April 06, 2018

Newly Diagnosed Diabetic Pets

Richard Goldstein, DVM, DACVIM, and Ruth MacPete, DVM, outline the conversation they have with owners when their pet is first diagnosed with diabetes and suggest tailoring treatment—including insulin, diet, exercise, and monitoring—based on the owner’s lifestyle.


Richard Goldstein, DVM, DACVIM: Let’s talk about treatment. Obviously, the diagnosis is made. Do you like to have the conversation with the owner in person, by the way?

Ruth MacPete, DVM: I do. Obviously, sometimes we end up talking on the phone if we’re calling somebody with lab results. But then I like to have them come in and talk to them, because I definitely think this is something that we want to give them literature for. We want to make sure we’re answering all of their questions and we’re really talking to them about what it means for their pet to be diabetic.

Richard Goldstein, DVM, DACVIM: I think we talked about this, but we’re going to have to tailor the treatment to the animal—to the pet, to the cat or the dog—but also to the owners and to their lifestyle and to their level of comfort. Sometimes, in a diabetic child or a diabetic person, it’s really important to have really tight regulations because of long-term effects of diabetes in people: the vascular affects, the renal affects, or the cardiac effects. Our goals are different in dogs and cats. We don’t have to have that kind of tight control in checking glucose every hour before every meal. How do you feel about our goals in having a diabetic pet?

Ruth MacPete, DVM: I agree with you. I think in veterinary medicine it’s important for people to know that our goal is to obviously ameliorate the clinical signs. We want a pet to not have to be urinating all of the time or urinating in the house, because that’s one of the things that’s hard as a pet parent. If the pet is having accidents in the house, if the pet is visibly lethargic or not doing well or losing weight, that’s stressful to the pet parent. Obviously, we want to get rid of the clinical signs. Another major goal in veterinary medicine is to prevent hypoglycemia.

Richard Goldstein, DVM, DACVIM: Hypoglycemia meaning?

Ruth MacPete, DVM: Meaning low blood sugar.

Richard Goldstein, DVM, DACVIM: Low blood sugar.

Ruth MacPete, DVM: Yes. When we’re starting treatment with insulin, we need to make sure we don’t go in the opposite direction and that we don’t lower their blood sugar to a dangerous level. With people, because they can talk, they know they’re not feeling well and they know to eat. With an animal, especially an animal that may be eating only when the person’s feeding them twice a day, they can’t communicate when they’re becoming hypoglycemic. It’s really important for us as a veterinarian and the pet parent to be in tune with that and make sure that when we start treatment, the pet parent knows what to look for with those signs and that they understand the normal clinical signs and some of the complications of treatment or diabetes itself.

Richard Goldstein, DVM, DACVIM: If anything, we err a little on the side of slightly higher glucose.

Ruth MacPete, DVM: Yes.

Richard Goldstein, DVM, DACVIM: Because what we’re really afraid of is hypoglycemia that can be life threatening.

Ruth MacPete, DVM: Yes.

Richard Goldstein, DVM, DACVIM: We talked about treatment a little bit before, but what are the areas that we talk about? There’s diet, there’s the insulin, and there’s exercise, so weight loss.

Ruth MacPete, DVM: Yes, and then home monitoring is another really important one.

Richard Goldstein, DVM, DACVIM: And home monitoring treatment.

Ruth MacPete, DVM: Yes.

Richard Goldstein, DVM, DACVIM: How do you try to tailor your treatment to the lifestyle of the dog and of the parents?

Ruth MacPete, DVM: I think it depends on the pet. The first thing you talked about was diet. It depends on the pet. With cats, and you mentioned this earlier, diet is really, really important. Recent literature and recent studies have shown that cats being on a low carbohydrate, high protein canned diet…

Richard Goldstein, DVM, DACVIM: The catkins diet.

Ruth MacPete, DVM: Yes, it’s really beneficial for them. It helps not only with weight loss but also to control their blood sugar levels throughout the day, and changing their diet coupled with insulin therapy has really shown that if you catch diabetes early, in the first 90 days, we actually have pretty good success with getting cats in remission. Not all cats. But again, the earlier it’s caught, the more likely there’s a chance that a cat can actually go into remission, meaning that they won’t need insulin.

Richard Goldstein, DVM, DACVIM: Right, similar to people. People with type 2 diabetes, if they’re good with their diet, if they exercise, and if they lose weight, can often definitely get off insulin and often off of all drugs. Cats are just in that same category.

Ruth MacPete, DVM: Yes.

Richard Goldstein, DVM, DACVIM: Not so lucky with dogs, though.

Ruth MacPete, DVM: Yes. The one thing I would mention is they’re not necessarily in remission forever. They are still an animal that needs to be monitored. Some cats are in remission for months to years and then eventually will need insulin. It’s something that people are still going to have to really monitor and pay attention to and work at with their veterinarian. But that’s really our goal. If we can get a cat in remission, that’s great. Again, we’re trying to get rid of the clinical signs and make sure that the pet has a good quality of life and doesn’t have any kind of hypoglycemic episodes.

Richard Goldstein, DVM, DACVIM: Right.

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