Insulin, Injections and Home Testing

After eating, carbohydrates from food are converted into glucose in the blood stream. As the level of glucose rises, the hormone insulin is released from the beta cells in the pancreas. It's job is to unlock the cells in the body so that the glucose can enter them to provide energy. A diabetic dog's pancreas no longer produces insulin resulting in glucose levels remaining and rising in the bloodstream. If glucose is not removed from the bloodstream in it's normal way, your dog will become hyperglycemic. Hyperglycemia means to have high blood sugar levels. In this state, a diabetic dog can develop ketones in the blood. Ketones are an acid remaining when the body burns its own fat. Ketones build up due to insufficient insulin helping fuel the bodys cells and if left untreated can lead to Ketoacidosis so it is very important to maintain safe glucose levels in the body.

As the pancreas in a diabetic dog stops producing sufficient insulin naturally, we must give insulin injections daily to reduce glucose levels in the body. Hyperglycemia is not immediately life-threatening however, consistent hyperglycemia can lead to Ketoacidosis as previously mentioned, which can be fatal and can also cause many other problems throughout the body. Weight loss caused by hyperglycemia is a result of energy not getting into the cells, a consistently hyperglycemic dog is literally starving to death. Hyperglycemia can also cause blindness and cataracts to form in the eyes. This can happen slowly over a period of time or rapidly overnight. Hyperglycemia can also cause dehydration, pancreatitis, damage to nerves, kidneys and blood vessels and is the main cause of urinary tract infections in diabetic dogs.

Signs of hyperglycemia include frequent urination, sticky urine, excessive thirst, increased appetite, weight loss, cloudy eyes, blindness, stomach problems and lethargy.

Once your dog is diagnosed with diabetes, it is important to start insulin therapy as soon as possible. Your vet will start your dog on a low dose, usually 0.50 units of Caninsulin per kilogram in weight, twice a day. Your dog will then go to the vets weekly or fortnightly at first, for curve tests to determine how much insulin is needed and whether the current dose needs adjusting. When raising the insulin dose, it should ideally only be raised by half a unit of insulin at a time, especially for smaller dogs and allowed to settle for around 7 days before performing another curve to see how your dog is responding to the new dose. If you raise the insulin dosage too quickly or too much at one time, you could risk not only missing your dog's ideal dose and increase the chance of going into rebound but also you risk sending your dog's blood sugar levels too low causing hypoglycemia which can be fatal very quickly. The dosage of insulin given should only ever be adjusted depending on the lowest readings of a curve, never the highest.

Hypoglycemia is the opposite to hyperglycemia. Hypoglycemia is when the blood glucose levels drop too low (under 4 mmol/L). Signs of hypoglycemia include listlessness, lethargy, unusual behaviour, confusion, lack of appetite, trembling and twitching, glassy eyes, poor coordination, weakness in the legs, hanging of the head, collapse, seizures and coma. Hypoglycemia can also be brought on from stress, pain in the body, changes in the household or usual routine, cold temperatures, exercise and excitement. Unfortunately, some dogs show no outwardly signs of hypoglycemia which is why home testing is vital to your dog's safety.

For some unknown reason, some vets try to dissuade the use of home testing a dog's glucose levels but home testing is a very important weapon in dealing with and successfully treating your dog's diabetes. Without home testing you will not know whether it is safe to inject a full dose of insulin and are risking a hypoglycemic event each time you give insulin. Once a dog is hypoglycemic, is is paramount to raise the sugar levels as fast as possible as untreated hypoglycemia is deadly. If you suspect that your dog has low blood sugar, rub honey/ syrup on your dog's gums immediately. This is the fastest way to safely get sugar into the blood stream. Repeat until the signs of hypoglycemia cease then feed a carbohydrate such as peanut butter or jam on half a slice of bread or a cracker, to maintain a safe level of blood glucose. If you have a test monitor, test your dog's blood sugar levels around 15 minutes after treating with honey and food to ensure the glucose levels are rising. If your dog is still low, repeat with honey and test again until your dog is showing a reading of around 8mmol/ L. Ensure the peanut butter you use does not contain sweeteners, especially Xylitol as this is highly toxic to dogs.

Regardless of your vet's opinion, your dog is your dog and you are the one who will be dealing with the disease daily. If you can test, you should test. Human diabetics would not inject a dose of insulin blindly without knowing their current glucose levels and your dog shouldn't be any different.

Home testing is often better for your dog as within a veterinary clinic, a dog's stress levels can rise giving inaccurate readings which in turn can mean the wrong dosage of insulin is decided on. Performing curves in a relaxed, familiar environment will be far less stressful for your dog and will give you truer readings of your dogs glucose levels throughout the day. A curve is a test that you run throughout the day to see how the insulin is working for your dog. To perform a curve you will need a pet glucose monitor. The most accurate type, which is also used by vets, is the Alphatrak2. You can find the best priced suppliers in our menu at the top of this page. The Alphatrak2 monitor comes with a tub of testing strips and a lancet. Before using your test monitor for the first time, you will need to calibrate the test strips. On the side of the tub containing the test strips you will find a code for dogs which you will enter into the monitor before testing. The code is usually 36 but this can change so it is important to check the code each time you open a new tub of strips. It is also a good idea to get your dog used to the clicking sound of the lancet before you start using it as it can startle a dog who has never heard it before making the process of getting a blood drop very hard. Do spend some time reading the instructions before using the monitor.

Your dog can be tested on different parts of the body such as the carpal pad, edge of inner ear, inside lip and a shaved area above the base of the tail. Other than the inner lip, you will get better results if you gently warm the area for a minute before testing. This will help you get an adequate blood bead. You can warm the testing site using a rice filled sock, warmed gently in the microwave for a few seconds. Always test the heat level on your inner arm for a few seconds before using on your dog. We find turning the top lip back is a great place for testing as the mouth being warm produces a nice amount of blood for each test. Once you have the blood bead, gently hold the corner tip of the strip onto the surface of the blood and allow the strip to draw the blood up. Do not immerse the strip in the blood or smear the blood onto the strip as you will not get a reading. You may find at first that you don't get enough blood to get a reading or that your dog doesn't like the test but just like the injections, in a short time both you and your dog will get used to it and it will become much easier and a normal part of your daily routine. You may also find using the lancet needle without the lancet is better for your dog if he can't get used to the clicking.

When you start your curve, you should take the first test at fasting. This is just before the morning feed is given. You will then repeat the test, once every two hours until the next fasting test just before the evening feed is given, seven tests in total. Some people will also test an hour after each meal to see if there are any high blood glucose spikes after eating. Once you have your curve results written down, you will be able to see how the insulin is working and decide on the next course of action to take.

Injecting insulin should be pretty painless for your dog. To make injecting insulin more comfortable, make sure you insert the needle bevel side up and warm the insulin in the syringe before injecting. Cold insulin stings. You can warm it to room temperature by drawing the correct amount of insulin into the syringe then placing it with the lid on between your lips, under your armpit or the crook of your elbow for a minute or two before injecting. Do not use hot water or microwave the insulin to warm it. To inject, tent the skin and inject at around a 45 degree angle so that the needle is going under the skin. You do not want to go into a muscle. Push the needle in quickly and firmly and then once in place, whilst still holding the tented skin, begin to press the plunger steadily until all the insulin is injected.

Do not push the insulin in too fast (or too slow!) as this could upset your dog. It will take a little practice and your dog will let you know if he is happy with the way you are doing it. If your dog yelps, don't feel too bad, we have all been there! Comfort him and let him know everything is fine. It's a lot of adjustment for him too. Persevere and you will both get the hang of it in no time! Try to make injecting times a happy occasion, getting stressed and irritated with your dog will only cause him to associate injections with negative experiences. Once the insulin has been given, praise your dog to show him injection time is a positive time! Try not to rub the injected area as this will cause the insulin to absorb faster. It's okay to gently wipe over the area with your hand to feel the fur for dampness.

Do not use alcohol wipes on your dog or the needle. The needle is coated to make it enter the skin easily and once wiped this coating is removed. Do not inject in the same place each time. This will cause a build up of scar tissue which not only will become tender for your dog but will cause poor absorption of the insulin. Try to rotate around the injection area. Many people stick to a 'left side in the morning, right at night' routine. As you and your dog become more comfortable with the injections, you can start with injecting in other parts of the body but keep in mind, different parts of the body absorb the insulin faster than others and can cause a faster drop in blood glucose which is another good reason for home monitoring the glucose levels.

Do not use syringes more than once. Syringe needles have a covering of lubricant which makes injecting smoother and less painful. Once the needle has been used this lubricant is removed. Needles are very fine, whereas skin is quite tough and when the needle is used significant tip damage can occur, blunting the needle. In the picture, you can see how the needle changes with each use.

If you experience a fur shot, don't beat yourself up, it happens to most of us at least once! You will know if you have given a fur shot as the fur will be wet with insulin. If this happens, do not give your dog another dose of insulin as you will not know how much was given in the fur shot and can risk overdosing your dog. Your dog's numbers may be high for the rest of the day but you can get back on track with the next scheduled shot.

When you begin injection therapy with your dog, it can be a very frightening experience, especially if you don't like needles anyway but you must try to remain calm. Pet your dog beforehand to get both of you in a calm relaxed mood before injecting. try not to show your fears to your dog as he will sense them and become tense and scared himself. You can use a treat to reward your dog after his injection to give him something to look forward to afterwards and he will begin to associate the injections with the treat and except them easier.

Some people give the injection whilst the dog is eating their food. This is not recommended as your dog may start refusing to eat if he associates the injection with food.

If you are unsure that you are doing it right, you can see many dogs receiving their insulin injections and blood glucose tests on You Tube.