Steps to Treating Diabetes in Pets

Richard Goldstein, DVM, DACVIM: We’re joined by Brittney Cirone. Brittney is a veterinary technician at a large specialty practice called CARES in Langhorne, Pennsylvania. Thank you so much for joining us, Brittney.

Brittney Cirone: Thank you for having me.

Richard Goldstein, DVM, DACVIM: And Brittney, Azi, Dr. MacPete, we’re talking about treatment now. We’ve touched on this just a little bit, but I really want to focus on something that’s really important, which is that initial conversation. How do we have, all of us, that initial conversation with the owner on a newly diagnosed pet, dog and cat? Dr. MacPete, what is your spiel?

Ruth MacPete, DVM: I think the first thing, when I’m telling someone that their pet has diabetes, is to let them know first and foremost that it’s manageable, that it’s a manageable condition and that we’re going to approach it as a team. Then I start to explain what diabetes is, because everybody’s level of understanding is different.

Richard Goldstein, DVM, DACVIM: How do you do that? What do you say?

Ruth MacPete, DVM: I talk to them about the fact that diabetes is a metabolic condition that occurs in dogs and cats just like humans, and I explain the fact that it’s a condition where the body is unable to regulate the blood sugar. That can be either type 1 or type 2 diabetes, but the end result is the same: The body is not regulating blood sugar. The animal has high levels of blood sugar that spill over into the urine and that’s why people see the clinical signs that they do: increased thirst, increased urination, increased hunger, or all of those signs. I explain that to them, and I talk to them about the fact that just like with humans, it’s manageable. It’s typically treated with diet, insulin therapy, as well as at-home monitoring. I obviously go into what the diet is going to look like for their particular pet, and then I talk to them about insulin and what that means as well.

Richard Goldstein, DVM, DACVIM: We’re going to talk a lot about at-home monitoring because I think that’s just so important. That’s really something we’re focused on a lot these days. But I think one of the initial shocks is that they have to change their lifestyle, they have to be home twice a day. Giving insulin though…People are afraid of giving insulin. They’re afraid of needles. They think they can’t do it. How do you handle that?

Ruth MacPete, DVM: I let them know that’s common. Their fears are a very common thing. Most people are initially shocked and frightened of the fact that they’re going to give their pet an injection. I let them know though that animals are braver than people. I know we all know this up here, but I see that every day as a veterinarian. Even with immunizations, we see that where people might be screaming from a shot, pets just really don’t do that.

I let them know that the insulin needles are very, very, very tiny. I’ll show them what the needle looks like. It’s a very small needle. It’s nothing like what people are getting when they get a flu shot. It’s a much smaller needle. The fact is that pets really tend to be very brave, especially compared with people. That this is something that they’re going to find their pet is not going to be bothered by. They’ll set up a routine where they give their pet food or a treat afterwards, so it becomes a positive experience. And then, most importantly, I let them know that we’re there for them, that we are going to teach them how to do this.

Richard Goldstein, DVM, DACVIM: That’s going to be something Brittney is going to teach them.

Ruth MacPete, DVM: Yes, well, the whole staff. I may talk to them about it first, but then my team, our veterinary technicians and assistants, is going to go in and talk to them. We’re going to show them how to give the injection. And then we’re going to have them show us how to give the injection. We are not going to leave them on their own until they’re perfectly comfortable giving injections. We’re there for them. We’re there as a team and we’re going to help them. We teach them how to log and pull up the insulin, everything.

I want them to know, obviously, that we’re going to educate them. We’re going to make this simple for them. We have handouts as well. We give them handouts that show how to handle the insulin, how to give the injections. There are videos. There are things like this, PetConnections, so I just want them to know that they’re not alone and that this isn’t something where we give them a medication and send them on their way. This is definitely something that we are going to work with them on until they’re comfortable and we know that they’re comfortable at home doing it.

Richard Goldstein, DVM, DACVIM: You talked previously about hypoglycemia, low blood glucose. What is that going to look like? How do you prepare them for that?

Ruth MacPete, DVM: In addition to teaching them about treatment, we want to make sure that they also know about possible complications. Specifically, when giving insulin, we want to make sure that they understand that an animal can then have the opposite effect when we give insulin. They can actually develop dangerously low blood sugar, or hypoglycemia. And so, it’s very important that they understand the symptoms. Regarding those symptoms, I’ll go over with them the fact that the animal may look like they’re drunk. They may be wobbly or have what we call ataxia, where they’re unsteady on their feet.

They may appear lethargic. They may actually have tremors. And if it progresses, they can have seizures and even go into a coma. It’s very important that they understand those symptoms and they understand what to do if they think that’s happening. We prepare them so that they feel if something like that happens, they know what to do. We also talk to them about situations where they can help avoid that from happening as well.

Richard Goldstein, DVM, DACVIM: Such as, “My dog didn’t eat this morning. What do I do?”

Ruth MacPete, DVM: Yes, making sure the pet eats before you give insulin. You mentioned this before, but if there’s any question, we want to err on the side of having the animal be hyperglycemic, have more blood sugar…

Richard Goldstein, DVM, DACVIM: High blood sugar.

Ruth MacPete, DVM: Yes, high blood sugar rather than low blood sugar, because that’s ultimately safer. If there’s any question, we want to make sure that they understand they can call us no matter how often. Azi talked about how she spoke with her veterinarian nonstop in the beginning, and that’s OK. We want to make sure they understand that they can talk to us and they can talk to our veterinary staff. We’re here to reassure them and work with them as a team.

Richard Goldstein, DVM, DACVIM: Until things are…I don’t want to say on autopilot, because it’s never really on autopilot. Every day is interesting, right? Every day you have to look at them and make sure they’re eating, make sure everything is OK. But in the initial and more intense period, how often are they going to see you, typically? How often do you do blood tests? How do you prepare them for that?

Ruth MacPete, DVM: I let them know that in the beginning, as all of you know, there’s going to be a lot of visits. We’re probably going to see them a lot for the first month. Initially, their animal may be hospitalized while we start insulin. And we’re monitoring their blood sugar levels throughout the day to make sure that they’re OK on that insulin dose. And then we’re probably going to see them every week until we feel like they’re more stable. That phases out. Then we start to see them in 2 weeks, 4 weeks, and eventually—when they’re pretty well controlled and we feel that the owner understands how to manage the disease—that becomes less frequent and we may see them every 3 to 6 months.

Richard Goldstein, DVM, DACVIM: They do most of the work at home.

Ruth MacPete, DVM: Yes, they do most of the work at home.