Diabetes Training. for Pet Owners. Supporting your practice every step of the way

Transcription

1 Diabetes Training for Pet Owners Supporting your practice every step of the way 72720_Canin_Nurse_Pres-2.indd 1 16/12/ :45

2 What is Diabetes Mellitus? Insulin is a natural hormone that lowers glucose levels in the blood Insulin is a natural hormone that controls the level of glucose (sugar) in the blood. Glucose is derived from the food your pet eats and is vital as it is the fuel that powers the body. When your pet eats, food is digested and glucose is released resulting in a rise in blood glucose levels. Insulin is released in response to this increased blood sugar. The role of insulin is to lower this blood sugar level and keep blood sugar within defined limits. Diabetes usually arises when not enough insulin is produced (or the body becomes resistant to insulin) Diabetes occurs when your pet either does not produce enough insulin or your pet s body cells become resistant to the action of insulin. Either way, glucose levels in the blood become very high and remain so. Diabetics have abnormally high blood glucose levels High blood glucose levels result in glucose leaking through the kidneys and being lost in the urine (normal animals do not have glucose in their urine). High blood glucose ultimately results in your pet drinking more, eating more, urinating more and losing weight High blood glucose causes an increase in urine production and your pet drinks more to replace the fluid lost in the urine. Also, because an important energy source is lost from the body, affected pets tend to lose weight, even though they often eat more than usual. Finally, there may be more general signs such as lethargy and a poor hair coat. Diabetes is confirmed by measuring high blood glucose, glucose in the urine and clinical signs Elevated blood glucose levels Glucose in the urine Clinical signs of drinking more, urinating more, losing weight and hunger 72720_Canin_Nurse_Pres-2.indd 2 16/12/ :45

3 Treating with Caninsulin Diabetes can be controlled with Caninsulin Just as in people, diabetes can be effectively controlled by the injection of insulin. We have prescribed your pet Caninsulin, which is specifically formulated to be used in both dogs and cats. Treatment should allow your pet to lead a happy and healthy life and help to avoid diabetic complications It typically takes a number of weeks and a number of dose changes before your pet s diabetes comes under control. The main aim of diabetic treatment is to restore a good quality of life, not just for your pet but you as well. We can do this by stopping the clinical signs of diabetes. By treating the condition, we can also reduce the risk of any diabetic complications arising. Giving injections may seem daunting initially but with practice it is very straightforward Insulin cannot be given orally and has to be given by injection. You may find giving injections daunting at first. However you will find with a little practice that it is a very straightforward process. We will take you step by step through the process of giving Caninsulin injections so you can get it right. Caninsulin must be stored correctly or it may not work Store the Caninsulin vial/vetpen cartridge upright before it is first broached. Ensure the Caninsulin vial/vetpen cartridge is in date. Do not shake, freeze or allow Caninsulin to overheat Insulin is delicate. Do not vigorously shake the Caninsulin vial/vetpen cartridge as this can damage the insulin. Unopened Caninsulin vials/vetpen cartridges must be kept between 2-8 O C so should be stored in your fridge. Caninsulin can be damaged if overheated, frozen or left in direct sunlight. Discard the bottle 4 weeks after you withdraw the first dose Once opened, a vial/vetpen cartridge of Caninsulin may be used for up to 28 days. Two vial sizes are available so that we can select the most economical option for your pet s needs. VetPen cartridges owing to their low volume avoid waste and are very economical for your pet s needs _Canin_Nurse_Pres-2.indd 3 16/12/ :45

4 Injecting Insulin with VetPen Loading a cartridge Remove pen lid, unscrew pen body from cartridge holder and check internal plunger is fully retracted Remove pen lid and unscrew pen body from cartridge holder. Check to ensure that the internal plunger is fully retracted. If the internal plunger is extended, rewind the internal plunger by holding the grey lower part of the pen body between the thumb and finger. Turn the pen body until the internal plunger is fully retracted. Mix insulin by gently turning cartridge up and down Prior to loading, the insulin cartridge should be turned up and down several times to ensure the insulin is mixed and appears uniformly milky. Do not use the cartridge if there are agglomerates in the insulin after mixing thoroughly. Load the cartridge and put cartridge holder and pen body firmly together Load the insulin cartridge into the cartridge holder by inserting the metal cap first. Screw the cartridge holder (containing the cartridge) and pen body firmly together. Attach the VetPen needle to VetPen and remove outer protective cap Peel the protective film from a new VetPen needle. Screw the VetPen needle straight onto the cartridge holder. Remove the outer protective needle cap from the pen needle. Replace the pen cap onto the insulin pen. Gently turn the pen up and down at least ten times. Prime VetPen It is important to prime VetPen before use to avoid the injection of air and to ensure a proper dose has been given. To prime VetPen, dial one unit on the dose selector and remove the needle cap. Hold the pen with the needle pointing up and tap the cartridge gently with your fingers a few times to push any air bubbles to the top of the cartridge. Expect to expel AT LEAST 8 units of air. These steps are repeated until a strong, steady stream or jet of insulin appears at the needle tip. Also check the cartridge is free of air bubbles by viewing the cartridge through the VetPen window and inverting or tilting the pen. The insulin pen is now ready for use _Canin_Nurse_Pres-2.indd 4 16/12/ :45

5 Injecting Insulin with VetPen Injecting your pet Ensure the arrow on the VetPen body points to the start line on the dose selector Make sure before injecting that the arrow points towards the start line on the dose selector. Dial up the number of units required as per your veterinary surgeon s direction. If you over-dial, never wind back the dose selector. Expel the insulin and draw up the correct dose Never attempt to forcefully dial back the dose selector as doing so may damage the insulin pen and result in inaccurate dosing. If at any time you over-dial the dose, we recommend that the incorrect dose is fully expelled into a safe place and the required dose is redialled. The injection should be given under the skin behind the shoulder blades The injection should be given under the skin, 2 to 5cm (3/4 to 2inches) from the middle of your pet s back, varying from behind the shoulder blades to the middle of the back region and alternating the sides. Insert the needle using the injection technique recommended by your veterinary surgeon then push the release button toward the pen needle and hold it in place until the start line on the dose selector returns to the arrow on the pen body. Count to a minimum of 5 seconds before removing the needle from the skin After the dose selector has returned to the start line, wait a minimum of 5 seconds. If the dose selector stops before the start line returns to the arrow this indicates that your pet has not received a full dose. If only a partial dose is administered, do not attempt to re-dose. Wait and give your pet its usual dose at the next injection. Remove the needle from VetPen and dispose of appropriately Remove the needle by inserting it in the removal device and unscrewing it. Press the blue tip on the device to release the needle. Always check that your pet s needle has been removed. Replace the pen cap onto the insulin pen. Dispose of used VetPen needles carefully in accordance with the advice give by your veterinary surgeon. Always remove the needle before replacing a cartridge Before changing the cartridge, always make sure that the VetPen needle has been removed to prevent accidental injury. Then unscrew the cartridge holder from the pen body and remove the cartridge _Canin_Nurse_Pres-2.indd 5 16/12/ :45

6 Injecting Insulin with VetPen Injecting your pet - Troubleshooting If the dose selector does not return to the start line, and no insulin has been expelled, this may indicate one of two possibilities The first is the needle on the VetPen is blocked. The second is the rubber bung in the cartridge is stuck and will have to be un-stuck. VetPen needle blocked The pen needle that you are using may be blocked. Remove the pen needle currently attached to the pen and replace it with a new needle. Un-sticking cartridge bung Replace the outer protective cap onto the needle. Unscrew the cartridge holder. Slide the release button toward the internal plunger and hold in place until the start line on the dose selector returns to the arrow on the body. Dial up 2 units on the dose selector without screwing the internal plunger back together and simply push and hold down the release button towards the internal plunger until the start line on the dose selector returns to the arrow on the body. Without rewinding the internal plunger, screw the cartridge holder and body firmly together. This will release the cartridge plunger and expel some of the insulin. However, the device will not be primed. Now prime the cartridge _Canin_Nurse_Pres-2.indd 6 16/12/ :45

7 Injecting Insulin using Caninsulin syringes Always use a new syringe When giving insulin, always use a fresh new Caninsulin 40IU/ml syringe each time. Never use other types of syringe. They are 100 IU calibrated and will result in the incorrect dose being given. Do not reuse needles. Gently mix the insulin and then draw up the required dose Take the Caninsulin vial from the fridge and gently invert the bottle several times to mix the insulin. Remove the protective cap from the needle and holding the bottle upside down, insert the needle into the bottle. Draw up into the syringe slightly more insulin than needed. The numbers on the syringe correspond to the number of units of insulin. Ensure you remove any air bubbles Expel any air bubbles by tapping the upright syringe with your finger and then gently press the plunger until the correct dose remains. Tent the skin at the injection site and gently push the needle through the skin Lift the skin of the scruff of the neck upwards and form a depression with your forefinger. Insert the injection needle at right angles gently through the skin in the depression you have formed Draw back on the syringe. If you see any blood, simply withdraw and reinsert the needle elsewhere Gently draw back the syringe plunger and if blood appears remove the needle from the skin and restart again with a fresh syringe (this will rarely happen). Administer the insulin by depressing the plunger Release your hold on the skin. Slowly depress the plunger to administer the insulin. Dispose of the used syringe appropriately Once administered, the used syringe needs to be disposed of. The protective cap should be replaced back onto the needle and the syringe should be placed into a sealed container or sharps bin. Our practice will dispose of these syringes for you _Canin_Nurse_Pres-2.indd 7 16/12/ :45

8 The Daily Routine A consistent routine is the key to successful diabetic management A healthy animal produces insulin on demand. In a diabetic animal, you have to supply the insulin yourself. Controlling your pet s diabetes depends on a consistent daily routine of Caninsulin injections, feeding, exercise and home monitoring. Insulin should be given at the same time(s) each day Caninsulin can be given once or twice daily (always twice daily in cats). It is important that Caninsulin is given at the same time(s) each day. It is also important not to change the dose of insulin unless instructed to do so by your vet. If you forget to give a dose of insulin, don t worry, simply administer the next dose as usual. If you are unsure whether you administered the dose properly, this is not a concern either. Simply wait until the next dose is due. Feed a consistent diet at the same times each day (no titbits) Diet should be fed at the same time each day. Typically food is given twice daily and given at the same time as the Caninsulin. It is important not to change the amount or type of food given without advice from the practice. It is also important not to give titbits or treats and to ensure that your family and friends are aware of this. Allow access to fresh water at all times Fresh water should always be available to your pet at all times. Exercise should be of consistent intensity each day Exercise is important for your pet s health and quality of life. It is vital to ensure the level of exercise is consistent from day to day. No over-strenuous exercise Diabetic stability relies on maintaining the balance between energy intake (food), energy use (exercise) and the required dose of insulin. Large changes in exercise intensity or duration from day to day will upset this balance and may cause diabetic instability. Bouts of strenuous exercise (such as a 12 mile hike at the weekend) are to be avoided _Canin_Nurse_Pres-2.indd 8 16/12/ :45

9 Keeping Records (what to monitor) Monitoring your pet s condition and advising the vet of any changes will help with diabetic control An important element of the management of diabetes is monitoring your pet s condition. This can be included as part of your daily routine. Your pet s insulin requirements may need to change with time. In order to spot this, you should look out for certain signs and consult your vet if you notice them. The specially designed Caninsulin diary will allow you to accurately monitor your pet. The diary will provide your vet with a record of your pet s progress. Water intake Excessive thirst is one of the signs of diabetes. A reduction in water intake should be noticeable in most animals as their diabetes comes under control. Measuring the amount your pet drinks each day is helpful and you should consult the vet if thirst increases again for more than a few days. Food intake It s vital that the correct ration is fed at the correct times as discussed with your vet. In some cases a special diet may be considered helpful in improving control of your pet s diabetes. Measure the amount of food your pet eats each day. Ideally you should weigh out your pet s daily food ration to ensure that it receives the correct amount. Avoid giving kitchen scraps and titbits as these do not help achieve a consistent diet. Consult the vet if your pet s appetite increases or decreases. Bodyweight If your pet is under or overweight at the time of diagnosis, then your vet will adjust your pet s feeding to try and restore a normal weight. Once normal, ideally weigh your pet regularly and notify your vet of changes, whether up or down. Weight loss may be a reason for concern that control may not be ideal, but it is also important to prevent your pet from being overweight because this can make control of diabetes harder. General demeanour If you pet appears unwell in any way, consult the vet as soon as possible _Canin_Nurse_Pres-2.indd 9 16/12/ :45

10 What to do if you suspect a hypo? May occur if overdosed or pet does not eat Hypoglycaemia often referred to as a hypo is when blood sugar levels fall too low. This may happen if too much insulin is given, your pet s insulin requirement has fallen, or if your pet is given its insulin but refuses to eat. In this situation the brain, which is very dependant on a supply of glucose, cannot get enough energy. May be life-threatening if untreated Signs to watch out for: Weakness, shivering, muscle twitching, unrest or lethargy, progressing to fits and unconsciousness. Treat quickly with a glucose/sugar solution and then feed as soon as safe to do so Give food immediately if your pet will eat. If your pet is not able to feed, syringe a glucose solution into the mouth and/or rub glucose powder on the gums and under the tongue (take care not to get bitten). If you do not have this available, you can use a concentrated solution of sugar mixed in water, or jam/honey. (When treating hypoglycaemia, aim to give 1 gram of sugar per kilogram bodyweight). Make sure you have this available at all times in case of an emergency. Glucose powder and solution are available from your local pharmacist. After treating, contact us A dose adjustment may be necessary to prevent recurrence _Canin_Nurse_Pres-2.indd 10 16/12/ :45

11 Summary Give Caninsulin injections at the same time(s) each day Most diabetic dogs and all cats require twice daily injection. It is vital to ensure the animal gets the same dose at the same time(s) each day. Do not change the dose without consulting us Changing the dose without advice can potentially result in diabetic instability and runs the risk of complications such as hypoglycaemia. Ensure food and exercise are consistent Because diabetic control is reliant on matching the insulin dose with food intake and activity levels, it is very important that all three remain as consistent as possible. Monitor eating, drinking, weight and demeanour Monitor and record these in the diabetic diary. This information is invaluable in controlling your pet s diabetes. Always ensure water is available to your pet A diabetic animal drinks excessive water to compensate for the disease. As we achieve better control of the disease, water consumption should drop. However, you should never deny your pet access to water. Contact us if you have any concerns Our practice is here for you and your pet. Do not hesitate to contact us if you need further advice or help regarding your diabetic pet _Canin_Nurse_Pres-2.indd 11 16/12/ :45

12 What is Diabetes Mellitus? Insulin is a natural hormone that lowers glucose (sugar) levels in the blood Diabetes usually arises when not enough insulin is produced (or the body becomes resistant to insulin) Diabetics have abnormally high blood glucose levels Diabetes results in your pet drinking more, eating more, urinating more and losing weight Diabetes is confirmed by measuring high blood glucose, glucose in the urine and clinical signs 72720_Canin_Nurse_Pres-2.indd 12 16/12/ :45

13 Treating with Caninsulin Diabetes can be controlled with Caninsulin Treatment should allow your pet to lead a happy and healthy life and help to avoid diabetic complications Giving injections may seem daunting initially but with practice it is very straightforward Caninsulin must be stored correctly or it may not work Do not vigorously shake, freeze or allow Caninsulin to overheat. Store out of direct sunlight Discard the vial 4 weeks after you withdraw the first dose 72720_Canin_Nurse_Pres-2.indd 13 16/12/ :45

14 Injecting Insulin with VetPen Loading a cartridge Remove pen lid, unscrew pen body from cartridge holder Check internal plunger is fully retracted Mix insulin by gently turning cartridge up and down Load the cartridge and put cartridge holder and pen body firmly together Attach the VetPen needle to VetPen and remove outer protective cap Prime VetPen Hold VetPen with needle facing up Dial 1 unit and release. Repeat this until a steady stream of insulin is seen coming from needle 72720_Canin_Nurse_Pres-2.indd 14 16/12/ :45

15 Injecting Insulin with VetPen Injecting your pet Ensure the arrow on the VetPen body points to the start line on the dose selector and then dial up the number of units your pet requires If you over-dial, never wind back the dose selector. Expel the insulin and draw up the correct dose The injection should be given under the skin behind the shoulder blades After dose selector has returned to the start line, wait a minimum of 5 seconds. After pressing the release button count to a minimum of 5 seconds, making sure that the dose selector has returned to the start line before removing the needle from the skin Remove the needle from VetPen and dispose of appropriately Always remove needle before replacing a cartridge 72720_Canin_Nurse_Pres-2.indd 15 16/12/ :45

16 Injecting Insulin with VetPen Injecting your pet - Troubleshooting If the dose selector does not return to the start line and no insulin is expelled, this may indicate two possibilities o o Blocked needle Cartridge plunger is stuck Remove needle, dispose and replace Un-sticking cartridge o o o o o o Replace needle cap and unscrew cartridge holder Slide release button to return dose selector to arrow Dial two units and push release button Without rewinding internal plunger, screw cartridge holder and body firmly together This will release the plunger and expel some insulin Now prime the cartridge 72720_Canin_Nurse_Pres-2.indd 16 16/12/ :45

17 Injecting Insulin with Caninsulin syringes Always use a new syringe. Only use 40 IU Caninsulin syringes. Gently mix the insulin and then draw up the required dose Ensure you remove any air bubbles Tent the skin at the injection site and gently push the needle through the skin Draw back on the syringe. If you see any blood, simply withdraw and reinsert the needle elsewhere Administer the insulin by depressing the plunger Dispose of the used syringe appropriately 72720_Canin_Nurse_Pres-2.indd 17 16/12/ :45

18 The Daily Routine A consistent routine is the key to successful diabetic management Insulin should be given at the same time(s) each day Feed a consistent diet at the same times each day (no titbits) Allow access to fresh water at all times Exercise should be of consistent intensity each day No over-strenuous exercise 72720_Canin_Nurse_Pres-2.indd 18 16/12/ :45

19 Keeping Records (what to monitor) Monitoring your pet s condition and advising the vet of any changes will help with diabetic control Water intake Food intake Body weight General demeanour 72720_Canin_Nurse_Pres-2.indd 19 16/12/ :45

20 What to do if you suspect a hypo? May occur if overdosed or pet does not eat May be life-threatening if untreated Signs to watch out for: Weakness, shivering, muscle twitching, unrest or lethargy, progressing to fits and unconsciousness Treat quickly with glucose/sugar solution and then feed as soon as safe to do so After treating, contact us 72720_Canin_Nurse_Pres-2.indd 20 16/12/ :46

21 Summary Give Caninsulin injections at the same time(s) each day Do not change the dose without consulting us Ensure food and exercise are consistent Monitor eating, drinking, weight and demeanour Always ensure water is available to your pet Contact us if you have any concerns Caninsulin contains 40iu/ml of highly purified porcine insulin. Legal category POM-V Further information is available from MSD Animal Health, Walton Manor, Walton, Milton Keynes MK7 7AJ 72720_Canin_Nurse_Pres-2.indd 21 16/12/ :46