Dog Diabetes Treatment

Insulin

Several kinds of insulin are used in dogs:⁶

• Intermediate-acting insulins, including a porcine (pork) zinc insulin approved for dogs, usually given twice a day. AAHA recommends these as a first choice.⁴
• Long-acting insulins, including a veterinary-approved protamine zinc insulin, given once or twice a day
• Newer ultra-long-acting insulins, which AAHA says can be considered as a first option. They are "peakless" and usually started once a day, but aren't approved for dogs.

Your vet will choose the type and dose and adjust it slowly. The dose shouldn't be raised in the first 24 hours, and after each change your vet will usually recheck glucose within 5 to 14 days, or every 3 to 7 days with a continuous glucose monitor.¹⁰

Giving Insulin at Home

• Feed first. Give the full dose only if your dog eats at least half the meal, and ask your vet what to do if less is eaten.⁸
• If you miss a dose or aren't sure it was given, don't give extra. Give the next dose at the usual time.⁷
• Handle insulin correctly. Some types are gently shaken until evenly milky and others are rolled, so follow the label and your vet.^8,6
• Store it in the refrigerator, never frozen, and away from heat and sunlight.⁷
• Replace insulin that is out of date, clumpy or discolored.²¹
• Use the right syringes or pens for your insulin's strength.⁸

VCA notes that "it is always better in the short term for the blood sugar to be too high than too low."⁷

Monitoring

• Watch for signs: AAHA calls a dog well controlled when it isn't drinking, urinating or eating excessively and its weight is stable.⁹
• Keep a daily log of food, water, insulin and anything unusual.¹⁰
• Glucose curves: blood glucose checked every 1 to 2 hours over about 10 to 12 hours.²² They're repeated every 5 to 14 days until your dog is controlled.^10,7
• Continuous glucose monitors (CGMs): a small sensor under the skin, usually between the shoulder blades, that reads glucose for about 2 weeks¹⁹
• Fructosamine: a blood test that shows average control over about 7 to 10 days²³
• Urine checks for ketones in poorly controlled dogs¹⁰

Once your dog is stable, rechecks are usually every 3 to 6 months.^10,1 Single spot glucose readings are unreliable and shouldn't be used alone to change the dose.¹⁰

When Diabetes Is Hard to Control

Common reasons include missed or incorrect injections, insulin that has gone bad, diet changes and conditions that cause insulin resistance.²¹ These include infections, dental disease, Cushing's disease, hypothyroidism, pancreatitis, the heat cycle and steroid medicines, including creams, eye drops and ear drops.^21,24 Spaying is recommended for unspayed diabetic females.^21,1

Cost

PetMD estimates insulin at about $30 to $150 a month and total care at upward of $2,500 a year. Pet insurance may help.¹² Costs are highest during regulation or if complications arise.^11,25 If cost is a concern, ask your vet about insulin types and monitoring plans that fit your budget. Untreated diabetes isn't an option for most dogs: in one study only 7 of 40 dogs not started on insulin lived more than a week, and most deaths in that study were euthanasia.²⁶

Frequently Asked Questions

Can a diabetic dog live without insulin?

No. Dogs lack working insulin-producing cells, so insulin is required.

Does insulin have to be given exactly 12 hours apart?

Twice-daily insulin is usually given about 12 hours apart with meals. Ask your vet how much flexibility your dog's plan allows.

How long until my dog feels better on insulin?

Thirst and urination often improve as the dose is adjusted, but full regulation can take a month or more.

What if my dog won't eat before an insulin shot?

Don't give the full dose. Follow your vet's plan, and call them if your dog skips two meals.

Are there pills for dog diabetes?

No pill replaces insulin in dogs.