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Diabetes Control
Diet is an integral part of the treatment for diabetes. It is important to feed a maintenance diet which meets your dog's individual caloric needs and varies as little as possible. For a dog receiving insulin two times a day, the optimum feeding schedule is to feed four meals a day. One at the time of each insulin injection, one in the early afternoon and one in the late evening. It is probably best to feed a high carbohydrate, medium fiber diet. You can just add fiber to your dog's normal dog food using a fiber source such as psyllium (Metamucil), pumpkin pie filling or other fiber source. There is some difference between fiber sources (soluble vs. insoluble) and how well they work, but it may not be clinically significant. Or you can buy a commercial food containing the proper quantities of fiber. Some of these foods are Prescription Diets w/d, Science Diet Maintenance Light, Theradiet Reducing (dry), Purina Fit and Trim, Purina Dog Chow - Low Calorie Formula and Cycle 3 Light (canned). The canned version of Theradiet Reducing may have more than the optimal amount of fiber and this is also true of Prescription Diet r/d. These food vary in fiber content but no one knows for sure what the optimum amount is.
There are a lot of different recommendations on how to start insulin therapy (dosages to start with) so it is entirely possible that your vet chose a starting value that falls within one of the recommended ranges in the literature. We usually use about 0.25U per pound of body weight as a start but I have used up to 0.5U per pound in situations in which it seemed necessary to gain control of the situation as quickly as possible.
We think that most clients with dogs can learn to draw blood using the devices that come with glucometers and recommend that owners of diabetic animals purchase a glucometer. We usually recommend spot checking the blood glucose the first two to three days after starting insulin and then running a "glucose curve" after that.
A glucose curve is simply a plot of the blood glucose level over the course of an entire day. By taking blood samples and measuring blood glucose at 2 hour intervals for 6 to 8 (or even 12)samples during the day it is possible to get an idea of the effect of the administered insulin. Often it is possible to identify a problem such as overadministration of insulin, which results in very low glucose levels part of the day and very high "rebound" levels another part of the day. The more "level" the curve is during the day, the better. For us, this is the best way to fine-tune the insulin levels. Most of the time our clients catch on to what we are looking for very quickly and do most of the fine tuning themselves.
Not all pets will allow collection of blood easily. For these pets, the glucometers are not useful. It is a real challenge to try to stabilize a diabetic animal using information gathered at long intervals. It is expensive for the owners if we try to do the blood glucose curves too often. Getting the timing of when to do these down is one of the challenges of diabetes regulation.
Some vets do feel that monitoring the glucose in the urine and trying to keep it negative or only very slightly positive is an effective method of monitoring insulin administration. We thought we did OK with this before glucometers were available but we think our clients do better monitoring blood levels. Once a stable state is reached, longer testing intervals are OK. It is tempting to try to constantly fiddle with the insulin dosage but for most of our clients that seems to cause more trouble than just testing at reasonable intervals using glucose curves.
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