Diabetes & Its Management
There's a Problem
Diabetes mellitus is a common endocrine disorder, estimated to affect one in 500 dogs and one in 250 cats.1,2 Management strategies are constantly evolving, influenced in part by changing insulin availability, advances in blood glucose (BG) monitoring devices, and the expectations of owners. However, with an organized team-based approach and a sound understanding of this disease, practitioners can care effectively for these patients and help them live without troublesome clinical signs.
STARTING DOWN THE ROAD TO SUCCESS
- Successful management starts with a careful investigation of the client’s goals and concerns.
- It is important to ensure that the client understands the relationship between insulin and BG.
- The veterinary team must work to engage the clients in the management process and help them feel part of the treatment team.
BG monitoring at home is one of the most effective ways to achieve the latter two goals. Clients who partner with their veterinary team in this way are less anxious because they have a clearer understanding of diabetes. They can work with their veterinarians to troubleshoot problems and intervene appropriately. Recent studies assessing quality of life perceptions for owners of diabetic pets have highlighted some common fears: hurting their pet; making a bad decision; and not recognizing hypoglycemia.3,4
Initial expectations may be unrealistic and need to be redefined. For example, most diabetic dogs have some degree of polyuria and it may not be appropriate for a client to leave his or her dog alone for 10 hours. A preemptive discussion about installing a doggy door may make an enormous difference to this client’s perception of success. Conversely, some clients have negative prior experiences with diabetes, either with a previous pet or family member. Many worries are unfounded and can be alleviated through an up-front, thorough discussion that clears the way for the client to start treatment with a positive outlook.
THE FACTS OF THE MATTER
- Individual insulin needs are not predictable and are likely to vary over time.
- Most patients need periodic changes in insulin dose; appropriate monitoring is key to promptly identifying the need for a change.
- Although indirect assessments of glycemic control, such as fructosamine concentrations, can be helpful, regular measurement of BG throughout a typical day is the preferred way to assess and adjust insulin therapy.
- BG values collected at home are a more accurate reflection of glycemic control than readings obtained in the clinic, as the stress of a hospital visit is avoided and normal routines and activities are preserved.