More often than not, a diabetic can seem difficult to regulate for reasons having little to do with the patient itself, such as damaged insulin (shaken too vigorously or not refrigerated) or inconsistent or incorrect use of the proper syringe for the insulin and dose used. Nevertheless, there are several important conditions which a patient may have concurrent with their diabetes which may cause insulin resistance. Below is a checklist of reasons why a patient may not respond as expected to a particular insulin dose. We assess this list thoroughly before making recommendations to change insulin types, doses or frequency of administration.

• Is the insulin stored and handled properly? It may be prudent to open a fresh vial of insulin before making hasty judgments about the efficacy of a particular dose or insulin type.
  
  
• Are the syringes used appropriate for the insulin concentration and dose?
  
  
• Is the insulin being administered properly? A demonstration in front of your veterinarian of how you administer the insulin may reveal unanticipated technical problems which can easily be corrected.
  
  
• Has the diet been adjusted to provide more complex carbohydrates and fiber and less simple sugars? Science Diet by Hills makes a canned and dry formulation of W/D which helps to reduce the insulin dose required to manage many diabetics. Other pet food manufactureres, such as IAMS and Purina, also have high fiber formulations available. 
  
  
• Is the insulin selected the optimum choice given the source species and duration of activity?
  
  
• Is the duration of insulin activity too short given the frequency of administration?
  
  
• Is there evidence of Somogyi?
  
  
• Are there concurrent illnesses which may have caused increased resistance to the effects of the insulin? Simple bladder infections may cause an otherwise regulated diabetic to respond poorly to insulin. Other more serious conditions, such as a uterine infections or pregnancy may require spaying before the diabetes can become regulated. Other endocrine disorders, such as Cushing’s disease (an excess in cortisol production) render diabetes nearly impossible to regulate until the cortisol levels are controlled.

It is important to address changes in appetite, mentation, drinking and urinating patterns when they arise. Dysregulation of a previously regulated patient may be a sentinel for a more life-threatening condition. Furthermore, prolonged loss of control itself may become life-threatening if ketoacidosis results.

Return to Diabetes Mellitus Main Page