Veterinary Technician's Role in Home Monitoring
Richard Goldstein, DVM, DACVIM, and Brittney Cirone describe her role in training owners on home monitoring of diabetes in pets and Ruth MacPete, DVM, reinforces the importance of home monitoring and instructing the pet owner on what to do with therapy based on the data in the logs kept by the owners.
Richard Goldstein, DVM, DACVIM: Brittney, you get that call and they say, “I got home, I have this thing, Dr. MacPete explained everything, she was super nice, but I don’t know what to do.” How do you get people to get over that?
Brittney Cirone: I’m sorry, to get over what?
Richard Goldstein, DVM, DACVIM: The monitor, the fear of drawing blood.
Brittney Cirone: I think often what I find with owners is that they have the same anxiety and anticipation of causing pain to their pets. Once they get comfortable with getting a sample of blood glucose, they realize that most of the time pets don’t even notice and it’s their own anxiety that becomes self-limiting. I always tell them, “If you’re worried and you’re concerned and you need a run-through, come in and we’ll go through it. We’ll walk through it. I’ll show you, and you’ll try it.”
Richard Goldstein, DVM, DACVIM: This is one area where dogs and cats are different. How do you use it in a cat, drawing blood from a cat?
Brittney Cirone: When drawing blood from a cat, there are mostly 2 common areas that I typically recommend, and those are the little vein that runs on the ear pinna and then the paw pad. Some cats are super big fans of their feet being touched, so I think the ears are what most of my clients like to use. Often, if you put a little bit of light right underneath the ear pinna, that fluid becomes very prominent and very easy to see.
Richard Goldstein, DVM, DACVIM: Is that what you use as well?
Ruth MacPete, DVM: Yes, we usually recommend the ear and also the paw pad. I completely agree with Britney: with people, it’s usually their anxiety. I know Azi was shaking her head. It’s the fear of hurting your pet, but people are usually really impressed and surprised at how the animal doesn’t react.
Richard Goldstein, DVM, DACVIM: What kind of compliance do both of you get? Obviously with insulin, everybody ends up doing it. Does everybody end up doing the at-home monitoring? Is it that easy?
Ruth MacPete, DVM: We really try to get people to do it.
Richard Goldstein, DVM, DACVIM: Yes, it’s so much better.
Ruth MacPete, DVM: It’s definitely better for the pet, but not everybody does it. I would say most of my patients do because most people, once they start insulin, get more comfortable with syringes and realize how tough their patient is. And then, they get more empowered. People may not always start off monitoring. They might be monitoring the urine. We always let people know that’s an option too. If they’re too afraid to do the blood test, they can still do the urine test and work up to that. Like Brittney said, it’s really about letting people know that we as a hospital are there for them, that they can change their mind. They can just decide in the first week that there’s no way they’re doing it, and then decide, “Oh, this isn’t that hard, I think I can do it.” We’re there for them. If they need a refresher, we’re there to do that and to help them.
Richard Goldstein, DVM, DACVIM: This all happens in really close collaboration, right? You’re not telling people, “Measure glucose: If it’s 80 mg/dL, give this much insulin; if it’s 130 mg/dL, give that much insulin.” You’re not doing that?
Ruth MacPete, DVM: No, no we’re not. The logs and the diaries that people are keeping are not for them to adjust insulin. We actually don’t want people to do that. We want them to always speak with their veterinarian and talk to their veterinarian before making any changes. That being said, there are some conditions. If an animal has very low blood sugar, we do have clear instructions as to what they’re supposed to do in that situation, and that is to not give insulin and actually correct the low blood sugar as quickly as possible.
Richard Goldstein, DVM, DACVIM: Just by feeding.
Ruth MacPete, DVM: Yes, by feeding them or putting corn syrup or honey on their gums. Again, we instruct people so they know all of this ahead of time. But for changing the dose or increasing insulin, we never want people to do that without talking to us. We want to look at those logs and make an educated decision based on what they’re getting at home and their clinical signs, their weight, and possibly fructosamine levels. Before we’re making changes, we’re looking at a bunch of different things.
Richard Goldstein, DVM, DACVIM: It sounds like it’s trivial, but that ability to identify low blood sugar at home is pretty amazing because without that, they keep giving insulin and then we see the cat or dog when they’re in a coma and have to be in the hospital for a week. Sometimes, they actually don’t even come out of it. Being able to see that initial low level and say, “Oh, I know, if it’s less than whatever my vet told me—120, 150, or 200 mg/dL—I don’t give insulin and I feed them.” That’s an amazing thing that can happen at home now with this.
Ruth MacPete, DVM: Yes.
Richard Goldstein, DVM, DACVIM: And that wasn’t the case even just a few years ago.