SCoVE February monthly leaflet 2016

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Client Communication on Feline Diabetes Mellitus IVSA Standing Committee on Veterinary Education (SCoVE)

What is Diabetes Mellitus?

Diabetes means “to pass through” (large urine volume) Mellitus means “sweet” (glucose found in urine) Diabetes mellitus (DM) is a metabolic disease seen commonly in about 2% of cats. Most cats diagnosed with diabetes require lifelong insulin treatment. The correct diet, drugs, type of insulin, and the cooperation of the owner and the animal are vital to the success of the treatment. To achieve this, clear communication between the veterinarian and the owner is necessary.

Pathophysiology Type 2 DM occurs in 90% of cats! (Type 1 is more prevalent in dogs) Over-presented in Burmese cats in many countries Mean age of onset is 10 years Obese, neutered male cats are at risk

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Etiology

Clinical Signs Most common: (Simple DM) o Polyuria / Polydipsia o Polyphagia o Weight loss (cats may be obese or thin) o Dehydration

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Others: o Exercise intolerance o Ketotic breath o Recurrent infection (urinary tract infection, conjunctivitis) o Hepatomegaly o icterus

Diagnosis Clinical Signs Blood examination ü CBC – usually normal ü Biochemistry – persistent hyperglycemia ü Urinalysis – glucosuria, ketouria ü Fructosamine – elevated ü Glycosylated hemoglobin - elevated Intravenous glucose tolerance test for early screening Determine plasma insulin level

Treatment for Simple DM ü Dietary therapy with low-carbohydrate/highprotein and high-fibre/low-fat diet (owner cooperation) ü Insulin injection (animal cooperation) Read more at http://www.cliniciansbrief.com/article/diagnose-treatfeline-diabetes-mellitus

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Client Communication CommCommunicationCo “Your cat has type 2 diabetes mellitus.”

Many clients express shock and distress after hearing the diagnosis. You must allay the fears and explain that the disease is treatable and emphasize that successful management requires high level of care and strong commitment from the caregiver.

Most clients are concerned with the insulin injection process and the demanding injection schedule. You must stress that it takes the time, financial, and emotional commitment to successfully manage the disease.

Once the client is committed, comfortable and accepting the diagnosis, you may begin the instructions for insulin injection.

Equipment Inform clients that the proper syringe should be used to prevent under or overdosing. It is vital to teach the owner how to measure the dose as overdosing will cause hypoglycemia.

Injection Insulin injections can be given between the shoulder blades in cats with a good body condition, whereas for emaciated cats it is best given at the hip.

This should be demonstrated to the owner. The client can perform and practice mixing, dosing, and injecting at the clinic until you are satisfied.

Some clients are unsure if the injection is delivered into the skin, especially when the cat is long haired – You can clip a patch of hair and create a target area for the client. Change the injection site every few days to prevent injection-site fibrosis.

If the client is unsure, skip the dose and proceed normally to the next scheduled injection.

Skipping an occasional dose is usually harmless, but overdosing can be disastrous!

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Most cats are given insulin injections twice a day, given 12 hours apart. Client should make every attempt to give the injection at the designated time. If not, the client has a two hour window before or after the designated time to administer the scheduled injection. If the window is missed, skip the dose and continue the injection at the next scheduled time.

If the caregiver cannot meet the demand of the frequency of the injection, a plan should be formed if the duty is divided among other family members, such as posting a calendar and affix a pen at the refrigerator where the insulin is kept to avoid confusion and improper dosing.

“Does that mean I can’t go on a vacation?”

Since the insulin injection is life-long, the owners may feel overwhelmed with this demand. Assure them that there are many other options, such as leaving the cat at boarding services where they can also professionally administer insulin. Or teach an adult, such as a trusted friend, the injection routine and the proper feeding.

Complications Hypoglycemia – Usually a result of insulin overdose due to confusion on injections among family members Clinical signs: weakness, ataxia (best described to clients as “drunken gait”), lethargy, staring into space, seizures, or coma If clinical signs show, the caregiver should immediately give normal food to the cat. If the cat is unwilling to eat, rub corn syrup onto its gums or force feed by the use of a syringe, unless the cat is a having a seizure or is in coma. The signs should resolve in a few minutes, but if it persists, the owner must contact the veterinarian or take the cat to the ER. Client will find the description of hypoglycemia distressing, assure that it is uncommon and chances can be minimized with careful planning.

Read more at http://veterinarycalendar.dvm360.com/feline-diabetesmellitus-important-client-communication-pointssponsored-intervet-schering-ploughan?id=&sk=&date=&%0A%09%09%09&pageID=2

Diet Inform the client that diet plays a crucial role in diabetic cats as obesity is a major factor that affects insulin sensitivity. A high protein/low carbohydrate diet is best for weight loss, or opt for a high-fiber diet if the first diet is unpalatable, or if the cat has concurrent renal failure.

Monitoring Serum fructosamine can reflect the cat’s average blood glucose over the next two weeks. Tell owners of newly diagnosed diabetic cats that a baseline serum fructosamine level is necessary to establish the starting point and that serum fructosamine levels need to be checked two weeks after any change in insulin dosage is made to determine if the new insulin dose is adequately controlling the diabetes.

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IVSA SCoVE hope you enjoyed this short but useful leaflet on Client Communication on Feline Diabetes Mellitus. SCoVE is here to support you on your veterinary educational journey. We always appreciate feedback and if you would like us to produce leaflets on other topics then please do not hesitate to contact us via our Facebook Page! We also have the IVSA Vet Education Forum group on Facebook to connect with students globally and to share and support one another with educational material.

Good wishes from SCoVE Committee!