Richard Goldstein, DVM, DACVIM, and Ruth MacPete, DVM, describe how to start a pet on insulin, including the possibility of hospitalization during the first 24 hours to track the sugar levels. Azi Chegini shares her experience of when her dog was started on insulin and how as her comfort level increased with administering insulin and at home monitoring, managing diabetes became easier.
Richard Goldstein, DVM, DACVIM: Back to Spider. Spider’s a dog, right, Spider? Yes, Spider’s a dog. He’s coming to you. What would you have instituted with Spider with this story? Azi did a wonderful thing, adopting him from a foster family. What would your recommendation have been for Spider? Does he have to be hospitalized during this process? Can this be done at home?
Ruth MacPete, DVM: Yes, usually they are. If the animal is first diagnosed, we talk with the pet parent about diet. Depending on the animal, we’re going to change their diet. With dogs, high fiber in their diet seems to help with diabetes. We may change them to a diabetic diet that’s appropriate for whether they’re a cat or a dog. We’ll also talk about weight loss. If they’re overweight, we’re trying to get them to obviously lose weight. If they’re thin, we’re trying to make sure they’re not continuing to lose weight. And then we start insulin therapy. If we’re using insulin, the type of insulin that we use, and the amount, varies for each individual pet. Typically, there are some insulins we use with dogs more frequently and some that we use with cats more frequently, just based on studies. But we would start them on insulin.
Richard Goldstein, DVM, DACVIM: We’re really lucky to have veterinary-approved label inserts for both dogs and cats, which is great.
Ruth MacPete, DVM: Yes.
Richard Goldstein, DVM, DACVIM: It’s great because we know what we’re doing and we know that the companies are behind us if there’s a problem.
Ruth MacPete, DVM: That’s more recent, too. We didn’t used to have all that. But then we start them on insulin. The insulin is usually started twice a day, and most of the time there’s some variation depending on the pet. But usually they’re started on insulin and monitored very closely the first 24 to 48 hours. That can be done in a hospital setting or sometimes, depending on the pet parent and the communication with the veterinarian, that’s done at home. I would say a lot of the time it’s done in the hospital. The reason for that initially is to monitor by doing serial blood glucose checks that are looking for hypoglycemia. Once insulin is started, we’re looking to make sure we don’t lower the blood sugar too low. If that’s the case, then the insulin level may be lowered or adjusted. We usually don’t go up at all with insulin right away because it takes the body a while.
Richard Goldstein, DVM, DACVIM: It takes the body awhile. What do you mean?
Ruth MacPete, DVM: It takes the body awhile to adjust to being on insulin, so we don’t want to make any quick moves in terms of increasing insulin. But we will lower it if it seems low.
Richard Goldstein, DVM, DACVIM: That’s an important point. I think people sometimes get impatient and they want them regulated right away. There is something called glucose toxicity. Let’s say he was diabetic for at least a few weeks, maybe months, prior to his diagnosis. His body will take a while to get used to insulin. He will actually become more sensitive to insulin in 3, 4, or 5 days than he was on day 1. That’s why you were saying we can’t just hit them hard with insulin on day 1, because then it’s going to be too much.
Ruth MacPete, DVM: It’s the same with the diet, too. We’re also implementing a diet change, and that’s another thing that’s going to happen as their weight changes, as they have a better diet that’s controlling their regular blood sugar after they eat. It’s the same thing. That insulin level can change. So, initially, we’re really watching to make sure that they’re OK, that they don’t have a dangerous hypoglycemic, or low blood sugar, incident. And then we’ll actually send them home. Ideally, I’m talking to the pet parent about home monitoring, watching them at home when they go home.
Richard Goldstein, DVM, DACVIM: So, Azi, how did you take all this news? Was that the same type of news that was given to you?
Azi Chegini: It was.
Richard Goldstein, DVM, DACVIM: With Charlie and with Spider, I’m guessing.
Azi Chegini: Absolutely, yes. I learned that with Charlie. Charlie stayed at the hospital actually for a Saturday, and that’s what they did. They told me that they would be starting in the morning and basically measuring his glucose level every hour from 7 to 5 o’clock. When I picked him up, they had a very interesting graph that had shown exactly when his sugar fell and that’s when I knew to give him insulin.
Richard Goldstein, DVM, DACVIM: And we’ll get to this. But you were later able to generate those kinds of graphs at home, too, right?
Azi Chegini: Absolutely. With the right tools and a better education and some practice.
Richard Goldstein, DVM, DACVIM: You could actually do that at home.
Azi Chegini: Absolutely.
Richard Goldstein, DVM, DACVIM: Back to when he was first diagnosed. They talked to you about changing his diet. They talked to you about insulin. What was the hardest things that went through your mind? I know it took you 24 hours to assimilate with Charlie.
Azi Chegini: Yes. I think the first question after the shock has gone is, what do I do? Give me a good step, tell me what I should look for, and tell me how to manage it. When do I call you? I think the first 2 weeks I was calling my veterinarian every day, which is understandable. That’s normal; it’s OK. Nobody should panic.
Ruth MacPete, DVM: Yes, and we’d rather have you call than not, definitely.
Azi Chegini: I did. I called a lot, and after 2 weeks, when I got the answers with much patience from my veterinarian, I knew what to look for. I did change the diet; he’s on a proper diet. But I also got used to the idea of giving the shot, making it part of your life just like you drink water, just like you get up and do your workout or you go to work. It’s very much like that. I know that his life is depending on it, and that’s the first thing I think about. It’s not life changing; it just becomes part of the routine in your life, that’s all.
Richard Goldstein, DVM, DACVIM: You were able to start with a different diet. You started with insulin, and you even started home monitoring.
Azi Chegini: Yes, that came a couple of weeks later, as soon as I got comfortable with giving insulin and changing his diet, which is really not that difficult I think. I talk to my friends and family, and I know everybody always tries different things or if they have skin problems, they get a new diet. So, that wasn’t a big change for me or for Charlie at the time. But just getting comfortable with the idea of giving insulin shots…
Ruth MacPete, DVM: That’s something I hear a lot. I think a lot of people are initially afraid and ask, “Oh my god, you want me to give the shot at home? How am I going to do that?”
Richard Goldstein, DVM, DACVIM: Yes, we’re going to go over that conversation in just a minute. One of the things about people with diabetes is how human endocrinologists would love for people to eat exactly what they tell them to. We’re lucky that we can say, “Eat this. It’s palatable, you like it, and it’s good for you. It’s good for your diabetes.” It’s different with people.
Azi Chegini: Very true. I, for one, think it’s so much easier for me to control his diabetes. If I had one, I’d be in trouble completely.
Richard Goldstein, DVM, DACVIM: All right. Great, thank you.