Diabetes is a relatively common disease in older people and is being recognized more frequently in older pets. If untreated the disease has serious effects and can ultimately result in the death of your pet. The good news is that the majority of diabetic animals can now be treated. However, treatment options can vary between individual dogs, owners and budgets, so it’s important to work closely with your vet to find the best option for your pet, your household and your budget.

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Diabetes mellitus in dogs is a health condition where the body cannot properly control blood sugar levels. The most common reason a dog is diabetic is because their body isn't making enough insulin. Insulin is a hormone produced by the pancreas, that helps cells use sugar for energy. The pancreas is an organ that sits near a dog’s stomach and is also involved in digestion. Another reason a dog can be diabetic is because the body's cells aren't responding correctly to insulin that the pancreas produces, for example in the presence of conditions/medications that may interfere with its action.

Animals with diabetes have high blood sugar levels and lose sugar in their urine. Dogs with diabetes will drink much more water than usual and need to urinate more frequently. They may have accidents during the night or drink from places that are unusual for them - for example your drinking glass, licking the side of sinks or obsessively drinking from puddles. Many diabetic dogs lose weight despite having a good appetite. They may be less energetic than usual, sleeping more or becoming intolerant to exercise. If the condition is untreated, eye problems such as cataracts and organ damage including the kidneys or other illness may develop. If the early signs of diabetes are missed, more serious signs such as vomiting and depression may develop. If diabetes is left untreated for weeks or months your pet could go into a coma and it can be fatal.

When you bring your dog to the veterinarian with suspected diabetes, based on the clinical signs, they will perform several tests. It is likely that they will perform a blood test to check your dog's blood sugar levels. Blood tests may be taken from your dog’s jugular vein on their neck, or their cephalic vein. Sometimes, just a drop of blood is required and a skin prick test may be used – often from your dog’s ear, footpad or lip. Your veterinarian will also likely test your dog's urine for the presence of glucose and ketones (chemicals that indicate the body is breaking down fat for energy). They may recommend additional blood work to check your dog's overall health and to rule out other conditions.

Unfortunately, some dogs are just more likely to develop the disease than others. Middle-aged female dogs are most likely to get diabetes, and there are breed predilections, but any dog can be affected. Obese dogs are slightly more likely to develop the disease, but there are many obese dogs who do not develop diabetes. In females, the disease often starts within a month or two of a season or ‘heat’ due to the effects of hormonal changes. It is advisable to have all female dogs neutered if they are not going to have puppies, and most certainly if your dog already has diabetes, as the disease will be more easily controlled.

The main treatment for diabetes in dogs is insulin therapy, which usually involves giving insulin injections twice daily. Your veterinarian or veterinary technician will teach you how to give these injections properly and help you establish a consistent schedule. It is important that you are confident to give this medication at home, so do not hesitate to request additional lessons if required. Insulin generally needs to be kept in your fridge unless indicated, eg insulin in  an insulin pen. Your veterinarian will provide you with syringes and needles which are compatible with the brand of insulin your pet has. It is important to not change the type of needle or syringes without checking with your veterinarian. Your veterinarian will also provide a sharps bin for the needles and syringe. Dispose of any used needles and syringes in this bin and return it to your veterinary practice once it is full. Sometimes, instead of needles and syringes you will be provided with an insulin pen. It is important to “prime” and “load” these correctly, your veterinarian should provide training on this but often the manufacturer will also provide resources.  Along with insulin, managing your dog's diet is often recommended. Your veterinarian will recommend specific foods and feeding times that work best with the insulin schedule. Your veterinarian will also be able to advise you on giving treats. If your dog requires treats for training or for recall, your veterinarian may recommend some low sugar, low fat options. Weight loss can help control diabetes in some cases. If your dog presents very unwell, such as collapsed or with very unstable blood sugar, they may be admitted to hospital to stabilize their condition before returning home. During their lifetime treatment, there may be occasions where your pet may stay at the veterinary practice for 12-24 hours to monitor their blood glucose in response to their insulin, although with correct equipment and training, this can sometimes be done at home.

Caring for a diabetic dog requires dedication and routine. You'll need to give insulin injections at the same times each day, typically every 12 hours. Feeding should occur at consistent times, in relation with the insulin administration. It's important to ensure that this routine works for you and your dog so that it can be managed easily for the rest of your pet’s life. There are many resources to help you with your diabetic pet’s routine. If you work shifts, speak to your veterinary clinic about mobile veterinary technicians or trained pet sitters that can assist you when you aren’t home. Many owners also learn to test their dog's blood glucose levels at home using a small blood glucose meter or by using a portable device for continuous assessment of the glucose levels. Some dogs don’t have the temperament for home glucose monitoring or injections, you should discuss these concerns with your veterinarian.

Unfortunately not. Oral tablets of insulin are not effective in dogs. Whilst the majority of dogs tolerate daily injections well, not all will be amenable to this. If performing injections every day is going to make your dog (and you) very unhappy then it is worth considering euthanasia as a welfare friendly option. It is kinder to offer euthanasia than to let your pet become an unstable diabetic and suffer the unpleasant complications that this entails. Likewise, if family finances mean that committing to long term care is not realistic then it is important to discuss this with your vet and discuss options such as rehoming or euthanasia as welfare-friendly choices. Rehoming via a rescue centre, even with diabetes can also be an option, but this often depends on your dog's age. If you will physically struggle to perform injections due to your own physical limitations (arthritic hands can struggle with syringes, poor eyesight can be a real challenge when injecting etc) then please discuss this with your vet as they may be able to suggest ways to support you with this. Sometimes an insulin pen is easier to use than a needle and syringe, but it depends on your individual circumstances.

When sugar levels in the blood get very high the sugar starts to spill out into the urine. Urine samples from your dog will need to be tested regularly for the presence of sugar. The results from these samples will help your veterinarian to monitor your dog’s progress and ensure that the treatment is correct. This can also help looking for the presence of ketones, which are metabolic by-products which accumulate when diabetes is uncontrolled with risks of severe systemic signs. It may take many weeks (or even months) to find the correct combination of diet and insulin dose for your dog.

Your dog should be regularly monitored to make sure it doesn’t gain or lose weight. Regular check-ups are essential, typically every 3-4 months once the diabetes is well-controlled. These check ups will include blood tests and/or urine tests and therefore getting your dog used to having their head held up or sitting with one foreleg extended will help reduce their stress when visiting the vet practice.

There are two important complications which you must be aware of:

• Low blood sugar (hypoglycemia): symptoms develop rapidly with restlessness, confusion, tremors, twitches, convulsions or coma being the main signs. Always keep a source of sugar, such as glucogel or honey (xylitol/birch sugar free), available to rub on your dog's gums if hypoglycemia occurs. If your pet is still awake it may be offered food and should eat voluntarily. Contact your veterinarian immediately if these signs develop.
• High blood sugar (hyperglycemia): this usually develops more gradually and your pet may become unwell over a number of days. As the disease progresses your pet may go into a coma, although will not respond to sugar solutions. Contact your veterinarian immediately if your pet is unwell and be prepared to be called straight into the veterinary hospital.