INSULINS
NPH (Brand Names: Humulin/Novolin/Reli-on/Protaphane)

Starting Dosage:
 *Usually calculated at ¼ unit per pound and given twice a day
 *Larger dogs need  closer to ½ unit per pound
Example: 40 lb dog = 10 units given 2 times a day (12 hrs apart & after feeding)
Storage:
 * Unopened vials should be kept in the refrigerator (always look at expiration date)
 * Opened vials maybe kept at room temperature out of sunlight (effectiveness varies but normally replace with
fresh vial after 28 days)
Syringes Recommended:
 *Ultra thin 31 gauge 1/2 cc 5/16” short needle
 *Can be purchased on-line without a prescription at http://www.hocks.com

VETSULIN (Caninsulin)

Starting dosage:
 *Vetsulin dosage varies based on the weight range of the pet and whether the pet receives one or two shots per day.

Dog 
INITIAL RECOMMENDED VETSULIN DOSE IS 1 UNIT INSULIN PER KG  OF BODY WEIGHT, 
There are 2.2 pounds per kg so this means one unit of insulin for every 2.2 pounds of body weight.
Divide your dog's weight in pounds by 2.2 to determine his weight in kg.
example: Queenie weighed 22 lbs. or 10 kg (22 lbs. divided by 2.2 is 10 kg.)
PLUS A BODY-WEIGHT-DEPENDENT DOSE SUPPLEMENT, AS SHOWN IN THE FOLLOWING TABLE.

Body Weight	Dose Supplement
less then 10 kg or 22 lbs	one unit
10 to 11 kg or 22 to 24 lbs	two units
12 to 20 kg or 25 to 44 lbs	three units
over 20 kg or 45 lbs	four units

Some Examples of Starting Doses for ONE shot of insulin per day for dogs prescribed vetsulin.
Remember your veterinarian might have a reason for giving less or more then the recommended starting dose.

Body Weight	1 unit per kg or 2.2 lbs	plus dose supplement	Total Starting Dose
4 kg or 8.8 lbs	4 units	1 unit	5 units
5 kg or 11 lbs	5 units	1 unit	6 units
6 kg or 13.2 lbs	6 units	1 unit	7 units
7 kg or 15.4 lbs	7 units	1 unit	8 units
8 kg or 17.6 lbs	8 units	1 unit	9 units
9 kg or 19.8 lbs	9 units	1 unit	10 units
10 kg or 22 lbs	10 units	2 units	12 units
11 kg or 24.2 lbs	11 units	2 units	13 units
12 kg or 26.4 lbs	12 units	3 units	15 units
13 kg or 28.6 lbs	13 units	3 units	16 units
14 kg or 30.8 units	14 units	3 units	17 units
15 kg or 33 lbs	15 units	3 units	18 units
20 kg or 44 lbs	20 units	3 units	24 units
21 kg or 46.2 lbs	21 units	4 units	25 units

Twice-daily therapy should be initiated if the duration of insulin action is determined to be inadequate. If twice-daily treatment is initiated, the two doses should be 25 percent less than the once-daily dose required to attain an acceptable nadir.

Example to determine twice be day dose:
If your dog's once per day starting dose is 5 units
then you reduce this dose by 25 percent (5 divided by 4 equals 1.25)
5 units minus 1.25 units equals 3.75 units 
and you would give this twice a day twelve hours between each shot.

Storage:
* Opened and Unopened vials should be kept in the refrigerator (always look at expiration date)
* Opened vials should normally be replaced with fresh vial after 28 days)

Syringes Recommended:
* U-40 syringes
* Can be purchased at your veterinarian's office or on-line without a prescription at http://hocks.com

PZI and Lantus (insulin for felines both have about the same action)
Starting Dosage:
* 0.25 units per pound twice a day for BG numbers 360 or greater and 0.10 Units per puund for BGs less than 360.
Example:
For a 10 pound cat 2.50 units twice daily for blood glucose greater than 360
For a 15 pound cat 3.75unit twices daily for blood glucose greater than 360
For a 15 pound cat 1.50 units twice daily for blood glucose less than 360
For a 10 pound cat 1.00 unit twice daily for blood glucose less than 360
Storage:
* PZI and Lantus should be kept in the refrigerator (always look at expiration date)
* Opened vials of PZI have a shelf life of 30-90 days and Lantus 30 days. 
  (home testing will help you best determine effectiveness)
Syringes Recommended:
* U-40 syringes for PZI and U100 syringes for Lantus
* PZI syringes can be purchased on-line without a prescription at http://hocks.com *Lantus need a prescription.

How Much Insulin to give if Pet Not Eating
NPH or Vetsulin users
*  No food eaten at all then give 1/3 dose of the insulin
*  1/2 of meal eaten thengive 1/2 dose of the insulin
*  3/4 of meal eaten then give 3/4 dose of the insulin

PZI  or Lantus users
* Per PZI Vet if your cat hasn’t eaten in 12-24 hrs, do not administer any insulin and contact your vet!

Diet/Nutrition:
NPH users should look for low- fat / high protein diets (either home-cooked or commercial)
Vetsulin Users should have diets with additional carbs because of peaking action
PZI /Lantus Users should benefit from high protein diets
*Our web-site list has a section devoted to nutrition/calories/etc

Recommended Treats:
* Because your pet now has diabetes does not mean they can’t have treats anymore. There are many suggestions on our web site and you have easy links to go to on the web-site reference sheet you were sent if you are a member of our email group.
* Quick suggestions would be: frozen green beans, bits of skinless chicken, small amounts of cooked chicken livers, pure pumpkin (unsweetened!).
*Our web-site list has a section devoted to nutrition/calories/etc

Reactions to look for:
Too much insulin (Hypoglycemia/ “hypo”)
Symptoms:
* Lethargy/weakness
* Head tilting
* Restlessness
* Hunger
* Shivering
* Convulsions or seizures
* Coma
* Glassy eyes
What to do with mild /moderate cases of hypoglycemia
* Rub corn syrup (Karo syrup) on gums
* Mix corn syrup in food if pet will eat
* Watch pet for several hours to make sure a hypo does not re-appear
* Insulin should be reduced by 25% and monitored until an accurate insulin dosage can be made.
* Contact your veterinarian.
What to do with severe cases of hypoglycemia
* Administer corn syrup on gums immediately
* Do not put liquid directly in pet’s mouth (possibly causing choking) & don’t put fingers inside the pet’s teeth if seizing)
* Call your vet immediately
Too much insulin (Somogyi / “rebound”)
Symptoms:
* With urine testing the morning test is persistently “high”
* The morning urine test is “high”, the afternoon test is “negative and the evening test is again “high”
* With blood testing when you get bg levels below 65 followed by 330 within 24 hrs.
* Very strange, inconsistent blood curve results
What to do when rebound is suspected
* Decrease insulin dose (usually 25% reduction per shot recommended)
* Stay on lowered dosage for 2-3 days monitoring results

Ketoacidosis (DKA)
Symptoms:
* Weight loss
* Loss of appetite
* Thirst
* Frequent urination
* High levels of ketones in urine (you can test this with keto-diastix)
* High blood-sugar levels
* Acetone odor/fruit sweet smell
* Hard time paying attention
* Confusion
What to do when DKA is suspected
* Your pet should immediately see your veterinarian.
* Depending on the severity of the DKA your vet’s treatment may include using a short-acting crystalline insulin, as fluids need to be replaced an intravenous fluid maybe used; an adjustment in insulin dosage will likely happen.
What you can do to prevent DKA
* There is no specific method for preventing DKA but careful monitoring is important
* Urine testing gives a pet owner the ability to catch the onset in the beginning
* Finding a diet that eliminates high fat foods
* Be especially watchful if a steroid is used as a treatment for your pet

Finally:
Print this article out and take it to your veterinarian.

Read the webpages found at:
 www.petdiabetes.com
 www.caninediabetes.org

Join an email list for owners of diabetic pets so that you can receive support from others in the same situation.
How to join an email list
 http://www.caninediabetes.org/maillists.html