ACVC 2019: The diabetes diagnosis: Keep (clients) calm and carry on
Clients who are well informed about this disease can offer their diabetic pet a very good chance at a long and happy life. Thats where the veterinary team comes in.
Up to one in 400 cats and one in 500 dogs have diabetes mellitus (DM), according to Rachel V. Poulin, RVT, VTS (SAIM), director of operations (Midwest) at AmeriVet Veterinary Partners. What's more, Banfield Pet Hospital noted in its 2016 State of Pet Health report that the incidence of DM in dogs and cats increased by 18% and 80%, respectively, between 2006 and 2016.
Diabetes can be an overwhelming diagnosis for most pet owners due to the integral role they must play in meeting and maintaining their diabetic pet's daily health needs. In fact, Poulin says that many clients are not even aware that their pets can develop DM. It may come as no surprise, then, that an alarming 10% to 40% of pets are euthanized soon after diagnosis.1,2
At the 2019 Atlantic Coast Veterinary Conference, Poulin outlined the many details veterinary teams need to share with pet owners about this disease, including potential complications and warning signs of potential emergencies.
There are various complications that both dogs and cats may develop once diagnosed with diabetes, Poulin explained, including the following:
Cataracts: About 80% of dogs will develop cataracts within 16 months of a DM diagnosis.
Diabetic neuropathy: Ten percent of cats with chronic hyperglycemia will develop neuropathy, which in some cases may be resolved with good diabetic control.
Weak immune system: DM makes fighting infections challenging, which may lead to skin infections and urinary tract infections.
Decreased healing potential: DM reduces the body's ability to heal, which can prolong and complicate recovery time if the patient sustains an injury.
Diabetes red flags
Make sure clients are aware of these “red flags” with their diabetic pet.
Lack of appetite. Dogs and cats whose diabetes is well controlled typically do not skip meals, so appetite changes in these patients should not be taken lightly. Many factors can dysregulate a stable diabetic, including infection, stress and inflammation, among others. A decreased appetite may require an adjustment in the amount of insulin required, but clients should be instructed never to adjust the insulin dose on their own; instead they should call their veterinarian. If the appetite does not return over a 24-hour period, an appointment should be scheduled to investigate the cause.
Polydypsia, polyphagia, polyuria and polydipsia. These usually signal that blood glucose levels are high and there is a lack of diabetic control.
Ataxia and seizures. These are usually signs of low blood sugar, and affected pets should be brought to the hospital right away. Karo or maple syrup can be placed on the animal's gums to deliver sugar quickly as a short-term solution, but this will not last long and does not negate the need to bring the patient to the clinic right away.
Inappropriate urination. This can be a sign of hyperglycemia secondary to diabetes, but it can also signal a urinary tract infection, which is common among diabetic patients. Infection can be ruled out with a urinalysis and urine culture.
Vomiting and diarrhea. Vomiting and/or diarrhea in a diabetic pet can be as simple as an isolated upset stomach, or it could indicate the beginning of a crisis. To determine the seriousness of the situation and avoid a potential crisis, the client should call the clinic right away to help triage the situation.
Elevated blood glucose. If daily blood glucose readings are trending higher the client should be aware that changing the insulin levels without the direction of a veterinarian is very dangerous. Instead, a 12-hour blood glucose curve may be appropriate, as well as a fructosamine level. Therefore, discuss the importance of a re-evaluation with the client so that the veterinary team is staying on top of diabetic control.
Ketones. The detection of ketones at any time is a potential emergency. Clients should inform the clinic right away if ketones are detected in urine. What action is taken will depend on clinical signs and blood glucose readings.
The nurse's role
As noted earlier, veterinary nurses should take an active role educating their clients about diabetes and preparing them with a solid understanding of all that is involved both physically and financially in caring for their diabetic pet. She also recommended providing clients with take-home materials that make recommendations about nutrition.
“If we're not giving them the resources, they will run elsewhere,” she said, "and getting information from your veterinary practice is infinitely better than getting it from Dr. Google."
1. Niessen SJM, Hazuchove K, Powney SL, et al. The Big Pet Diabetes Survey: Perceived frequency and triggers for euthanasia. Vet Sci 2017;4(2):27.
2. Fall T, Hamlin HH, Hedhammar A, et al. Diabetes mellitus in a population of 180,000 insured dogs: incidence, survival, and breed distribution. J Vet Intern Med 2007;21:1209-1216.