Richard Goldstein, DVM, DACVIM, and Brittney Cirone comment on her role as a veterinary technician in training owners on administering insulin and reinforcing that they are not alone and have a support system at the vet office to help.
Richard Goldstein, DVM, DACVIM: Brittney, Azi talked about how when her vet initially told her all these things, she got nothing. She wasn’t really hearing what the vet was saying. It took a while to assimilate. Dr. MacPete gave that whole amazing talk about pathophysiology and diabetes, exactly what’s going to happen, and then goes on to the next case. You are left now with the client and the client says to you, “What did she say?” What conversation do you have with the client?
Brittney Cirone: When I’m approaching a new diabetic patient’s owner, the first thing I always tell them is very similar to what Dr. MacPete said; that they’re not alone and they have an entire support system.
Richard Goldstein, DVM, DACVIM: You’re not alone.
Brittney Cirone: I am definitely not alone. They have an entire support system behind them. We’re just often a phone call away, so don’t be afraid to give us a call. That’s why we’re here; for any questions and any concerns. I also like to let them know that they already have a lot of the tools, tools that they need at home that successfully monitor and administer the insulin, as well as the tools that we’re going to provide them. One of my most important jobs is to make sure that they feel comfortable and confident when they go home in getting the blood glucose samples, testing those samples, and administering the insulin.
Richard Goldstein, DVM, DACVIM: Right. Then they say to you, “Do I really have to do it?”
Brittney Cirone: And I say, “Yes.”
Richard Goldstein, DVM, DACVIM: Right. “So, how do I do it? I’ve never given an injection. I don’t know. It’s scary.”
Brittney Cirone: It is scary.
Richard Goldstein, DVM, DACVIM: How do you manage that?
Brittney Cirone: It often starts with a stuffed animal that we bring into the room with an insulin needle and saline. We show them. First, I’ll show them how I administer insulin.
Richard Goldstein, DVM, DACVIM: By the way, do you do it differently in dogs or cats or is it pretty much the same?
Brittney Cirone: It’s very similar. It’s a subcutaneous injection. I’ll tell them the most common spots where I recommend administering the insulin, just based on ease. Often we discuss the tenting mechanism where you pull up the skin and you look for the tent for easy application of the syringe. And then I show them and I sit with them as they practice.
Richard Goldstein, DVM, DACVIM: Now when you say “them,” one of the things that has happened to me before is that the husband picks up the cat and then the wife is the one giving insulin. We need to make sure that’s not going to happen.
Brittney Cirone: I do. It’s very important that I’m asking, “Who will be administering the insulin?” If you’re not sure, I want to find a time where both the husband and the wife can make it so we can show them, navigate through it, discuss it, and answer any questions that they have.
Richard Goldstein, DVM, DACVIM: Dr. MacPete talked before about how often the pet will be hospitalized for maybe a day. You have time to go through this. It doesn’t have to be an all-in-1 quick 10-minute session.
Brittney Cirone: It isn’t. It’s in a process, and I often tell my pet parents, “Go home, think about it, take some time, absorb it, process it, and ask me any questions that you have. I’m here to help.”
Richard Goldstein, DVM, DACVIM: But you don’t set them loose until you’ve seen them handle the insulin, right? Which is also interesting. It’s not like orange juice where you shake it.
Brittney Cirone: Please do not shake the insulin. There’s obviously techniques that have to be appropriately handled to handle the insulin; often a slight ruling mechanism or a slight inversion of the tube. I show them the appropriate insulin syringes to use and how to go about successfully pulling up that insulin. Before they leave, I always make sure that I see them handle the insulin bottle by pulling up the insulin and making sure that it’s at the right units.
Richard Goldstein, DVM, DACVIM: With a stuffed animal.
Brittney Cirone: A stuffed animal.
Richard Goldstein, DVM, DACVIM: When do they actually practice on Spider?
Brittney Cirone: When they’re comfortable with the stuffed animal, we’ll move on and actually practice on their own pet when they feel like they’re ready to take that step. We don’t start with insulin, we usually start with saline, but we’ll work our way there. And once they feel comfortable, I’ll even have them bring in their vial of insulin, show me how they pull up the insulin, and stand with them while they administer it to their pet.
Richard Goldstein, DVM, DACVIM: That’s a really important point, because people sometimes forget their insulin, they drop their insulin, or they leave it in their car. They go to the pharmacy and get a different insulin. We think they’re giving one thing, but they are actually giving something else, as they have the wrong syringe. So, you actually look at that when they come in for their recheck?
Brittney Cirone: Absolutely. Every time they come in for the recheck I already ask them, “Please bring in the insulin that you’re using and the insulin syringes that you’re using to administer the insulin,” to make sure that they are compatible and they’re the correct insulin syringes.
Richard Goldstein, DVM, DACVIM: Wonderful. As nervous as people are initially, what would they say typically? We’re going to ask Azi in a second, but what would they say technically 2 or 3 weeks later?
Brittney Cirone: They say, “I’m still nervous, but I feel better about it.”
Richard Goldstein, DVM, DACVIM: And they do. They actually do it.
Brittney Cirone: They do it, and each day it gets a little bit easier.
Richard Goldstein, DVM, DACVIM: I think for me the first thing is, don’t euthanize your pet. People often will say, “I can’t do. I just can’t do it. I’m sorry, I need to give up my pet.” Obviously, Spider was given up, right? Maybe because he was urinating in the house. Maybe because they couldn’t handle the diabetes. We’ll figure out a way to make this work for you, and in the end, they’ll do it. They’ll all do it, no matter how squeamish they first started out.
Brittney Cirone: I don’t care how many times you have to call me or how many times you need to come in to go over it 1 more time. That’s what we’re here for.
Richard Goldstein, DVM, DACVIM: They become pros, not only at giving insulin but at home monitoring.
Brittney Cirone: They often give me advice and techniques on how to successfully administer medications.