A new set of notes on “key essentials” of diabetes mellitus in pets has been produced to assist vets in general practice to manage their diabetic cat and dog patients. The guidance was published in the March issue of UK-Vet Companion Animal, together with further information and discussions around the management of diabetes mellitus in dogs and cats, and has now been made available free. https://www.magonlinelibrary.com/doi/10.12968/coan.2018.23.3.143
The guidelines came out of a roundtable held in London in November 2017, attended by veterinary surgeons and veterinary nurses from the UK, Europe and (via Skype) Australia, with considerable experience and expertise in the diagnosis and management of diabetes. A high degree of consensus was reached on the essential points regarding pathogenesis of diabetes mellitus, monitoring and instability, owner considerations and the requirements for successful treatment.
Diabetes mellitus is probably better considered as a syndrome rather than a single disease. Management of diabetic pets is complicated by the fact that while they share the basic clinical signs of polydipsia/polyuria, polyphagia, and so on, the pathophysiology underlying the condition is complex and varies not only between species but between individuals within the same species. The classifications traditionally used for human diabetes – type 1 and type 2 – are not applicable to dogs and cats, which can lead to confusion when discussing diabetes with owners. In some cases, where an underlying cause can be addressed, it is possible to cure the diabetes or achieve temporary or permanent diabetic remission. But in most cases, lifelong treatment with twice-daily injections of insulin will be needed.
Key points highlighted by the discussions included: the importance of the clinical condition and signs of the patient to guide treatment, rather than numbers for blood or urine testing; and the need to consider common and easily treated causes of diabetic instability, such as insulin administration errors or urinary tract infections before looking for more complex causes. Teamwork, both within the veterinary practice and including the owner, is paramount for successful treatment to maintain a good quality of life for both the diabetic pet and its owner. An agreed practice policy for diabetic management, and making use of diabetic nursing clinics, are both highly beneficial, while making the treatment regime practical (e.g. injecting at 8am and 10pm if necessary, rather than 12-hourly) is vital.
During the roundtable, Stijn Niessen, an internal medicine specialist at the Royal Veterinary College, emphasised that ‘the goals of treatment are to ensure good quality of life of the pet and its owner’ – noting that the disease and the treatment required put a great deal of strain on the bond between pet and owner. Nicola Ackerman, a highly experienced veterinary nurse, added that ‘owners often find their pet’s diagnosis of diabetes mellitus overwhelming, and they don’t always tell the vet that’ – which is why having time with a nurse to discuss the condition is so beneficial.
Dr Debra Bourne MRCVS, the Editor of UK-Vet Companion Animal said: ‘Given the range of specialists involved in the roundtable, and the diversity of backgrounds, it was great to see such a high level of consensus developing on so many points. I am confident that the ‘key essentials’ will prove incredibly valuable for vets in practice, helping them to make better use of the available detailed guidelines on diabetes in dogs and cats.’