Helping Clients Understand and Manage A Recently Diagnosed Diabetic Pet

A beloved pet that has been recently diagnosed with diabetes can be a shocking and sometimes scary experience for a client, especially if they have no prior knowledge of the disease. Today, I will talk about how you, as a veterinary nurse, can help to educate, support and reassure your clients about their pets recent diagnosis.

Step One: Explaining Diabetes

I always begin by explaining exactly what diabetes is. Hearing this information can, at times, be scary for clients. Be sure to start off by assuring them that although diabetes is an incurable disease, with the proper treatment, care and diet, diabetes is manageable, and as long as it is done so correctly, they will have many more happy years with their pet! Even if the client is familiar with the disease, explaining it from the beginning can be both useful and educational for the client.

What is diabetes?

Diabetes is an endocrine disorder which is characterized by insufficient production of insulin in the body. In simpler terms, when food enters the body, it is broken down. One of the components of food, glucose, is then carried to the cells by insulin. If the body is unable to produce enough insulin, or the insulin it has isn’t used properly, the glucose cannot be used properly either. The bodies blood sugar levels will rise as a result.

Okay...but what is insulin?

Insulin is natural hormone produced by the body. Insulin is responsible for turning food into energy and managing the body's blood sugar level. When a patient is diabetic - this does not happen correctly.

How did this happen?

Like humans - we aren't entirely sure why some pets will develop diabetes. It may be, that their pet is just more genetically prone to developing it. It is a known fact, however, that obesity can increase the risk of developing diabetes. Diabetes is also more likely to develop in the pets senior years, but not always. It is also more likely to develop in females more-so than males.

What are the symptoms of diabetes?

The most common symptoms of diabetes are:

• Increased thirst

• Increased urination

• Increased appetite

• Unexplained weight loss but other, less uncommon symptoms include:

• ‘Sweet-smelling’ breath

• Lethargy

• Frequent urinary tract infections

• Loss of eyesight (cataracts)

How is it diagnosed?

Diabetes can be diagnosed in multiple different ways:

BG Test: Diabetes is most commonly diagnosed with a blood glucose (BG) test. A blood glucose test, is a blood test that determines the direct measurement of the body's blood sugar (which tells us if it's elevated).

Fructosamine: Gives an idea of the bodies blood sugar levels over the last several weeks to confirm if blood glucose levels have been elevated over time.

Urine Test: Elevated blood glucose, along with the presence of glucose in a urine sample (which usually only happens if blood sugar levels are so high that glucose starts to "spill over" into the urine), can also be used to help diagnose diabetes.

Step 2: Explain The Treatment

Once I have explained to clients what diabetes is, my next step is usually to explain how exactly we are going to treat and control it. Treatment of diabetes usually involves a number of different components:

Sol-Vet u40 Insulin Syringe

• Daily insulin injections: Insulin, unfortunately, can only be injected. It is a small shot under the skin, usually twice daily. These shots are given every 12 hours, immediately after eating.

For most clients, this can sound very intimidating. At this point, I show them the insulin syringe and note how small the needle is. Most pets tolerate their insulin shots extremely well and if they do not at first, they will likely get used to it over time. Reassure the client that while it might seem scary at first, it will become second nature in no time for both the client and the pet! At the beginning stages, trial and error is usually the vets approach to establish the correct dose of insulin to give. A Glucose Curve may be (or have been) preformed in order to determine the pets insulin dose per day. A glucose curse involves many blood glucose measurements during the duration of action of insulin. A glucose curve is used to determine how effective the insulin is at controlling the body's sugar levels. This helps the vet to decide if the insulin dose needs to be altered.

Royal Canine Diabetic Dog Food

• Diet: Diet is one of the most crucial factors in managing diabetes. The goal is to ensure the body's blood sugar levels remain as close to normal as possible. A high protein, high fibre, low carb, low fat diet, is most recommended for diabetic pets. I do strongly recommend to clients they consider one of the diabetic foods we have for sale in our clinic, as these diets are specifically catered to the disease, and will therefore, be more beneficial to the pets health and management of the disease in the long run. Sometimes, this just isn't possible for clients which is okay - most pets do fine continuing on their regular food. I like to work out (according to their pets weight/breed/etc), how long the food would last and the cost per day for the client, in these cases. Like the insulin shots, pets should be fed every 12 hours (twice a day), and it should always be at the same time.

A commonly asked question I get is at this stage is "what about treats?"

Pets with diabetes are on strict diets, but yes, they can still have treats. I do not recommended treats if the pets diabetes is not fully under control. Treats for diabetics are different to regular treats, so I recommend diabetic treats only. Diabetic treats are designed to help regulate blood sugar, limit carbohydrates, and don’t contain unnecessary added fats or sugars. Make sure to emphasize this to the client. In an ideal world, I would say no treats, as the more consistent and structured the diet, the better. This however, can be quite unmotivating for clients, so diabetic treats are what I recommend instead. Like all treats, diabetic treats should also always be given in moderation, as they can still lead to weight gain.

• Routine: A daily routine is just as important (especially in the beginning) as insulin and diet. I always recommend that clients feed, exercise and medicate their pets at the same time every single day, along with keeping their daily routine the same as much as possible. Having a daily routine can also help with lowering pets stress, (which can raise blood sugar levels)!

• Close Monitoring: Close monitoring of the pet (again, especially in the beginning) is very important. After a recent diagnosis, the vet may recommend a glucose curve, and will usually ask the client to return for a check up in 7 days to review how their first week of insulin went. Once the pets diabetes is under control, the client is usually asked to return every 3 months for a glucose check. It is important for clients to know what to look out for at home, in case something goes wrong.

What should I look out for?

• Hyperglycaemia: This happens when the body's blood sugar levels are too high. This could happen for example, if the pet has eaten something outside of their normal diet, or if their insulin dose isn't effective enough. These symptoms are similar to diabetes symptoms (like when the pet was first diagnosed), for example, increased urination, increased appetite, increased thirst, etc. It is important for the client to watch out for these symptoms at home, as this may indicate that their pets insulin dose needs to be altered.

• Hypoglycaemia: This is the opposite, when the body's blood sugar levels are too low. This can happen, for example, if the pet doesn't eat and is still given their full dose of insulin. This can be very dangerous, and symptoms can include lethargy, seizures, trembling, vomiting, etc. If a diabetic pet displays any of these symptoms, they need to be seen by a vet as soon as possible.

Step 3: Demonstration

The next step I take, is to demonstrate to the client how exactly how to inject their pet with insulin.

Injecting insulin:

For demonstrative purposes, I like to use sterile water in the insulin syringe and show the client exactly how their pet should be injected. Remind clients that insulin needs to be stored in the fridge.

WikiHow

• Start by showing them the bottle (of sterile water - but pretend it's insulin) and showing them how to draw it up. First, remove the cap from the insulin syringe. Hold the bottle of insulin (or sterile water) upside-down and insert the needle it into the top of the bottle (the soft part).

• Pull the bottom part of the syringe (the plunger) down until the right amount of insulin is in the syringe. Be sure there are no air bubbles. Tap the barrel a few times to move any air bubbles to the top of the syringe. Slide the plunger up slowly, enough to push the air bubble out.

• Gently lift the pets skin at the back of the neck/back and hold the needle at roughly a 45 degree angle. Insert the needle into the skin, and give the pet lots of praise! I tell clients to inject into a different part of the skin each time, so their pet doesn't get sore due to being injected into the same spot every time.

• Push the plunger slowly until the syringe is empty and gently remove the needle. A new insulin needle should be used every time, to avoid any infection or contamination.

• Place the cap back on the needle and dispose of it in the sharps bin. Most clients do not have a sharps bin at home, so I tell them they can hold onto the needles and drop them into us, where we can dispose of them.

Remind clients that insulin should be injected immediately after eating and should be at the time time every day!

What if my pet doesn't eat their food?

If the pet does not eat, or only eats half of their food, give only a half dose of insulin. If this happens more than once, the pet should be taken to see their vet for examination. It is always better in the short term for the blood sugar to be too high than too low!

Step 4: Cost & Follow Up

How much will this cost?

At first, it may seem expensive. However, the beginning is usually the most time-consuming and financially demanding stage. Once the insulin dose and treatment plan have been established, maintenance becomes much simpler and requires far less check-ups. Costs in the beginning may include all the initial diagnostic tests, purchasing insulin and needles/syringes, and a special diet. Over time, the cost of managing diabetes becomes much lower (assuming the pets diabetes has been successfully controlled). Long-term maintenance costs usually involve refills of insulin and syringes/needles, diabetic food, and rechecks with the vet (once controlled usually every 3 months). I like to break down the cost of everything for the client, and how much it will cost them going forward.

Follow up:

In the early stages of the pets diagnosis, they are usually asked to return for weekly glucose check ups until their diabetes has been successfully controlled. Once it has been controlled, it is recommended the pet returns every 3 months. I like to book the client in for their follow up appointments at the end of their fist visit, and a phone call a few days later to see how they're getting on or answer any questions is often much appreciated. Remind the client that if they have any concerns at all, we are here to help them.