Take the sting out of a diabetes diagnosis at your veterinary practice

Diabetes. This single word can bite cat owners, especially if they're unprepared or they've witnessed the disease before in other pets or people they know. Although we go out of our way in the veterinary industry to prevent such disease, it's still a common illness that we see in feline patients. With proper communication and commitment, you can help cat owners manage their pet's disease.

As you know, all diabetic patients are treated and managed on a case-by-case basis. They can all experience different outcomes, depending on concurrent disease, lifestyle, personality and so on. Not all clients will choose the same treatment for many different reasons. Your practice will have its own protocols for effective diabetic treatment and may not follow the same approach in this example.

Diabetes diagnosis: the first bite

Mrs. Sweet calls because she's concerned about her 11-year-old cat, Toonces. She says he's been drinking and urinating a lot, and he's not grooming himself like he used to.

Mrs. Sweet: "My friend told me he's just getting old, and not to worry. Should I be concerned?"

You: "Mrs. Sweet, you did the right thing by calling us. I know Dr. Cares will want to take a look at Toonces. She will thoroughly examine Toonces, including checking to see if he's lost any weight or is dehydrated. You might also watch to see if you notice Toonces isn't jumping well or if his rear legs seem flatter to the floor. Dr. Cares will also use blood work and a urinalysis to check for any abnormalities. This will help her give you a more complete picture of Toonces's health and how we can help him feel better."

When Mrs. Sweet and Toonces arrive at the clinic, the veterinary team will perform a physical exam, blood work and urinalysis to check for internal abnormalities.

Mrs. Sweet: "Why does my cat need all of these tests?"

You: "Generally your cat's symptoms help Dr. Cares make a diagnosis, but there are other factors that can affect the success of the treatment for diabetes. For instance if Toonces has pancreatitis or an underlying kidney problem, he may not respond well to the diabetic treatment and this can complicate the situation long term. So we need to be able to rule out concurrent disease so we can offer Toonces the right care to help him feel better."

When the doctor diagnoses diabetes, she may suggest hospitalizing Toonces for the day to perform further diagnostics, such as a blood glucose curve, administer IV fluids to correct dehydration if needed and any other testing required to treat any concurrent disease. It's not uncommon for clients to feel overwhelmed at this point, and it's vital to take the time to discuss the details of this disease and what they should expect in the future.

When a client first learns that their companion may have a lifelong chronic disease, it can be difficult to deal with. It's our job as veterinary professionals to help them understand what treatments are available and support them in any way we can. Many people know someone who's diabetic or they may be diabetic themselves. Sometimes referring to examples of people with this disease helps clients understand that with commitment and proper treatment, they can often manage their cat's condition.

Always try to discuss this diagnosis before bringing the cat into the exam room. Clients have usually been separated from the pet for some time and get very excited. You want them to focus on your information. Once you bring the pet in, give them time to visit. Then say you'd like them to practice giving the cat's injection. This usually gets them back on task.

Help clients offer gentle treatment

In this case, Mrs. Sweet is willing to treat her cat and seems open to the long-term commitment that's required. It's a good idea to lay out an initial estimate and try to explain what types of home care will be necessary, including insulin injections, monitoring and special diet needs. The owner's commitment becomes crucial to help successfully treat the pet.

Remember to discuss how the outcome of the treatment can depend on several things. If Toonces isn't easy to work with, it can be difficult for Mrs. Sweet to give injections at home. Also lifestyle can be an issue if Mrs. Sweet struggles to set a routine schedule. It's important to discuss all of these factors with Mrs. Sweet before making a game plan so she can make an informed decision on how to proceed.

The discharge instructions for this cat will be extensive and should be performed by an educated team member. Ideally, you'll create a reference sheet with the veterinarian's specific instructions to discuss all recommendations for home care. This allows the client to have all of the information in one place.

First discuss the insulin injections and how often Mr. Sweet needs to give them to Toonces. Show her the vial and the proper syringe she will use. Then fill the syringe with the amount of insulin Toonces will receive and show it to the client. Also teaching Mrs. Sweet how to remove any bubbles that may form in the syringe helps with accuracy. Next, ask Mrs. Sweet to fill the syringe herself so she's comfortable performing this step. Remind Mrs. Smith that she should replace the product according to the doctor's recommendation and send home a box of syringes to get her started.

Always try to designate a family member who doesn't mind giving the injections. If there's only one owner, then he or she has made the decision to give injections because it's the only way to make the cat feel better.

Euthanasia is very much a reality for some people. It's important to be prepared for this conversation as a team member and be able to discuss it appropriately. We're not here to judge or make assumptions about an owner's willingness or ability to be able to manage their cat's disease. There are many factors in a person's decision to decline treatment or try an alternative management technique. Depending on a client's lifestyle or limitations, they may not be prepared or able to treat their cat. Our job is to support a client's decision and help them in any way that we can.

Talk about food

Next, you'll need to take a few minutes to discuss the appropriate diet for this pet.

You: "Mrs. Sweet, we're going to send you home with a special food that will help to regulate Toonces' blood sugar. Let's talk about a feeding schedule for Toonces."

Describe in detail the diet the doctor recommends, when to feed Toonces, how much to feed him, what to do if he only eats some, what to do if he doesn't eat at all and any other specific instructions the veterinarian has for this patient.

You'll also want to take time to review the importance of monitoring. Watching Toonces' water intake, urine output and behavior is very important.

You: "Mrs. Sweet, it's important to watch how much water Toonces drinks, how much and how often he urinates and keep an eye out for changes in Toonces' behavior. If Toonces seems weak, exhibits an unstable gait, seems sleepier than normal or experiences tremors, this might indicate his blood sugar is too low. If you notice any changes, call us immediately. It's also a good idea to keep some Karo syrup on hand if Toonces' blood sugar gets too low. In certain cases, we may ask you to rub the syrup on the gums or give it a syringe in the mouth when you're waiting to see Dr. Cares."

Trying to discuss the signs of low blood sugar can be tricky. You don't want to scare clients but they need to understand the importance if it occurs. If diabetic remission is possible, take a moment to discuss the signs, because it can come on quickly and monitoring is key to prevent major problems. Depending on your practice protocols you may also discuss the use of home blood glucose monitors to reduce the need for excessive hospital testing that can cause stress to the cat. You may also recommend glucose detecting crystals and dipsticks the client can use in the litter box at home.

Then explain you'll schedule follow-up exams and blood work until you reach regulation. This gives the doctor more information to discuss long-term recommendations.

You: "Mrs. Sweet, we'll want to schedule follow-up appointments to check on how Toonces is responding to treatment. During these visits, we will conduct a physical exam and ophthalmic exam, conduct weight check, check your pet's blood pressure and perform blood work to assess the blood glucose level. We will also discuss diet, injections and any other concerns you might have."

Before Mrs. Sweet leaves, you'll offer any supportive materials the clinic recommends, such as web links or handouts on diabetic management. Encourage Mrs. Sweet to call with any questions, and give out an emergency number for your clinic or the emergency hospital you recommend in case she needs helps after hours.

Finally, it's time to bring Toonces in and show Mrs. Sweet how to give the injections. Fill the insulin syringe with saline—or insulin if Toonces hasn't already had it—up to the correct dose line and replace the cap on the syringe. You could then show Mrs. Sweet how to tent the skin and what angle to place the syringe to hold it properly. Sometimes clients will hold their thumbs on the plunger, and they prematurely squirt the liquid, so show them where to hold their fingers to avoid this common mistake. Discuss proper injection sites for optimal absorption—on their sides if possible—and remind Mrs. Sweet to rotate sites to prevent scar tissue from forming. Once Mrs. Sweet is comfortable, give her the syringe without the cap and have her inject Toonces. Be sure to ask Mrs. Sweet if there are other pet owners in her household, and encourage her to designate someone who will give the injections so Toonces isn't double dosed accidently. Reassure Mrs. Sweet that she will adjust to this procedure with time, and encourage her again to call with any questions.

When you call to remind clients about follow-up appointments, be sure you discuss any need to withhold food or the insulin injection for blood work, if indicated.

Prevent future stings with follow-up care

It's critical to offer recalls for Mrs. Sweet and Toonces. This allows you to check on treatment, ask if the diet's going well and offer motivation as needed. Most of the time a client's concerns will relate to diet or injections. If the cat's appetite hasn't been good or owners struggle giving the injections, this is a good time to talk. Also regulation can be difficult in some cats, so it's imperative to be sure they understand the importance of compliance and to encourage them to ask any questions they have. Most clients are fine with giving the injections by this time. Set up the next appointment and offer to order food and supplies whenever needed.

With these steps, you can help pet owners manage the sting of a diabetes diagnosis. Your support will ultimately make managing diabetes more manageable.

Mandy Stevenson, RVT, is a Firstline Editorial Advisory Board member and a technician at Rolling Meadows Animal Hospital in Adrian, Mo.