Dr. Jennifer
Why does my vet not know enough 
about diabetes mellitus?

 
This question was posted on the Rainbow Pet Diabetes Email List.

Hello List

In Defense of Vets you must understand that we are expected to learn about every animal species and every disease in a matter of 4 years unlike human doctors who just learn the human body.  Therefore, we know a lot about a little.  And when you graduate, you have a a lot of book training, but not actual hands on stuff.  Unfortunately Vet School does not teach compassion among a lot of other things so you have to be comfortable with your vet and trust his or her judgement.  And just because you pass Vet School does not mean you have an overabundance of common sense, which in  my opinion goes A LONG WAY in this profession.   There are a lot of scary vets out there...every body makes mistakes, but the difference is admitting you don't know something versus just acting like you know.  Now I have only been out of school for 4 years, but feel very well versed in many areas and since my cat is diabetic I have first-hand personal experience what it is like which makes it easier for me to relate to owners with diabetic pets.

When it comes to health care whether it is for yourself or your pet, you must be proactive and do your research.  Be willing to listen to your vet.  If you have questions don't be afraid to ask.  If your vet doesn't have time or want to answer your questions, get another vet.  But also remember your vet is very busy and may not have an hour to sit and chat with you and if you have a consult, you may have to pay for it.  Your vet is trained and has the knowledge to treat your pet, but may lack experience.  You can ask how many diabetics has she/he treated.  We don't have tons of diabetics at our clinic but a few dozen for sure.  And yes we are in general practice so we see everything under the sun, do surgery and dental work, take x-rays, treat allergies, skin problems, etc. so bare with us.  There are internal medicine specialists if you want a specialist, but not really veterinary endocrinologists.  And you will pay more for the specialist opinion.  I hate to say it, but in every day real life practice, I have more people concerned with money than the well-being of their pets.  I am not saying that I would be able to afford to drop a grand on my pets, but I would do it.  Now I am sure you guys on this list go way above and beyond the call, but clients complain about their pets having to stay in the hospital, the price of the blood tests and the price of the prescription diets.  I have people who REFUSE to treat their diabetic pets as well.  Enough about that...it really gets me upset because I went to school to treat animals not worry about money issues....and they don't teach you about that in school either.

Diabetes is a complex disease process...it may be induced from steroids (prescribed or naturally occuring due to disease like Cushings), due to obesity, pancreas exhaustion or immune system disease.  Diabetics are also prone to other health concerns like cataracts, recurrent urinary tract infections and pancreatitis.  And we don't understand everything that goes on in the body. 

Diet is a major concern when having a diabetic pet.  I feed my cat the new Purina DM food because cats are not small dogs and they seem to do better with a high protein, high fat diet since they are obligate carnivores whereas a dog does better with low fat, high fiber diet (like diabetic people) to reduce blood sugar spikes after eating. I do also recommend Prozyme or some type of digestive enzyme supplement.  If you can cook for your pet, that's great as long as it is balanced.  There's a lot of preservatives and dyes in commercial food, but convenience usually wins and owners choose to feed kibble.

Now I currently do not have any owners who do home blood testing--mostly because no one really wants to.  All dogs I have owners check urine every morning before insulin.  All my dog patients are on TWICE daily insulin (either Humulin N, Lente or 70/30).  If the sugar is negative in the am, I have owners decrease insulin dose by 1-2 units, if trace sugar they keep the same dose and if +2 they increase insulin dose by 1-2 units.  Always feed before or during insulin administration.  Often give a snack mid-day and then repeat insulin and feeding at night.  Most of my cat patients are on Humulin U insulin ONCE daily but a few are on twice daily with Humulin N.  Some cats eat w/d but I prefer the DM due to above comments
 http://www.purina.com/institute/news.asp?article=232
Research has showed some cats required less insulin on DM diets.  Cats are really hard to check urine but Purina has come out with GLUCOTEST urine strips for the litter box 
 http://www.purina.com/institute/news.asp?article=399
Personally, I use them on occasion for my cat, but it's difficult with 2 cats in the house.

As far as monitoring, I now prefer doing FRUCTOSAMINE levels which monitors regulation over the past 2 weeks and stress does not affect this test unlike a blood glucose curve.  Dogs are much easier to do curves than cats.  Initially if the diabetic is stable, I will show the owner (or have tech show owner) how to give the injections and start on a low dose of insulin (0.25 Units per pound of body weight) and then in 1 week do a blood glucose curve--it does take the body some time to get used to the insulin.  If the animal has Ketones then that is a different story and the pet MUST be hospitalized for fluid therapy.

I always give owners a packet that explains how to draw up insulin, rolling the bottle versus shaking, the importance of diet etc.  Also, tell people only give half the insulin if the animal does not eat.  If the animal is sick, call the hospital before giving insulin.  I try to inform my clients as best as possible...now whether they listen, is another story.  I often run into the situation where the husband comes to pick up the pet, but the wife will be giving the shots and mis-communication between couples happens a lot more than not.  There are a lot of variables with each individual patient but having something written down helps A LOT!!  And I always try to write instructions down because  I know I forget if I don't write things down....we are only human.  So, that's my blurb.  I am not sure if I answered the questions or settled any contoversy but that's my story and I am sticking to it :-)  Gotta go cause ER is on now!!!

Dr. Jennifer

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