STEP ONE: INSULIN AND SYRINGES

Insulin is an over-the-counter medication that can be obtained in any drug store for $20 or less. Insulin comes in many brands and types. Insulin is a very simple hormone but there are very slight differences between the insulins of different species. In the U.S. insulin is almost exclusively of the human type and is manufactured via genetic engineering. (In older times, insulin was extracted from animal tissues for human use.) Human insulin is sold under the brand name "humulin".

Insulin

It is possible to obtain animal origin insulins (beef insulin is only one amino acid different from feline insulin and pork insulin is identical to canine insulin) but due to expense and difficulty in obtaining these products, most experts recommend attempting regulation with the human product first. This is successful in all but a few rare cases.

Natural insulin is modified biochemically by the manufacturer into different types which last for different lengths of time.

Humulin R - fast acting and is similar to insulin secreted by one's body. This insulin acts too fast and lasts too short a time to be useful in the home setting for pets.

Humulin L or N - intermediate acting. These are the most commonly used forms of insulin and are usually used twice a day in pets.

Humulin U - long acting insulin but famous for erratic absorption after injection.  It is mostly used for patients who require once a day insulin though there are certainly some animals who must take it twice a day.

Your veterinarian will select an insulin for you to buy from the local drug store.

Insulin need not be refrigerated. It is normal for a small white layer to settle in the bottle after it has been sitting.

Syringes

When getting ready to use the bottle, roll the bottle in your palms to mix in this layer. Do not shake the bottle.

BE SURE YOU UNDERSTAND THE DOSE OF INSULIN YOU ARE TO USE. DO NOT ALTER THE DOSE GIVEN ON YOUR OWN.

Drawing Insulin

SYRINGES

Insulin syringes are made for human use. Humans are notoriously afraid of needles thus the needles are made extra fine so that human diabetics will not feel them. You will require a prescription from your pharmacy to obtain a box of insulin syringes.

Syringes come in 0.5 cc volumes and 0.3 cc volumes. The syringes are graded in "units". The smaller the syringe volume, the easier it will be to read the tiny unit gradations. We recommend the 0.3cc size for cats (although the 05 size is pictured above).

When drawing up the insulin, always hold the bottle vertically to avoid unnecessary bubbles in the syringe. Since insulin is being given under the skin, the presence of bubbles is not an enormous problem (as it would be with an intravenous injection) but we still want to minimize the presence of bubbles. If you get bubbles in the syringe, flick the syringe with your fingers until the bubble rises to the top and then simply push the air out of the syringe with the plunger.

Before actually injecting your pet, practice drawing up the correct amount of insulin and feel comfortable handling the bottle and the syringes.

To dispose of used syringes it is best to keep a thick plastic container (such as the type liquid laundry detergent comes in) and deposit used needles here. The container can be closed when it is full and discarded in the regular trash.

GIVING THE SHOTS

Injection demo 1

Pull up a handful of your pet's scruff. A triangle of skin is formed. Aim your needle for the center of this triangle and stick the needle in. Do not be shy or the needle will not penetrate the thick skin in this area.  Pull back slightly on the syringe plunger to be sure you do not get blood back in the syringe. If you do see blood, pull the syringe out and start over. If you do not see blood, press the plunger forward and deliver the insulin.

Injection Demo 2

If there is struggling or your pet escapes or for some reason you are not sure if your pet got the entire dose of insulin, DO NOT GIVE MORE. Simply wait until the next scheduled dose.

DIET

Insulin works best in dogs in the presence of a high fiber diet. Ideally this is what your dog should be eating (either dry or canned).  Recent work shows that cats do best on a high protein diet (dry or canned Feline Growth).  Feed your pet, make sure that a reasonable amount has been eaten, and then give the insulin. If you think your pet is off food or not eating well, do not give the insulin and notify your vet.

Meals should be approximately equal and fed about 12 hours apart.

OPTIONAL OTHER MATERIALS

Keto-Diastix

Ketodiastix are special urine dipsticks made for human diabetics. They are meant to measure the amount of glucose in the urine and detect the presence of ketones. You may use these to keep track of your pet's diabetic progress (a journal is a handy record for your vet to periodically review).

If you begin to detect ketones in the urine, this can be a very bad sign. If ketones persist three days or more, you should notify your vet.

WHEN TO RETURN

Every individual animal will have a different insulin requirement. The initial dose selected for your pet is basically just a guess. It will take at least a week for your pet to adjust to the new insulin dose and stabilize. After this time, the pet returns to the hospital for a "glucose curve", a test requiring all day in the hospital. Blood sugars are measured every 1-2 hours to determine how long the insulin is lasting, when its peak activity is occurring etc. From here, we can tell if or how your insulin dose should be changed, if more frequent administration is needed and whether or not a different type of insulin is needed. A new dose is selected, another week or two goes by for stabilization, and a new curve is performed until regulation is achieved.

WHAT TO WATCH FOR

It is not unusual for a pet's insulin requirement to change over time. When this happens you will notice a return in weight loss, excessive appetite, and excessive thirst and urination. This is an indicator that your pet needs a glucose curve to re-adjust the insulin dose.

INSULIN SHOCK/HYPOGLYCEMIA

When the insulin dose is too high relative to the pet's activity or appetite, it is possible for a dangerous level of hypoglycemia to occur. The pet will become groggy, listless, cold, even uncoordinated and drunken. First aid at home can be life saving.

• Immediately offer the pet food.
   
• If the pet will not eat, you will need to give sugar. The easiest way to do this is with light Karo syrup. Spoon some syrup into the pet's mouth or you may wish to keep some frozen "ice cubes" of syrup in case of emergency. You may slip an "ice cube" into the pet's mouth. Swallowing is not necessary as sugars are absorbed directly through the mucous membranes of the mouth. Your pet should revive with this procedure.
   
• Contact your vet at once as sometimes IV sugar drips are needed for a few hours after such an episode. Your vet will need to determine what threw your pet out of balance in this way.
   
• Do not give more insulin until your vet tells you to. If you are lucky, your pet may no longer be diabetic but this will have to be determined for sure.

SUCCESSFUL MANAGEMENT OF THE DIABETIC DEPENDS ON A GOOD UNDERSTANDING OF THE DISEASE AT HOME. IF YOU HAVE ANY QUESTIONS OR PROBLEMS, BE SURE TO ASK YOUR VETERINARIAN.