.qu state starting dose of insulin .qu state max dose of insulin (@2iu/kg) &es &pname &pad1, &pad2, &pad3 Prepared for &client on &date. The treatment of &animal's diabetes Diabetes is caused by a lack of insulin, leading to a disordered metabolism of carbohydrates, fats and proteins. It is characterized by a high blood glucose level. The key to the successful treatment of &animal's diabetes will depend upon us helping you to understand the biochemical processes which cause &hisher problem, and how they may be controlled. This information is designed to provide you with a point of reference for some of the more important facts about diabetes and will not attempt to replace your discussions with us, or your own further reading. In condensing the information some points may appear to have been over simplified, if so just give us a ring at the surgery. Many owners are understandably horrified with the prospect of sticking needles into their pet for the rest of &hisher life. Rest assured that in the majority of cases there is such a dramatic improvement that you will soon overcome any of your initial qualms about the treatment. You will also be surprised at how quickly &animal will get into the routine, and even come to you when &heshe knows it is time for &hisher injection. &bs &animal's diabetes &us can&uf be controlled, and you can expect the treatment to increase &hisher quality of life. &bf &ef .pa &es WHAT SHOULD HAPPEN &ef The control of &animal's blood glucose level is maintained by the fine balance between two groups of hormones, a) &bs Hormones which lower blood glucose (e.g. Insulin)&bf: These allow cells to absorb glucose from the blood either to produce energy, or for storage. All cells can store glucose as glycogen, but the largest stores are in the liver and muscles. b) &bs Hormones which raise blood glucose (e.g. adrenaline, cortisone)&bf: These hormones encourage the release of stored glucose from cells. &animal's blood glucose is kept within fairly narrow limits by the balance of these two types of hormones. Thus when &animal eats food and absorbs nutrients, &hisher blood glucose will start to rise, the pancreas will recognise this and produce enough insulin to stop it rising above normal limits. Equally if &animal goes chasing after the neighbour's cat &heshe will produce adrenaline, which stimulates the release of glucose from &hisher stores of glycogen for use by &hisher muscles. &animal's body will be constantly adjusting the levels of these, and other, hormones in order to maintain &hisher blood glucose within fairly narrow limits. &es WHAT HAS GONE WRONG? &ef &animal's diabetes is due to an inability of &hisher pancreas to produce enough insulin. This usually caused by one of the following: a) Primary diabetes, a lack of insulin making cells. This is seen in young animals born with too few cells, or in older animals when the cells atrophy. b) Secondary diabetes, where there are enough cells, but the amount of insulin is not enough to control blood glucose. This may be seen after pancreatitis, conditions which produce too much cortisone, after long term use of female hormone injections, or in obesity. Whatever the cause there is an imbalance and &hisher blood glucose has risen beyond the normal upper limit. In spite of this, the lack of insulin leaves &hisher cells unable to absorb enough of the glucose they need to produce energy. &es WHAT ARE THE SYMPTOMS OF DIABETES? &ef This lack of insulin affects all &animal's cells in &hisher body, and the range of symptoms seen can include: * Excess drinking; the excess blood levels cause glucose to appear in &animal's urine, which makes &himher drink more than usual. * Weight loss in spite of eating more; although there are high blood levels, the lack of insulin prevents cells absorbing glucose and &animal craves more food. Other hormones will then cause &himher to use protein, from her muscles, and stored fat to produce energy. .pa * The use of stored fat causes the accumulation of compounds called ketones in &animal's blood. High levels of ketones can lead to some of the more serious complications of diabetes. * Cataracts * Liver and kidney disease * Many unspayed female diabetics will start to show early signs when they come in to heat &es DIAGNOSIS OF DIABETES &ef Diabetes may be suspected if glucose is found in &animal's urine; but the diagnosis is only proved when a blood sample from &himher , taken after 12 hours without food, shows raised glucose levels. Sometimes we will suggest further tests to look for other diseases that may be aggravating &animal's diabetes, or to assess the extent of liver and kidney involvement in &hisher disease. &es ABOUT TREATMENT &ef Before &heshe developed diabetes &animal was constantly adjusting &hisher blood glucose level to keep it within normal limits. Treating &himher with injected insulin must be done in the knowledge that the control will never be as accurate as nature intended. Some of &animal's symptoms will change quite quickly (e.g. &hisher thirst will diminish within a couple of days). Others may take some time, for example the damage to &hisher liver should resolve after a few weeks of successful control. Certain organs are so reliant upon a normal blood glucose that further changes will occur even during successful treatment, and most animals will develop some degree of cataract. &es STARTING TREATMENT &ef The dose of insulin required to stabilise each animal can vary considerably. It may be necessary to hospitalise &animal for frequent blood glucose tests during the first few days until we are sure of &hisher optimum dose. A veterinary insulin is used which takes between 4-10 hours to start working, and can last for 12-24 hours. The exact action will vary for each individual. We will start &animal on an average dose, which can be adjusted from time to time according to &hisher response to treatment and the results of urine tests performed at home. It is essential to establish a daily routine for &animal . The table below is a suggested timetable for injections and feeding, but keeping to &hisher regular exercise routine is just as important in maintaining &hisher blood glucose control. .pa &es SUGGESTED DAILY ROUTINE _____________________________________________________________________________ N.B. these times should be adjusted to fit your household routine, 8.00am - collect urine and test with ketodiastix 8.30am - feed 1/4 to 1/3 of daily food 8.35am - inject &var0 units of insulin - (1/2 dose if food not finished) 3.30pm - feed remainder of food 7.00pm - test urine daily with ketodiastix (until properly stabilized) ______________________________________________________________________________ KETODIASTIX &ef Regular testing of &animal's urine with Ketodiastix will give us an idea of &hisher blood glucose control during the previous few hours, as well as liver and kidney function. You should expect to see the ketones gradually fall during the first few weeks of &animal's treatment, as &hisher metabolism adjusts. Please keep a record of &animal's urine results and bring it along to &hisher regular check ups - from the record we will be able to get an overview of &hisher diabetic control. Even when stabilised you may also see an occasional ketone result of + or ++, after a long walk for example or if &animal did not eat all &hisher food that day. &bs If you find a ketone result of + or ++ &animal's urine should be tested every 12 hours for the next few days. If the ketones are present for more than two days, or if you find a result of above +++, this &us may&uf be a sign &heshe is destabilised and you should contact the surgery. &bf &es PRECAUTIONS &ef 1. Scrupulous hygiene is required to minimise the risk of complications during &animal's treatment for &hisher diabetes. - Vary the site of each injection, give one week's injections down one side, and use the other side next week. This stops the production of fibrous tissue which could interfere with insulin absorbtion. 2. Keep the insulin in the top of your fridge door &bf Do not allow it to get frozen. Do not shake the bottle, roll it gently between your hands to mix it. 3. Stick to your routine for testing and dosing. 4. Stick to the appropriate dose, any variations should be carefully calculated according to the blood test done by us at the Veterinary Centre. The frequency of these tests will vary - We will advise how often is necessary for each animal. 5. Do not put used syringes in the rubbish bin, they should be brought back to the surgery for disposal as clinical waste. .pa &es DIET AND WEIGHT &ef As &animal is being given just one dose of insulin per day, &hisher diet needs to be such that it is digested and releases glucose when the insulin is working. There is a range of Prescription diets that will help with a slow and steady release of nutrients, and provide carefully balanced proportions of carbohydrate, protein and fat, together with the vitamins and minerals &animal needs. &bs ****** NO TITBITS ****** &bf We will check &animal's weight every time &heshe comes in for a check up, if you would like to weigh &himher please feel free to use the scales in the waiting room. Once &heshe is stabilised, you should find &hisher weight will be fairly stable. &es HYPOGLYCAEMIA &ef Hypoglycaemia literally means 'low blood glucose'. It occurs when the insulin lowers the blood glucose too far, either because too much has been given, or if &animal has not eaten enough, or if &heshe has not eaten at the correct time. &bs You need to know the signs of hypoglycaemia as it requires &us immediate &uf treatment by you at home. Look for signs just before &heshe is due to be fed as this is when the insulin will be starting to exert its maximum action. If you notice any of the following signs in &animal - Excessive tiredness - Staggering - Weakness Give &himher two tablespoons of glucose syrup by mouth (keep some in the fridge for emergency use). Even if &heshe can't swallow, rubbing it around &hisher gums and under the tongue will allow glucose to be absorbed. Watch &himher closely afterwards, as &heshe may use the oral glucose quickly and need another dose. Once you have given &animal &hisher oral glucose phone the surgery immediately. &bf &es SUMMARY &ef 1. &animal's starting dose of insulin is: &var0 units per day 2. Stick to a routine 3. Contact the surgery if you notice ketones for more than two days in a row. 4. Contact the surgery if you notice signs of hypoglycaemia 5. Come in for check ups every month for the first few months, and then every three to six months or so. 6. Please give us about 3 days notice if &animal requires more insulin or syringes, or if you require more Ketodiastix. &bs .pa &es RECORD OF URINE TESTS &animal weighed &weight kg on &date &client &ef Date | Time | Ket | Gluc | Dose insulin | Comments (mls water/day) ______________________________________________________________________________ | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | &es IF IN DOUBT, PHONE THE VETERINARY CENTRE! &ef