Ok....This might give you an idea where I'm sort of looking...
Step One: Rule out Owner Related Factors
This may seem very basic but it is important not to skip the basics. Confirm that the amount of insulin being drawn into the insulin syringe is correct, that the injection technique is correct and that the patient is actually receiving the injection. Rule out any snacking or changes in the patient’s feeding schedule. Be sure the bottle of insulin is not expired and that it has been properly stored.
Step Two: Determine for sure that the Patient is Insulin Resistant
A glucose curve is needed to distinguish the following three phenomena:
* Somogyi Overswing
(we did this a few weeks ago)rebound check
In this case, the insulin dose is too high and drives the blood sugar low for part of the day. When the blood sugar is low, other hormones such as cortisone or adrenalin are released to raise blood sugar. These hormones can have a prolonged effect (many hours) thus creating hyperglycemia (high blood sugar). If the patient’s high blood sugar has been caused by a Somogyi overswing, a lower dose should be used and a new curve performed in a week or two.
* Rapid Insulin Metabolism
(not what we're seeing)
In this case, the insulin simply isn’t lasting long enough to create sustained normal blood sugar levels. If the curve shows that the insulin effect is wearing off too soon, twice a day administration of the insulin may solve this problem or a longer acting insulin may be needed. Longer acting insulins tend to have poorer absorption into the body from an injection site. This may also necessitate change to a different insulin type.
* True Insulin Resistance ( yep...checker here)
Here no significant drop in blood sugar level (levels stay greater than 300 mg/dl) is seen in response to the insulin dose used. Usually there is a history of prior increases in insulin dose all met with minimal response.
Step Three: Spay (Not applicable)
Step Four: Rule out Infection
Diabetic animals are at special risk for developing bladder infections since they have so much sugar in their urine. Stress of any kind will contribute to high blood sugar and infection would lead to stress.
A urine culture should be done to rule out bladder infection plus the teeth and skin should be inspected for infection in these areas. If infection per se is not found, the patient should be screened for other chronic illnesses that might constitute a stress. A basic blood panel would be a logical starting point.
If infection, or other stress is allowed to go unchecked, ketoacidosis, an especially life-threatening complication of diabetes mellitus can develop.
Step Five: Control Obesity
Insulin response is typically blunted in obese patients. If obesity is an issue, it should be addressed. A formal weight loss program using measured amounts of a prescription diet and regular weigh-in’s is necessary for success. For general information about weight loss for pets visit:
www.petfit.com
