Where a cat or dog is presented in a ketoacidotic state, it is essential to correct the fluid and metabolic imbalance before stabilisation is undertaken. Fluid and electrolyte therapy is necessary and continual assessment of blood chemistry is recommended. At this point the hyperglycaemia may be left until the animal is eating again, but if insulin therapy is to be commenced, continuous low dose intravenous infusion of Insuvet Neutral is advised at a dose of 5 iu per 100 ml of electrolyte, administered at 50–100 ml electrolyte per hour for dogs, and 50 ml per hour for cats. In the rare case of a ketoacidotic cat or dog with hyperosmolarity, rehydration, electrolyte and insulin therapy are all paramount.

Where the cat or dog is presented in a non-ketoacidotic hyperglycaemic state, stabilisation can be undertaken immediately. Depending on the degree of hyperglycaemia this may be accomplished by initiating therapy with Insuvet Lente or Insuvet Protamine Zinc, using a commencing dose of 0.5 iu/kg administered subcutaneously. Blood glucose must be monitored closely to establish the effect of the insulin dose.

An isocaloric daily ration to maintain a healthy weight should be established. A portion of the daily ration (normally between 1/3 and ½ for cats, and between ¼ and 1/3 for dogs) is fed within the hour before dosing with insulin. This applies whether the animal is dosed once daily, or in cases where twice daily dosing is required. The remaining portion should be offered at the estimated maximum hypoglycaemic state if dosing once a day, and at a similar time after the second dose if dosing twice a day. Once glucose levels have been established the insulin dose and feeding regime may be adjusted accordingly. Whenever the type of insulin, dose or feeding regime is altered, close monitoring of blood glucose should be undertaken.

Once stabilised, animals may go home but it should be borne in mind that the insulin dose may need adjustment at this time and close monitoring initially is recommended.

When adjusting doses of insulin it is recommended that the maximum change made, either increase or decrease, is 2 iu daily. It is important to realise that the full effects of an initial dose or dose change may not be seen until up to 3 days afterwards. Blood glucose should be monitored when changing doses and this possible 3 days delay should be considered before making further changes.