Nursing advice to the owners of Diabetics

A) General:

Give the same food every day High fibre soluble or insoluble fibre) diets are best as they regulate glucose absorption. Semi-moist type diets are worst as they are often preserved with sugars.

Exercise levels should be the same every day as exercise directly reduces blood glucose without the need for insulin.

Bitches should be spayed to prevent loss of control at dioestrus.

Weight should be stabilised and then monitored for gain or loss.

NO TIDBITS

Owners should monitor thirst, as this is quite a sensitive measure of poor control.

B) Daily routine:

1) Take the insulin from the fridge, and mix by inverting a few times gently NOT by shaking, as insulin molecules are fragile. Draw up the appropriate dose.

2)Inject the insulin subcutaneously , around the area between the shoulder blades. The owner should have been taught good injection technique.

3) Feed a small amount of food , say 1/6-1/4 of daily intake This also acts as a reward after injection.

WATCH for behaviour changes indicating hypoglycaemia- ataxia, disorientation, staggering or collapse. Maximum risk within the 2 hours preceding feeding. Give GLUCOSE, not household sugar (Sucrose). This is usually achieved with glucose dissolved in water, or dextrosol tablets or sweets such as a Mars Bar.

HYPERGLYCAEMIA IS A LONG TERM PROBLEM, HYPOGLYCAEMIA IS VERY RAPIDLY FATAL.

4) Feed the remainder of the dog's food at the time established by the glucose curve measurements. (Usually about 8 hours after injection).

C) If urine testing is used: (less common nowadays)

1) Take a morning urine sample, preferably the second of the day to miss the accumulated overnight urine, although this is often not possible. Test with a stick or clinitest.

2)If Glucose >2% increase insulin dose by 2 units; 1-2% increase by 1 unit; 1/4-1/2 % same dose as previous day; 0% decrease by 2 units

Failure of control

1) Owner not adhering to feed / exercise regimes; scavenging.

2) Improper care of or old insulin - it is surprisingly easy to damage this drug.

3) Poor injection technique.

4) Bitch in dioestrus

Less Commonly:

Insulin resistance, other disease developing

Establishing the reason for failure of control is often as much an exercise in tactful communication as a medical problem!

Current Ideas

Many diabetics are now managed on twice daily insulin injections
Cats may need a high protein diet and are sometimes fed this ad lib (e.g. kitten food) again in conjunction with once or twice daily insulin
Regular blood testing at the surgery is the preferred monitoring technique

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