Start Insulin Therapy…Now What?

      1. General Guidelines
           a. 4-6 weeks for control
           b. 7-10 days for animal to adjust to insulin
           c. Insulin requirements will be higher at home
           d. No need to hospitalize if stable
           e. Adjust therapy to owner
               i. Frequency of insulin administration
                ii. Frequency of monitoring

      2. Monitoring Parameters
           a. Ketodiasticks
               i. Call if 2 or more negative glucose readings
                ii. Check urine 4-8 hours after insulin
                iii. Hypoglycemia
                iv. Ketonuria
           b. Home Blood Glucose Monitoring
                i. Blood sampling sites
                     1. Ear pinnae
                     2. Foot pads
                     3. Gums
                ii. Blood glucose monitors
                     1. Which to choose – human or veterinary (alpha-trak)
                iii. Blood Sampling
                     1. Curl pinna back over gauze
                     2. Warm in hands
                     3. Vaseline
                iv. First Week
                     1. Spot checks
                     2. No hypoglycemia
           c. Physical examination
               i. Resolution of clinical signs
                     1. PU/PD
                     2. Polyphagia
           d. Fructosamine
                i. Fructose + albumin
                ii. Average serum glucose for previous 2-3 weeks
                iii. R/O stress hyperglycemia
                iv. Stable diabetics
                v. Not appropriate for unstable diabetics
                vi. Somogyi effect