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Linda Fleeman BVSc PhD MANZCVS; Animal Diabetes Australia, Melbourne, VIC, Australia
Feeding consistent meals at fixed times each day is the standard approach for successful management of diabetes in dogs. However, this does not mean that a “one size, fits all” approach is required. Instead, clinicians must be prepared to be flexible, offer options, tailor recommendations to the individual diabetic dog’s and owner’s preferences, re-evaluate and adjust as required. Assessment of compliance with feeding recommendations is as important as checking for compliance with insulin treatment.
Timing of meals and diet choice
When a twice-daily insulin dosing regimen is used, it is usually practical and effective to feed the dog immediately following each insulin injection so that the dog is ‘rewarded’ for compliance with injections. Every meal should contain the same ingredients and calorie content. Most diabetic dogs will readily eat twice-daily if meals are highly palatable, contain half their daily caloric requirement, and are similar to that fed before diagnosis of diabetes. A practical approach is to obtain a diet history and then negotiate an agreement with the owner on a set meal to be fed every 12 hours. If treats or dental chews are fed, they should also be consistent and fed following insulin injections. For finicky eaters, the meal should be fed after insulin administration and remain available until the expected end of the period of maximal insulin activity (approximately 4 hours for lente and NPH insulin).
Strategies to avoid hypoglycaemia
Owner compliance for feeding consistent meals at fixed times each day should be strongly encouraged to reduce the risk of hypoglycaemia and/or poor diabetic control. If mild clinical signs of hypoglycaemia are observed such as weakness, restlessness, pacing, and trembling, the owner should feed a meal of the dog’s usual food. Hand-feeding might be necessary to encourage the dog to eat. If the dog is unwilling or unable to eat, syrup containing a high glucose concentration can be administered orally. When the dog recovers, a meal of the dog’s usual food should be fed immediately, and then the owner should contact their veterinarian before the next insulin injection is due, at which point reduction of the insulin dose is usually recommended. As a general rule, half the usual dose of insulin should be administered whenever a diabetic dog is fasted and must miss a meal. Owners should seek prompt veterinary advice whenever a diabetic dog shows inappetence or anorexia because any concurrent illness in diabetic patients that causes inappetence or anorexia can be rapidly complicated by dehydration, depression, and ketosis. Withholding insulin because of the potential risk of hypoglycemia might result in further clinical deterioration when there is concurrent illness.
Resolution of polyphagia
Although concurrent illness is a potential cause of unreliable appetite in diabetic dogs, a scenario that perhaps is more common is reduced appetite associated with decreased calorie requirement and resolution of polyphagia when diabetic control improves. Diabetes often has an insidious onset and owners may become accustomed to increased appetite prior to the diagnosis and start of treatment. There is typically strong desire to comply with the recommendation to match insulin injections with standardised meals and therefore potential for owners to experience great anxiety if their dog does not eat all the food offered. It can be helpful to assess the dog’s body weight and body condition, review caloric intake and palatability of the meal, and to check for presence/absence of gastrointestinal signs. It is important to note the quantity of food consumed at each meal so that the meal size can be adjusted to suit the individual’s requirements. It might take up to 3 weeks to establish a practical revised feeding routine, but once established, diabetes management will become simpler and more successful.
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