be poorly controlled. Signs of poorly controlled diabetes include:

  • Excessive water drinking
  • Excessive urination or accidents in the house
  • Constant hunger and begging for food
  • Weight loss
  • Cataracts
  • Blood sugar levels consistently greater than 300 mg/dL despite insulin treatment

Diabetic dogs and cats may have additional medical issues that can lead to poorly controlled diabetes, and there are other dietary and insulin factors that can also be problematic.

Review the following checklists with your veterinarian to ensure you are doing everything possible with your pet’s diet and insulin to achieve good control.

Dietary Factors

Ensure that your pet is being fed an appropriate diet. In general, a canned high-protein/low-carbohydrate diet is recommended for the best blood sugar control in cats. Diabetic dogs can be managed on a wide variety of food types, but your vet may have a specific suggestion for your dog.

Feed the same type and amount of pet food at the same time every day. If your pet is given treats, discuss what kind and how many are appropriate for your pet's insulin schedule. Keep any treats consistent from day to day.

Discuss all foods your pet is receiving. Other sources of food (e.g., human food, prey, etc.) or treats or meals given in the middle of the day or between insulin injections can cause large blood sugar fluctuations, leading to poor control.

Insulin Factors

There are many important things you can take into account to make sure your pet’s insulin is working as well as possible. It can seem daunting at first, but getting in the habit of handling insulin properly can help make your pet’s diabetes management go smoothly. Here are some tips that can help.

  • The properly prescribed insulin must be used with the correct insulin syringes.
  • Insulin must be stored properly. Refrigeration is often necessary, and freezing and heating can be damaging to insulin.
  • Insulin must be handled properly. Some insulin products require shaking, while others must not be shaken to preserve activity.
  • Insulin must be administered properly. Bring your pet’s insulin to your next veterinary appointment and demonstrate how you mix the insulin, draw up the insulin and inject the insulin into your pet. You should rotate the area on your pet’s body where you inject the insulin every day.
  • 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!