• Educate yourself. You are responsible for the daily care of your pet.  Eventually you must have a thorough enough understanding of diabetes to be able to make some of the daily decisions on your own. You may not be able to contact your regular vet when a minor question arises and you must have the confidence to make a decision. 

• Don't become complacent. Diabetes can be a changing condition in your pet. Just because your pet is doing well for a few weeks or months doesn't mean something can't change.  Always be observant for signs of change.

• Don't panic.  Hypoglycemic episodes can be frightening, but you have to stay calm and think clearly so you can treat the hypo appropriately. Don't under-treat and don't over-treat and give your pet so much sugar or junk-food that the bgs are sky high for days. 

• You don't have to master everything all at once. For example, home bg testing can be stressful for the pet and/or owner. Take it slowly and give yourself and your pet a chance to adjust to all the new things you are learning. 

• Make changes one at a time. This may be a change to a new bottle of insulin (same type), a new type of insulin (eg. NPH to Lente), a new food, more exercise. Don't make lots of changes at once - unless advised to do so by your vet. 

• Have a plan for dealing with emergencies. This includes evening and weekends when your vet may be closed, emergencies when you and your pet are away from home, and disaster preparedness. Have a pet emergency medical kit and be able to add diabetes supplies to it quickly. Here's a page of questions you can ask your vet to help you prepare with common diabetes issues. 

You and your vet

• Develop a partnership with a good vet. 

• Don't lie to your vet. If you don't want to do what your vet advises, don't go home saying you will, then come back next week saying you followed the instructions and your pet still isn't better. This confuses diagnoses, treatment plans,  and can lead to more serious health problems for your pet. Discuss your concerns and agree on a treatment plan. 

• Following your instincts and don't be afraid to ask your vet questions. You know your pet and it's behaviors and if a vet gives you advice that seems wrong, ask questions and don't let your concerns be dismissed without adequate discussion or explanation. If you don't agree with your vet's advice, seek a second opinion. 

• Don't go it alone and don't assume you know more than you do. Diabetes is a complicated disease and even though you develop enough confidence in your abilities to make some of the day to day decisions, you must work with a vet to manage your pet's diabetes for the long-term. Your vet likely has a lot more veterinary knowledge and experience than you do.

Insulin, Hypoglycemia, and Sugar

• Keep a spare bottle of insulin on hand.  The bottles CAN break or go bad and you don't want to be without insulin. 

• Always double check the dose in the syringe before you inject. An overdose could be fatal. You can make a "guide" to double check how you filled the insulin syringe by making some ink marks on a piece of masking tape stuck on the counter. Then you can lay the syringe on the tape, line up the syringe properly, and match the mark on the tape with the position of the plunger in the syringe. This won't tell you the precise dose, but it might help prevent huge overdoses, for example filling the syringe to 17 units instead of to 12 units. 

• When we have a pet sitter, I take a red Sharpie pen and draw a line on the outside of every syringe at the exact spot they are to be filled with insulin. Then I show the person that the bottom of the plunger should line up exactly with that line and the insulin should fill the syringe to that mark. Read more tips about choosing and preparing a pet sitter.

• Start a new vial of insulin, new type, or new dose on a day when you're home to observe your pet. The new bottle of insulin might be slightly stronger than the old one - especially if you used your old bottle for several months. And an increased dose requires observation for signs of hypoglycemia.

• Never, never, never leave home without sugar. This means when you're out on walks, going to the store, groomer, vet, anywhere. Some people keep packets of honey or a small plastic bottle of corn syrup ("Karo") in their purse or in the glove box of the car. You can also purchase liquid glucose packets at the pharmacy. It's better to have a liquid sugar, but even little packets of table sugar would work. In an emergency, you don't want to spend valuable time trying to find some sugar.  Read how other owners have carried their emergency sugar supply.

• Learn your pet's normal behaviors. Abnormal behaviors, even the slightest ones, should make you ask "could this be hypoglycemia?"  If you are not home bg testing, assume hypoglycemia and treat accordingly. Many pets do not show any physical signs of hypoglycemia (low blood sugar). This is called asymptomatic hypoglycemia. Suspect hypoglycemia whenever your pet is not acting normally.  Read some personal experiences.

• Develop a daily routine and stick to it. If you get distracted while preparing the injection, start over. Throwing away a syringe and a bit of insulin is much better than giving an incorrect dose.

• Devise a way to tell if you've given the injection. This might be to give the injection, then record it in your daily care notebook.

• If you can't remember if you gave the injection, don't give another one. You may double-dose your pet.

• Ask your vet what to do in case you give a partial injection.  It's probably best to NOT try to give another injection with the remainder of the dose because you probably don't know how much actually got into your pet.  

• You will miss an injection. Really, you will, and it won't be the end of the world. You might forget, you might be sick one day and oversleep through the morning injection, or you might have to work late or attend a function one evening and can't get home for the evening injection. If you can arrange for someone to come check on your pet or give a shot, great. Just use common sense, and if you have any questions, ask your vet. 

• If you are home bg testing and get a very high or very low number, try to retest.  The number may be incorrect due to miscalibration, too small blood drop, or some other reason. 

• Be flexible. Diabetes is a long-term disease and it is important for the owner to be flexible so that they don't stress themselves, or stress their pet.  The owner also has to have a happy, normal life.  Or you might not be able to give the injections at exactly 12 hour intervals. Check with your vet and discuss what kind of flexibility you have in your pet's routine. Maybe it's okay to give a shot and feed at 7am, and then give the evening shot and food at 5pm.  

Multi-pet or multi-caregiver homes

• Give the insulin to the diabetic pet.  This sounds obvious, but if you have a multi-pet home, you must pay attention to what you're doing. Yes, it has happened....the non-diabetic pet got the insulin injection. If you make this mistake, call your vet immediately for advice. You may be advised to give corn syrup (Karo) and food, or you may be advised to bring your pet in for observation. 

• Give the proper insulin and the correct dose to the right pet.  Again, this sounds obvious, but there are owners who have more than one diabetic pet, and the pets are likely getting different doses or even different types of insulin. Pay attention to what you're doing, develop a routine, and double-check yourself. If you make a mistake, call your vet immediately for advice.

• A tip for the multi-pet home: it might help you to put a certain color collar on your diabetic pet. Then when you give the injection, you can always double check the collar to be sure you have the right pet. 

• Eliminate miscommunication in a multi-person household.  If there are two or more caregivers, you must develop a system for communicating who has done what - insulin, feeding, exercise.  It is too easy for both caregivers to give an insulin injection and accidentally double-dose your pet.

Daily Recordkeeping

• Keep a daily journal. Record the amount of insulin, shot time, bg levels (if you are home bg testing), exercise schedule, eating habits, drinking habits, pee habits, behavioral observations, and unusual events (for example vomiting or diarrhea) is very useful. You can decide what type of notes to keep on your pet. A journal will help you keep track of your pet's history, progress, and you can take it to the vet and have all the information in one place.  We found the journal especially useful when Barney was sick.  For example, each time he didn't eat or vomited, I would note it in the journal. I could then call the vet and say "Barney didn't eat much on Monday, and he vomited 4 times on Tuesday and twice Wednesday evening." It helped us keep very detailed notes on what was happening and try to figure out what was causing the problems.  We used a spiral bound notebook type calendar, or just a plain notebook would work well too. There are several notebook templates here.

• Keep a chart of how frequently and how much your pet urinates. Some owners keep a daily chart of the number of times their pet peed throughout the day.  If you take your pet outside to pee, or if you have only one cat using the litter box and you can check the box at certain times, you can even keep track of morning, mid-day, evening, and overnight pees.  For dogs, you can count the numbers of seconds it took them to pee. For cats using a clumping litter, you can note if the clumps were small, normal or large. Some pets are very tolerant and will let you slip a cup under them when they pee. I took a 1/4 cup measuring cup and would slide it under Barney just as he started to pee. I could get a very good estimate of his urine volume. You can't do this every time your pet pees, but it can be done occasionally.

• Weigh your pet's food with a food scale or use a measuring cup to determine how much your pet did or didn't eat.

• Mark your pet's water bowl like a measuring cup.  Make the top mark 0 and each mark farther down into the dish in some practical increment.  For example, marks for a dog might be in 1/4 or 1/2 cup increments, while marks for a cat might be in 1 ounce increments. Fill the bowl to the '0' line every time you refill it, and make a note of how much your pet drank. Over a period of a few weeks it will become clear what is 'typical', and then any change from typical is a sign that something may have changed and it might be time to have your pet's regulation checked. 

Be realistic

• Be realistic with your pet's care. Your pet needs a normal life too. As a diabetic, your pet has to put up with a lot of needle sticks, bg testing, vet trips, special diet, and maybe a special exercise routine.  So it's important to let them do things that are fun and healthy for them, and for them to have a little adventure once in a while. An occasional healthy treat, a small lick of ice cream or a mouse-catching adventure through the back yard is not the end of the world. Their psychological health is just as important as their physical health. 

Updated May 2004
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