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===Management===
===Management===
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The non-ketotic diabetic animal can be managed as an outpatient and a great deal of the monitoring and treatment of the disease will then devolve upon the owner. In dogs, almost all cases of diabetes mellitus are insulin-dependent and insulin is therefore a necessary part of the management regime. Since many cats suffer from non-insulin dependent diabetes mellitus, they can often be managed with a change in diet and oral hypoglycaemic drugs.
The non-ketotic diabetic animal can be managed as an outpatient and a great deal of the monitoring and treatment of the disease will then devolve upon the owner. In dogs, almost all cases of diabetes mellitus are insulin-dependent and insulin is therefore a necessary part of the management regime. Since many cats suffer from non-insulin dependent diabetes mellitus, they can often be managed with a change in diet and oral hypoglycaemic drugs.
====Insulin====
====Diet====
====Hypoglycaemic Drugs====
===Instability===
Animals that have previosuly been stabilised may suffer bouts of overt diabetes mellitus and even deteriotrate into DKA.
====Causes of Instability====
There are many documented reasons for this instability, of which the most common are problems with:
*'''Storage and use of insulin''' - Insulin should be stored in a fridge and should only be retained as long as is stated on its 'use by' date. The insulin should not be shaken vigorously before use and it should be kept out of sunlight. If it is to be given by infusion, the giving set should be generously run through as the insulin molecules will adsorb to the plastic of the set.
*'''Administration of insulin''' - The insulin should be drawn up into a suitable insulin syringe and injected intramuscularly. Subcutaneous injection will result in variable pharmacokinetics.
*'''Response to insulin''' - Some animals will show signs of marked hypoglycaemia after administration of insulin but then begin to show signs of polyuria/polydipsia. If the dose is too great for the animal, antagonistic hormones will be released that will result in a rebound hyperglycaemia after a period of hypoglycaemia, a phenomenon called a '''Somogyi overswing'''. This is remedied by reducing the dose of insulin given to prevent the release of antagonistic hormones.
*'''Rapid metabolism of insulin''' - Some animals metabolise insulin faster than others and begin to show signs of diabetes mellitus before their next dose is due. If insulin is given in the morning, glycosuria will often be detected in a morning urine sample. This is managed by increasing the insulin dosage or, preferably, giving two doses of insulin twelve hours apart.
*'''Insulin resistance''' - Failure to respond to insulin may occur due to an immune response to the recombinant drug or because of some underlying disease that results in the production of factors antagonistic to insulin. If an immune response is suspected, porcine insulin should be used in preference to bovine as it is homologous to the canine molecule. Disease that cause insulin resistance are listed above but the most common causes of instability are infections (particularly cystitis or skin infections), dioestrus, pregnancy or stress. Infections should be treated and female animals should be neutered after they have been stabilised.
====Investigation of Instability====
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==Prognosis==
==Prognosis==
==References==
==References==