Home Care Instructions for the New Diabetic:

Your pet has recently been diagnosed as having diabetes mellitus. In general, diabetes can be understood as the inability for your pet to use carbohydrates (glucose) for energy due to inadequate amounts of insulin in his or her body. This results in excessive amounts of glucose in your pet's blood (hyperglycemia), which can lead to excessive drinking and urination, weight loss despite good appetite, weakness, or even cataracts (frequent in dogs, uncommon in cats).

Because the body cannot utilize glucose for energy, it is forced to metabolize fats. Excessive use of fats for energy can lead to a severe disease called diabetic ketoacidosis (DKA). DKA can cause clinical signs such as excessive drinking and urination, weight loss, anorexia, weakness, depression, coma, or even seizures.

If you note any of these clinical signs, you should contact Leesburg Veterinary Hospital or an emergency facility to have your pet assessed.

The goals in treating diabetes are to resolve the clinical signs listed above and to prevent your pet from entering diabetic ketoacidosis. Please follow the instructions listed below to help us meet these goals:

Diet:

• Diabetics do better if maintained on a higher fiber diet. Recommended diets for cats include: Purina DM, Hill's M/D, Hill's W/D, and Purina OM. Diets for dogs include: Purina DCO, Purina OM, Hill's R/D, and Hill's W/D. These are all prescription diets, which must be purchased from a veterinarian.

• Please note that it is most important for your pet to eat consistently. Therefore, we would rather feed a less than ideal diet if we have to. Please try to vary the diet as little as possible.
· Feeding guidelines: Feed equal portions of food 12 hours apart, just BEFORE insulin administration. If your cat likes to "graze" dry food throughout the day, it is fine to leave this out for him or her.

Medications:

• Syringes: You can order syringes from your pharmacy on as needed basis (please call ahead for a refill). Please check that the syringes are B-D Ultra-fine, are used with U-100 insulin, and that they hold 0.5mL. If you have any questions regarding these requirements, you can discuss this with the pharmacist or contact us.

• Syringe disposal: As long as the syringes are in a hard plastic container with a screw on lid (i.e. a mild carton or empty laundary detergent bottle), they can be disposed of in the trash. You may also dispose of the syringes at our hospital.

• Insulin: Your pet should receive __________ insulin (also available from your pharmacy on an as needed basis (please call ahead for a refill)). Please check the bottle each time to ensure it is the proper type.

• Insulin Administration: Your pet should receive _____ units of insulin every 12 hours. You should determine a time that will be convenient for you (i.e. 7 am and 7pm, etc.) and you should be as consistent as possible regarding these times. Feed your pet 20-30 minutes prior to these injections. If he or she eats well, give the full dose. If he or she doesn't eat well or vomits, give ½ of the regular dose. Resume the normal dosage at the next scheduled time provided that he or she eats well.

To help ensure that your pet receives the proper amount of insulin each time, it is important to assign one family member as the insulin giver.

• Proper Insulin handling and storage: Keep the insulin in the refrigerator between uses and avoid exposure to excessive heat or sunlight. Before each use, gently rock the insulin bottle 15-20 times until any crystals that have settled out are re-suspended. Please avoid shaking the bottle.

• Proper injection technique: To give the injection, gently pull up some of the excess skin between your pet's shoulder blades, forming a "tent." Inject the insulin into this tent so that it is administered under the skin. If some (or all) of the insulin is injected onto the skin, do not try to administer any more insulin at that time. Simply give your pet the normal dose at the next scheduled time. You should vary the injection site to help minimize the risk of scarring. Any area around the shoulder blades is a safe place to administer the insulin.

Exercise:

It would be beneficial to encourage your pet to play for 15-20 minutes per day if it is a cat or to maintain the same activity level if it is a dog.

Hypoglycemia:

It is possible that your pet could receive too much insulin and become hypoglycemic (too little blood glucose). Clinical signs of hypoglycemia include weakness, loss of balance, incoordination, blindness, coma, or seizures.

• What to do if this happens: If you note any of these signs, please do the following:

• If your pet is alert and conscious: Offer food. If he/she eats, watch closely and call us as soon as possible.

• If your pet is unable or unwilling to eat: Give 5-10mL of Karo syrup orally. If there is no improvement within 5 minutes or if your pet is unresponsive, immediately contact an emergency facility or us. This is an emergency!

How to prevent Hypoglycemia:

The best way to avoid a hypoglycemic crisis is to hold off on giving the insulin when you are not sure whether to give it or not. Definitely do NOT give the insulin in the following situations:

• 1. You are not sure whether or not he or she received the insulin.
  
• 2. You think you gave the wrong amount of insulin.
  
• 3. The pet moved when you gave the injection and some of the insulin may not have been injected.

Home Monitoring:

As your pet's diabetes becomes better regulated, you should note that the clinical signs noted above are resolving. We will also need to do periodic blood tests (glucose curves or fructosamine levels). The first test should be done 7-10 days after beginning the insulin. Please contact us if you note any of these signs worsening or if you have any questions or concerns.

Summary:

Remember to call us if:
• You note signs of hypoglycemia.
  
• Your pet is not eating well for 2 consecutive meals.
• You note vomiting, diarrhea, or any other problems.


Local Emergency Clinic numbers:

• Animal Emergency Hospital (Leesburg):
  (703) 777-5755
  
• Emergency Clinic of Northern Virginia (Vienna):
  (703) 281-5121

Daily Routine summary:
• Feed twice daily, 12 hours apart.
• Give insulin injections twice daily, after meals.

It is important for you to realize that treating diabetes is a life long commitment and you will need to monitor your pet closely for the return of clinical signs or any abnormalities. Frequent veterinary visits and blood tests may be needed to help determine the dose of insulin that your pet needs. However, it is our goal to help you manage your pet's diabetes and for your pet to carry out the rest of his or her years with the highest quality of life possible. Thank you for your commitment to your pet and we will do our best to help and guide you through his or her treatment.

Your next visit will be on:

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for

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~ The Doctors and Staff of Leesburg Veterinary Hospital