Richard Goldstein, DVM, DACVIM, and Ruth MacPete, DVM, outline educating and training pet owners on home monitoring of diabetes and the value monitoring has in giving the feeling of control back to the owners.
Richard Goldstein, DVM, DACVIM: Britney, we’re going to get to you in just a minute because I have a feeling you’re going to get that call: “Do I really have to do this? What do I actually do?” But we’ll get to that in just a minute. Walk me through this Doctor, how does it actually work in your hospital? I’m the client and it’s day 4, 7, or 10, and we’re about to start. Do I get the monitor from you? How do you teach me how to do it? Who teaches me how to do it? How does it work? Do I get it at a drugstore? What do we do?
Ruth MacPete, DVM: We talk to people about home monitoring and the importance of it. Like I said, there are 3 advantages. And then I talk to them about how veterinarians can get you a home- monitoring glucose kit.
Richard Goldstein, DVM, DACVIM: Which is better than me going to get it at the pharmacy.
Ruth MacPete, DVM: Absolutely. Specifically—and this is why your veterinarian should be involved in the decision—it’s important that you make sure you’re using a glucose meter that is specifically designed and calibrated for pets. That’s because they’re more accurate. When using a human glucometer that you can get at a drugstore, those are not calibrated for pets and they can be inaccurate. It’s very important that you’re using the right tool to begin with, and your veterinarian will help you, tell you where to get it, or sell it to you. So, they’re going to help you with that.
I talk to people because, like the insulin injections—and I know Brittney knows this—people are afraid and ask, “What do you mean, I’m going to take blood from my pet?” I explain to them that it’s a lot easier than it sounds. Pets are really brave, they’re much braver than people, and we’re getting a really tiny sample. We’re getting just a drop of blood, just like a person who does that on themselves. We explain to them where we take it. I go through it and then I have my team follow up and go in and show them. It’s a lot to process, and sometimes they’re more comfortable talking to the veterinary technician and asking them other questions. They need to process it. So, I explain that to them. I think with most people, when they understand it, it gives them a lot of power and ability to be part of the team so that they understand we’re co-managing this pet’s diabetes. We’re working together as a veterinary team with the pet parent.
Richard Goldstein, DVM, DACVIM: Azi, you said you do it once a month typically.
Azi Chegini: Now, yes.
Richard Goldstein, DVM, DACVIM: When things are good and calm, is that the recommendation you give to people? What do you tell them? Eventually, you’re going to be doing this once a month.
Ruth MacPete, DVM: Yes, eventually it may be less frequent. In the beginning, it’s more frequent. They may be checking their pet weekly, and then it may be every month. I let them know that it’s a tool they have to do spot glucose checks. If for some reason they think their pet’s a little off, if their pet has been eating as well, or if they’re concerned about anything, they have this as a tool that they can use any time to check. Sometimes people, if their pet doesn’t eat in the morning or if they think their pet’s a little off, can do a little spot check and call me and let me know what they’re getting.
Richard Goldstein, DVM, DACVIM: That’s very important. You mentioned the word “ketone” before. To me, one of the most amazing and gratifying experiences is when they call you and say, “My dog vomited twice today, my dog didn’t eat breakfast, but I checked the urine and there are no ketones” or “I checked the urine and there are ketones.” That completely changes how we approach that situation. So, talk about these ketones.
Ruth MacPete, DVM: Ketones are something we don’t want to see in urine because they’re an indication that a pet may have a condition called diabetic ketoacidosis, which is an emergency. When a pet has that, they need to be hospitalized. They’re put on IV fluid and are treated with intensive insulin therapy until we stabilize them. It is a critical thing. It happens because their blood sugar is very high and it’s usually more of a chronic condition, so it doesn’t happen right away. But it usually happens with an animal that has chronic uncontrolled diabetes.
Richard Goldstein, DVM, DACVIM: There may even be something else wrong with him—inflammation of the pancreas, urinary tract infections, or something else that’s happening—to put them in a bad metabolic state.
Ruth MacPete, DVM: Yes, absolutely. But it’s a serious condition so we want people to know that if they see ketones, we need to know about it right away and the pet’s going to be hospitalized. That’s one of the things that we’re having people look for when they check urine.
Richard Goldstein, DVM, DACVIM: This is a gift because if I get a call at 9 o’clock in the morning and they say, “My dog didn’t quite eat right today but no ketones,” I will probably say, “All right, let’s see how he is when you get home from work.” If they say, “My dog didn’t quite eat right today, plus there are ketones on that little urine strip,” I tell them to come in right away. You have to, there’s no choice. He might not be there when you get home. So, that’s really very important.