Regulation

Staying under the renal threshold (180 mg/dl, 10 mmol/L) for most or all of the time on a regular basis is good regulation.

When your pet is first diagnosed with diabetes, your goal is to "regulate" the pet's blood glucose, which may take a few weeks or even many months. This process is basically the same as in type-1 diabetic humans. The goal is to adjust insulin dose to keep the blood glucose values in a comfortable range for the pet during the whole day, or most of it. Regulated cats or dogs can "slip out" of regulation at any time because the body is not a static system.

The well-regulated diabetic pet should look and act the same as he/she did before diabetes, or like any other non-diabetic pet.

Mealtimes

Dogs have their mealtimes strictly scheduled and planned to match with injection times. For dogs, the most common protocol is feeding and giving insulin injections 12 hours apart, with an Intermediate-acting insulin . Meals should be timed so that the maximum effect of the injected insulin occurs after it's been eaten, or post-prandially.

Since the insulin regimen for most dogs is of a fixed pattern, having a predictable glycemic response should be achieved each time. This means that each meal should be comprised of roughly the same ingredients and caloric content and fed at the same times each day. If food and insulin time varies from time to time for a period upwards of an hour--food and insulin being given up to an hour earlier or delayed by up to an hour, generally there should not be a problem. Being consistent with food and insulin times makes for the best results.

Adding more fiber to a dog's diet can be of help with both overweight and regulation. Insulin resistance can come, at least in part, because a pet or person is too heavy. Fiber helps with weight loss because it allows one to feel "full" without the need to consume more food. Those who have food spikes may find they can be eliminated or made manageable by putting more fiber in their diet. Putting the brakes on food spikes means coming closer to regulation. Overall because it helps reduce or eliminate some of these Regulation difficulties, more fiber can mean less insulin.

Insulin

Long acting insulins (such as Lantus, Ultralente, PZI) have a poor success rate among dogs. Most are well-controlled with one of the Intermediate-acting insulins-a Lente, an NPH or even one of the non-analog R/Neutral-isophane/NPH mixed insulins given twice daily, most commonly at 12 hour intervals after meals. It is the rare dog who requires regular injections of short-acting insulin in addition to the NPH or Lente given after meals.

Method

The commonly recommended method is to Start Low-Go Slow:

• Have an initial blood glucose reading, perhaps even a curve, taken at the vet's and receive an initial dosage recommendation. You also could do a curve at home with a glucometer. Hometesting blood glucose levels just before each shot and at midpoint is essential -- it will save many expensive trips to the vet, avoid dangerous overdoses, and give you a better handle on your pet's ongoing condition. Urine testing stix are not accurate enough for this.

• Your pet is "regulated" when its blood glucose remains within an acceptable range all day, every day. Acceptable levels vary somewhat between vets, but is roughly from between 5 and 10 mmol/L (90 to 180 mg/dL) for dogs. (The range is wider for diabetic animals than non-diabetic, because shots cannot replicate the accuracy of a working pancreas.) It's important, though, that the glucose level be in the lower half of that range for as much of the day as possible. If you are not testing blood glucose levels at home, some vets recommend that you stop increasing the dosage when the dog is drinking normally, urinating normally, and eating normally, although organ damage may continue in some cases until glucose is below the renal threshold -- testing urine with keto/glucostix will show when this has been achieved.

• If after a few weeks of this procedure, your pet's blood glucose level is still high, continue on to read about Regulation difficulties and curves.

Tighter control

All dogs will definitely benefit from tight control of blood glucose level, as it prevents long-term complications of diabetes, such as neuropathy, kidney damage, and cataracts. Remaining above renal threshold of 180 mg/dl or 10 mmol/l can cause cataracts in dogs as well as other bodily complications.

More Information

• Beyond Insulin Therapy: Achieving Optimal Control in Diabetic Dogs Fleeman, Linda, Rand, Jacqueline, 2005, University of Queensland
• Successful intensive insulin treatment of type 1 diabetic dogs leads to restoration of peripheral leukocyte insulin signaling gene expression and enzyme activities Mori A, Lee P, Sako T, Mizutani H, Arai T., 2009, Journal of Veterinary Medical Science