Home Monitoring of Diabetes in Pets
Richard Goldstein, DVM, DACVIM, and Ruth MacPete, DVM, discuss home monitoring of sugar levels in blood and urine of pets and keeping logs of this data and outline the 3 advantages of home monitoring: more accurate data, the ability to pick up serious complications, and seeing the veterinarian less often.
Richard Goldstein, DVM, DACVIM: Dr. MacPete, one of the things that has changed, one of the things we do so much better now than we used to, is monitoring, right? There was a time when I was a resident and the only really reliable piece of data that we had was owner perception. If the owner thought they were doing well, that was actually better than some of the tests we were doing in the hospital because pets are just so different in the hospital. Since you’ve been doing this, what has changed and how do you feel home monitoring has changed your practice?
Ruth MacPete, DVM: Home monitoring has really been a game changer like you said, because it enables us to see what’s going on and get actual data from a pet when they’re in a home environment: when they’re relaxed; they’re not stressed; and they’re going about their day as they normally would, with their normal level of exercise and everything being the same. A lot of the time, if pets come in the hospital they don’t eat the same amount of food that they would because they’re nervous or they’re stressed. You talked about this earlier, but cats in particular get nervous.
Richard Goldstein, DVM, DACVIM: Yes, it’s just useless.
Ruth MacPete, DVM: Yes, they get very stressed in a veterinary setting. We just do not get as reliable data as we would if we do it at home. Home monitoring allows you to get the actual data, but it has also really helped us to prevent complications. It has really allowed us to fine-tune diabetes management and avoid serious complications that would happen otherwise.
Richard Goldstein, DVM, DACVIM: With monitoring, we’re clearly talking about measuring blood glucose, but what else do people do? We’ll get into that. What else should people be looking at when you want to ask them, “How is Spider doing?” What should be incorporated in Azi’s answer to that?
Ruth MacPete, DVM: We want to look at blood obviously, and we want to look at urine too. A lot of the time, we actually have people using a urine dipstick and looking for glucose in the urine. That’s an easier thing for people to do as well. We also have them looking at clinical signs. You mentioned that was what we used before; we still use that, and that’s still a very important tool for us. How is the pet doing? Is the pet still drinking a lot of water? Is the pet still urinating frequently or having accidents? How is their weight? We have people look at their weight as well, their activity level, and their overall behavior. Those are all really important parameters for us to have pet owners keep track of and record and tell us about.
Richard Goldstein, DVM, DACVIM: Tell me about this record. How do they keep a record?
Ruth MacPete, DVM: We like people to keep a diary or a log of all these things. A lot of the time, your veterinarian will give you this and it will be a log that you’re going to keep track of that has dates and times. You’re keeping track of their weight, their behavior, how much they ate, when they ate, when they got their insulin, and any other home monitoring that you’re doing. Checking urine or blood glucose, those are going to be recorded on there. And then those data are given to your veterinarian weekly, or depending on the pet, it may be less frequent. In the beginning, we’re going to want to look at that weekly to see how well controlled the pet is and what else we see with those clinical signs as well as home monitoring.
Richard Goldstein, DVM, DACVIM: When do you do this in your practice? Initially, it’s all about giving insulin, right?
Ruth MacPete, DVM: Yes.
Richard Goldstein, DVM, DACVIM: You get over that. They come in to see you relatively frequently. And then you say, “By the way, I also want you to draw blood at home.” How do you have that conversation?
Ruth MacPete, DVM: I do let people know in the beginning that part of diabetes management is obviously insulin, diet modification, weight loss, exercise, and home monitoring. I don’t go into the details until we get everybody comfortable. Sometimes people ask, “What does that mean? What do you mean home monitoring?” We explain that it’s not scary, that we’re going to talk to you about it. But it’s not something they start right away. Initially, the pet is usually hospitalized to get the insulin started, and they might be in the hospital for 24 to 48 hours. Sometimes, depending on the pet parents, the animal can go home right away and the pet parent can do the monitoring, depending on who it is and their level of comfort. But usually, the monitoring is going to start maybe a week or 2 later.
We talk to the pet parent about what home monitoring involves and why we want them to do it, why it’s so important. I think most people understand why it’s important and how there are 3 major advantages to home monitoring. When they understand those, they get on board. They’re really interested.
Richard Goldstein, DVM, DACVIM: And how do you explain this?
Ruth MacPete, DVM: I think the first thing is that we let people know we’re getting more accurate data. By getting accurate readings of the pet’s blood glucose when they’re at home, that information can be relayed to their veterinarian or their veterinary team so that we can more appropriately manage their pet’s diabetes and make decisions about whether we need to change insulin levels or not. That’s the first thing. The second thing is we talk about the fact that it also helps us pick up serious complications. Home monitoring allows the pet parent, if they think their animal is off or if they’re worried that their animal seems wobbly or drunk or anything like that, to do a spot blood glucose test because we’re going to teach them how to.
Richard Goldstein, DVM, DACVIM: It may be even a urine test, too.
Ruth MacPete, DVM: Yes, even a urine test. We’re empowering them to do that. By having this tool, by being able to do that and be part of the healthcare team, they are able to pick up life-threateningly low blood sugar. They may be able to pick up the opposite. They may be able to see a trend of really, really high glucose, or they may see something called ketones in the urine. All of those things enable them to help us pick up complications that can be serious. So, that’s the second thing.
The third thing that’s also very valuable is that it decreases time and money and stress. By doing home monitoring, they don’t have to come in and see me as often, and that’s less stressful for the pet as well as the pet parent. It saves them time and it saves them money. So, it’s really a win-win with those 3 things as to why you want to push home monitoring.