When I make the diagnosis of diabetes for a dog or cat, I understand how overwhelming it can be for the new diabetic pet owners, so I try to be generous with my time. I’ve seen some surprising mistakes over the years, so I try my best to instill basic principles of diabetes management into the minds of these pet owners on day one.
I have always worked in busy practices, so when I diagnose a diabetic it’s hard to dedicate an entire hour with a client for a diabetes lesson. It usually means I give up my lunch break so that I can show a client how to give injections, discuss diets, give them homework reading materials, and provide all the hand-holding I would want if my mother’s dog was diagnosed with diabetes.
Additionally, I typically have the client come in for a recheck the following week – first thing in the morning. At the recheck I have the client give the morning injection in front of me so that I can witness his or her technique to make sure it is done correctly. If the client has agreed to proceed with home glucose monitoring, I also watch the client check the blood glucose in case I can offer any pointers that might make the process easier. If the client has not chosen to perform home glucose monitoring, I will likely keep the pet in the clinic for a glucose curve that day. Also, this recheck appointment is a good time for clients to ask any questions they’ve formulated since our first lesson.
Upon diagnosis, don’t be insulted if your veterinarian or vet tech asks to watch your technique. You are probably smarter than the average bear, but over the years we’ve witnessed all kinds of simple mistakes that can result in poor response to therapy. Therefore, it’s very common for vets to ask to witness a diabetic pet owner’s injection technique soon after diagnosis or sometimes later if the pet isn’t responding to the insulin as expected. Before we think of insulin resistance we first rule out faulty administration.
Even the smartest client can make a mistake. I once diagnosed a diabetic cat that belonged to an MD. She really didn’t have the time that day to come in to spend her mid-day for my “lunch-break diabetes lesson”. As a doctor there was no doubting her intelligence. But, just as my hairdresser doesn’t like me to trim my own bangs between haircuts, she really should have come in. To my horror I got to work the following day to find a report from the local emergency hospital. Instead of giving her cat one unit of U-100 insulin she gave one milliliter. It was a hundred times the amount I had intended for her to give. Instead of using an insulin syringe she used a regular syringe. That kitty survived, but she spent the night in the ER on an IV sugar drip. If a doctor can make such a mistake, anyone can. Mistakes can be made in the other direction as well. For example, if a client doesn’t tap out any air bubbles in the syringe they may be giving less than the prescribed amount of insulin.
My follow-up recheck appointment may seem a touch type A, but its one thing to discuss how to do something, another to show clients how to do something. I feel much more comfortable having clients show me how they do it. This re-check is also a good time for me to check whether the prescribed food is palatable to the pet, discuss the diabetes log book or calendar, remind the owner of online educational resources, ask if the pet has experienced any lethargy after the insulin injections (which could be episodes of hypoglycemia), etc. I typically once again stress the main signs of hyperglycemia and hypoglycemia. I make sure the client is keeping the insulin in the fridge and doesn’t shake it which could inactivate the insulin. This is an opportunity for me to gauge if the pet owner has grasped the basic principals of diabetes.
As clients initially give injections they may feel more comfortable if their veterinarian shaves a spot of Fluffy’s fur so that they can see the skin better. Down the road we will ask pet owners to rotate injection sites, but initially clipping a spot may help while the pet owner gains confidence in technique.
I always hope that clients appreciate my extra attention when I diagnose a diabetic pet. To this point I’ve not yet actually smothered a client.