Hi everybody, my name's Sophie McMurra. I'm an RVN and a veterinary technician specialist or VTS in small animal internal medicine. I'm also a certified recovery rescuer and an author, one of which I've authored is the endocrine chapter of the BSAVA manual of Advanced Veterinary nursing.
I do also have a a social media platform called Veterinary Medicine Geek if you are on Facebook or Instagram. And I have the pleasure of talking to you today about feline diabetes. So before we dive straight in, I just have one slide just to recap the normal glucose regulation in the body.
We all need a little recap at time, so just to briefly touch on this. Glucose is absorbed via a few different methods, so either from the gastrointestinal tract when the patient eats a meal. It can be released from the liver after gluconeogenesis, and it can also be stored and released from skeletal muscle as well.
Tissue cells need glucose in order to perform their normal cellular functions, and that's every cell within the body. And then we have insulin which is required to send the glucose intracellularly so that those cells can actually utilise the energy or store it for use later on. Now insulin is produced by the beta cells in the pancreas, and this should be in response to the glucose in the bloodstream.
So it should be proportional to the concentration of the blood of the the glucose in the blood. So if we eat a really high sugary meal or a high carbohydrate meal which is converted into sugars, the insulin or the beta cell will have more demand to produce insulin and that insulin will be increased. To send that glucose into the cells and get it out of the bloodstream.
So when we look at diabetes mellitus, obviously we're talking about persistent hypoglycemia. And hyperglycemia is deemed as anything over 8.5 millimoles per litre.
We know that glucose is renally excreted by the renal tubules, and if it exceeds the renal threshold, which is around 18 millimoles per litre in the cat, depending which which textbook you read, then it will start to spill into the urine. When it spills into the urine, we then get glucosuria, which promotes an osmotic diuresis, and it does that because the the high level of glucose in the urine has an osmotic pulse which draws the water with it and activates the first sensors in the brain. So we will get a polyurea with a rebound polydipsia.
And it's also worth noting that if the patient is on glucocorticoid, so it's on steroids for any other reason, they can also get a mild hypoglycemic effect as well. Because we know that glucocorticoids promote activation of glucose in the liver via gluconogenesis. So if you do have any cats on glucocorticoids, have this in mind if you're thinking of testing for diabetes.
So diabetes is different in cats than it is in dogs, and usually it's due to a relative lack of insulin or insulin resistance. And the beauty of insulin resistance is it may not always be permanent, it could be reversible. And this is known as non-insulin dependent diabetes mellitus, which is also very similar to type 2 diabetes in humans.
Obesity causes insulin resistance. We know that, so typically we may see a lot of overweight cats become diabetic. And then with that insulin resistance, it causes the insulin to be hyper-seed because the the level that it's currently secreting is not effective because of the resistance.
So with that hypersecretion, that causes amylin release from the beta cells. This then accumulates in the islets, the pancreatic islets, and then we get cell death. So then we have a lack of sufficient insulin production off the back of that.
And if we have beta cell impairment to a large degree, it can cause an absolute lack of insulin production. This is then called insulin dependent diabetes mellitus. And some patients with non-insulin dependent diabetes will eventually progress and become insulin dependent.
But that's not to say that they can't revert back, depending on what the insulin resistance is being caused by and if it's something that we can reverse. We need to think of some of the insulin antagonistic diseases such as acromegaly is, the one that always springs to mind, chronic pancreatitis. You've got chronic neoplasia, things like chronic kidney disease can all play their part in causing an insulin resistance in cats.
And feline diabetic remission is seen in anything between 20 to 80% of cases depending on the study. Some say more like 30 to 50%. It just depends on the study that you read, but we know that a large proportion of them can go into remission, and we'll talk about that a little more in detail later on.
So signalment for diabetes mellitus in cats, it can occur at any age, but it's most common between the ages of 9 to 10. And we tend to see male neutered cats are overrepresented. Now the classical clinical signs of diabetes, which we need to educate our owners on are the PUPD which we mentioned earlier, because of that osmotic diuresis and the high glucose level in our urine.
The body then can't use the glucose as energy, so we become polyphagic to try and get energy from elsewhere. And weight loss is typically seen because the body will start to break down the fats to use as energy as well. We can sometimes see hind limb weakness in cats with a planar grade stance.
They can become cakeic with weight loss, marked lethargy, and if some, some pets, if they are overweight and they do start to to lose weight, you can see hepatic lipidosis and you'll feel hepatomegaly on abdominal palpation. And then you will occasionally see Paul Coate health. So the treatment goals of diabetes are to resolve clinical signs, to prevent complications such as DKA and hyperglycemia, and improve the quality of life.
And when I say improve the quality of life, that must be for both the pet and the owner. This is an absolutely huge journey for the owners. So it's them who will decide whether it's appropriate, whether they can continue and the type of care that they can provide to their pet.
So it's important that we Look after them as well as the pet on this journey and put ourselves in their shoes. If you work long hours, could you yourself look after a diabetic pet? Are you always in 12 hours apart?
And could you keep up with the the daily injections or the the long term management of these cases? So it is a very long-winded and can be a difficult journey. So we need to make sure that we have empathy when we're speaking to the owners because they are on this journey as well as the pet.
So to diagnose diabetes mellitus, we need a persistent fasting hyperglycemia, consistent clinical signs, which we've mentioned earlier, and a glucose urea as well alongside. Now remember the cats get stress hyperglycemia and this can cause a problem during the diagnosis phase. And stress hyperglycemia can go up to around 25 millimoles per litre in the cat.
Now I mentioned earlier that the renal threshold for glucose spilling over into the urine is around 18, so you can get glucosuria even just from a stressful episode from stress hyperglycemia if it goes up to 25 millimoles per litre. We can also look at fructosamine, so we know this is a glycosylated protein which reflects the glycaemic state over a longer period, so over 2 to 3 weeks. If you are testing with fructosamine, bear in mind that hyperthyroidism can reduce fructosamine level back to a normal level.
So if you are dealing with a hyperthyroid cat, have that in mind when you're looking at your figures and deciding when it's appropriate to do that test. Underlying causes of diabetes need to also be investigated to see what we're dealing with and look at the full clinical picture. And the blood work and urinalysis that we need should include a full biochemistry, haematology, urinalysis and a culture and sensitivity.
Now there are different treatment options available now, with SGLT2 inhibitors coming out earlier this year. So although there can be significant incidents of non. Insulin dependent diabetes, all patients still need to start on exogenous insulin or an SGLT2 inhibitor, if they're a suitable patient.
And we'll talk a little bit more about those in a minute. So unless they are a pre-diabetic and have a blood glucose less than between 7 and 10 at all times, then the cat should have an insulin or a SGLT2 inhibitor therapy. Insulin combined with weight loss in overweight cats is absolutely paramount and ideally they need a diabetic prescription diet.
I think often the diet is something which is deemed as less important than the insulin. However, if we're putting the patient on a, on insulin therapy or any type of diabetic therapy, and they're not on an appropriate diet and the carbohydrate is too high, for example, we're fighting an uphill battle. So yes, diet may not seem as vital, but it absolutely is in order to gain a normal, a good glycemic control of these patients and to allow our treatment to work and get the most benefit out of what we can provide to this patient.
So there are different insulin therapies available. There's the short acting insulin which is called neutral insulin. This one can be given IV or, excuse me, IV or IM as a bolus or even as a CRI.
It's effective within 30 minutes and it can last between 2 and 4 hours depending on the patient. And usually this is used for your diabetic ketoacidosis patients who are admitted to the hospital. And then we have our medium acting insulin, porcine insulin, which is also known as can insulin in the UK.
This is licenced for use in both dogs and cats, and it is the first choice under the veterinary cascade. It's given subcutaneously and it lasts around 12 hours, but significantly shorter in some cats and sometimes it's too short to actually be effective. And then we have our longer acting insulins, protamine zinc or glargine insulin, which is also known as Lantus.
So prozinc is currently not available in the UK, but it is licenced for the use in cats. It's given subcutaneously and it lasts around 12 hours. And then glargine or Lantus is used for cats, but it's off licence, given subcutaneously and it can last between 12 and 24 hours, so that one is very long lasting.
Glasgian insulin is the longest acting insulin therapy and it is becoming more popular for the use of feline diabetes. And in one study it was even found to have better glycemic control than. And higher rates of remission than the PZI or the Lenta, and this was up to 80% of patients that they looked at.
And then we also have the more newer drug to veterinary. This has been around in the human field for a long time, but we haven't had the benefits of using this drug in the veterinary field. SGLT2 inhibitors, which the brand name is Selvengo, which was released, I think early 2024.
Possibly a little bit earlier than that. So what this is, in our kidneys, we have sodium glucose co-transporters, and they do what they say on the tin, so they co-transport sodium and glucose back into the body via reabsorption in the kidneys. We know that we can excrete and reabsorb a lot of nutrients in our kidneys and our body will almost recycle them, so we, we reabsorb a lot of those.
It's a protein in the kidney and it it reabsorbs the glucose and the sodium back in, but if we give an inhibitor, it will inhibit that reabsorption. So instead of reabsorbing, it keeps it in the, the kidney, which is then promoted into the urine and is excreted by a glucoseura. Now it only mildly inhibits the SGLT one so that the body doesn't go hypoglycemic.
We know that we rely on this reabsorption, . Event. So we don't, it's not blocked completely, and the SGLT one inhibitor will will only partially have effect so that the patient doesn't become profoundly hypoglycemic off the back of this.
The dose is 1 mg per kg, once a day, and it's given orderly either straight into the mouth or on the patient's food. And they must be deemed as a, as a stable diabetic in order to deem them as a suitable patient. So it's not appropriate for any pets that are in diabetic ketoacidosis.
And according to the Salvengo website, they must be eating, drinking, maintaining their body weight, well hydrated, no diarrhoea, no ketones present, and have no clinical pancreatitis as well. So this is a small window of our diabetics. However, it's great to have that choice.
We know how much injections can put owners off or become. They can become very overwhelmed and over-faced by a lot of the things that come along with diabetes. So it is great to have this as an option.
Once the patient starts this treatment, the owner checks the ketones at home every 1 to 3 days. We monitor for signs of DKA and all of those symptoms coming in within the 1st 2 weeks. And then we reassess them in the clinic by doing a full TPR assess them for clinical signs and ketones on week 1 and week 2 in the clinic as well.
If the patient were to have any signs of DKA, you would treat it as a typical DKA and then because this drug is quite new to us on the veterinary market, there is a helpline for you to call Boringer so that you can get further advice to say this has happened, what would you suggest is the next, the next treatment. They do have vets and nurses working for them who can advise you on the next. And then part two of the treatment plan is diet, and as I said earlier, this is very important.
It needs to be a low carbohydrate with higher protein, especially for your cats. Wet food is great because it has that higher moisture content, and we know that they can become dehydrated easily. The patient, the pet needs to have the food measured so that they're having the same amount in each meal and it needs to be fed around the same time each day.
Now cats are different to dogs, so they can ad-lib throughout the day. This is the easiest if they just eat some kibble and graze on it throughout the day, that's absolutely fine. And ideally we want them to have no treats because again, any treats that are given will spike the patient's blood glucose.
And initially we want to reassess the patient's weight regularly. If they've lost weight, we want to see that they're gaining. If they are an obese pet, we want to see that they are are losing.
Now just to touch on obesity, obesity we know causes insulin resistance, so it is absolutely vital that this is part of their treatment plan and weight loss is key. And there are some studies here that show in the UK 39% of cats who are overweight or obese were juveniles, so that shows that cats are overweight from a very early age. So we can educate on that, even in puppies and kittens to prevent the obesity happening before it's already causing issues.
And in the USA, 60% of cats are classed as overweight or obese, so an absolutely huge proportion of them. Now when we introduce a new diet, it's even more important with the diabetic that we do it gradually. So again, tell them to mix the diet, don't just switch from one day to the next.
Mix it over 7 to 10 days. We must ensure that the patient is eating, so the most important thing for a diabetic is that they eat their food. So if you switch to a diet that they don't like and they don't eat, switch back.
There's no rush, this is a lifelong therapy, and we need to make sure that we're doing it correctly for the patient and not rushing any of these things. If the patient is not overly keen and they're only eating half their meal, despite having insulin therapy, then we're gonna start getting into the danger zone. So the patient eating is the highest priority.
And if the patient has a concurrent disease, choose the diet for the other condition over the diabetic diet. And if you are looking at a weight loss plan for some of the cats, the Royal Cannon satiety diet is great, and I've had really good results of switching patients to. And with regards to treat, I put this page in there because every time we speak to a diabetic owner, it's the lack of being able to give the pet a treat that really affects them.
And we mentioned about the quality of life for both the pet and the owner. Often that is something that is a really big bond for the owner and the pet, so. It can actually be really hard on them to not give their pets a treat when they're 10 years old and they've had it at 50 p.m.
Every single day for the whole of its life. And now they're they're begging for it and they're not allowed to give it. So I would always offer some suitable alternatives, so if they absolutely can't resist giving that treat, make sure it's low in sugar.
You can give some of their own kibble. So some of the kibble that they're usually on, just use that as a treat. We're also cucumber or cooked courgette.
Sounds like a strange one, but it, it goes down quite well with both cats and dogs, and it's low in sugar. So give them that suitable alternative so that they feel like they can still have a pet and the comfort that comes along with a pet. Because after all, 12 hours is a hell of a long time compared to what the owner will be used to.
And even myself, if I couldn't eat for 12 hours, I know that would definitely affect my quality of life. So the small things, we would like these patients to be textbook perfect, but life doesn't work that way. And actually I'd much rather have a pet who has a little bit of cucumber or a low sugar treat every now and again, than a pet who is put to sleep early because the owner just cannot deal with the really strict regime of a diabetic pet.
Now, the treatment goals of diabetes, again is to resolve clinical signs, prevent complications and improve quality of life. So just the three take home points that we need to focus. And then the number 3, the part, another part of treatment is exercise.
So we know that exercise plays a really good part in our hypogly in our normal glycemic control. It needs to be gentle and frequent and consistent from day to day. It will help regulate our glucose levels and it will also aid in weight loss.
So there's lots of different ways that the owners can can do this with cats. You can get the the treat balls where the the foods they have to play for their food. Again, do it gradually and don't just put the food in this bowl and expect the cat to know what to do and still get the same volume.
Make sure it's done, say, a small amount of the meal or a little bit of the kibble to try and promote them to work for it. You can use the the little tickle things which cats love on the end of a stick, like feathers and things to try and get them to chase it around. There's many different things that you can do.
It is a little bit more tricky with cats than it is in dogs, but the most important take home message for the owners is that it's consistent. We don't want an absolute huge amount on one day and nothing on the other, because they're going to use more glucose on one day and risk going into a hypoglycemic episode. And I've put a little caution message here because pet's going on holiday and exercising more this.
It's probably more applicable to dogs, but people do take their cats away as well, and we'll go for for walks or taking them out somewhere for hours on end. And not see a problem with that. I think they're treating their pet, but we need to make sure that they are not doing this sporadically on weekends and that they understand that that will burn off more glucose and will potentially become unstable.
So consistency is key and owner education is absolutely paramount. And then we know that infections can cause an insulin resistance and diabetics have a high glucose level in the bloodstream and also in the, the bladder, so infections such as urinary tract infections are more likely to occur. And bacteria can thrive off that glucose.
Infections, it's important to point out infections of anywhere can cause an insulin resistance, so whether it's the skin, the ears, the ordinary tract, if the patient is, has any of these a diagnosis, then they do need to be treated, or if this patient suddenly becomes unstable, we need to look out for signs of these as well. And it is really important that we treat the infection rather than leave. Water access, absolutely vital for diabetics.
So again this owner education comes in if they go out and they're on a long 10 hour shifts, we need to make sure that pet will always have access to water. Remember that osmotic diuresis will draw the water out, so they are, it's out of their control. They need to have that rebound polydipsia to compensate for that.
Or it can become really severe with dehydration. And if it is bad enough, they can get a go into a coma or it can even cause them to to die. So large water bowls and fountains and a few of them dotted around the house, if they are times.
And then management is, there's many different ways of managing diabetes and your nurse diabetic clinics are absolutely paramount for this. So we can advise how to inject, but also just go over all of the different aspects of diabetes and why they're all important and spend some time to build a relationship with this owner. They're likely to this pet will have this for life potentially, and we need to make sure that we are approachable and someone that they can ask questions to if if needed.
Because this is brand new to them, it's a big life change and it is important that we have them on board in order to successfully treat the pet. So freestyle Libras are really useful. We can place these and then monitor the glucose trend from the first injection.
7 to 10 days for the patient to adjust to any new insulin regime. So remember, educate the owners that if we change the dose, it doesn't happen overnight. The body has to get used to it and it can take 7 to 10 days for that adjustment to occur.
So patience is key. And then we can review the results weekly and then titrate the dosage up if need be. But stab stabilisation of the diabetes with good glycemic control can take between 4 and 6 weeks depending on the patient.
So again, it's not an immediate effect. And if the patient does go into a good glycemic control, then they can start to enter remission within 2 months of therapy. Insulin doses should not be increased by more than 25% at a time, ideally to prevent hypoglycemia, and the Libras will allow you to alter or to monitor the glycaemic trend.
So they're especially useful during early diabetic management and around the time of any insulin, adjustments, dose adjustments. Now, feline diabetic remission is is achievable in some cats, between around 30 to 50%, depending on the study. Typically, It happens within the 1st 6 months of treatment and after that the likelihood of it occurring does reduce, but it's not impossible.
And if the patient has concurrent diseases, maybe they have pancreatitis or neoplasia or CKD or some other long term disease or lifelong disease, we may not be able to achieve remission, so it may not be a possibility for those patients. And if we, as we are approaching remission, we should be able to progressively lower the dose of insulin until the insulin can then be stopped without hypoglycemia occurring. And again, your freestyle Libra is really helpful to guide you on this.
And once the patient is in remission, they are not out of the woods yet. We need to make sure that that weight management is continuing so that they don't just pile on the weight again and become insulin resistant again, and they need that diabetic diet or the low carb diet afterwards as well. So we can't just bounce back to a normal life.
We need to prevent this from happening again, because they can go back into remission even once they, once they are there. So maintenance is key at this stage. And then because they can bounce back into a diabetic state, we need to educate the owners on what to look out for.
So the PUPD, the polyphasia, and the weight loss so that they can monitor and look out for those signs at home. So what does a stable diabetic look like? So a stable diabetic should have a good appetite, but not be ravenous.
They should drink normal amounts, urinate normally, maintain their body weight. And have no signs of hypoglycemia. That this can take months and sometimes it's not always possible, and it does require teamwork so that the owner is not in this alone, neither is the vet.
The nurse can also play a huge part in this, and I myself do a lot of our diabetic check-ins weekly. I'll have instructions from the vet to say, find out how they're doing, if they're OK, and their glycemic control looks OK on the freestyle Libra. Check in with them.
If this meets X, Y and Z, we will alter the insulin by this volume. And I can then relay that message, check in, educate the owner, and then decide that next step based on what the what the vet has has requested. So the vet doesn't need to be the one doing all of this work.
Teamwork is absolutely vital. And then glucose monitoring, obviously you can have do your glucose curves if you still require, if you still still wish. However, I do personally really like the continuous glucose monitoring devices, the freestyle Labra 2.
You can do your fructosamine, which gives you a value between 2 sorry, over the 2 to 3 week period. And when we're educating the owner, make sure that you tell them what the normal glucose range should be. Often patients will come back in and have a nurse clinic and they don't actually know what they're aiming for.
But remember that we're not always, we're not aiming for a diabetic to go between, say, 3 and 8.5. We're aiming to resolve the clinical signs and improve their quality of life without complications.
So. We're, we're not aiming to get to within that normal glycemic range, the teens is absolutely fine, providing the clinical signs have resolved. So owner education is key.
And the, just to touch on the continuous glucose monitoring devices, they are human sensors and it's just a small disc which with a subcutaneous needle. It doesn't measure blood glucose, it measures interstitial glucose. And there is a slight lag between blood glucose and interstitial.
So I tend to explain it to the owners in a way of picturing train carriages. So the first carriage is the blood glucose, but the interstitial are the carriages behind. So they will tell you the same thing.
There's just a slight lag. So if you're ever in doubt and maybe it's going, you think it's giving you hypoglycemic, reading, jump through your glucometer and get a blood glucose, because that will tell you what it is right now, rather than 15 minutes ago. In case you need to act on it.
It comes along with a mobile phone app and you can use this with pretty much any phone and the phone then just scans the sensor that's on the pet's skin. And each scan will tell you the current glucose level, and then we'll give you a trend of the next 8 hours. You need to make sure you're scanning it as an absolute minimum every 8 hours, but.
More often than that will be really helpful. And it also has an arrow up or down on a sharp arrow or a gradual arrow to tell you which way it's currently trending. You can also set alarms for hypoglycemia and you can tailor these to within certain time frames or whichever values you like to, you would like to be alerted.
When you're placing the freestyle Libra, this is a nursing skill. A vet does not have to be placing a freestyle Libra device. Give your nurses this credit, give them that involvement with these patients, and step away from the freestyle Libra.
So allow your nurses to do all of this. They will liaise with you and it will be a much easier journey for all of you. And again, I've mentioned a few of these pointers to say what a little bit more detail on what we can do and how how we can place them.
It's super easy. The blood glucose curve that it gives you allows you to see any peaks and nadis. It gives you a more detailed picture and it allows you to make easier decisions with your treatment therapy because you can see every minute of the day if you, if they scan it frequently enough.
Unlike some of the old dexcom . Sensors, it doesn't need any calibration. You literally scan it in the console when, when it's been placed and it takes 1 hour and then it will start working.
And you can get up to 14 days of action. Sometimes we will see that, but it is a human device. Humans are not as agile as pets, and they also are not as fairy usually.
So by day 14, there's a decent amount of hair growth underneath that sensor again, so sometimes they can come off, they can be scratched or removed by the pet, or they can just stop working. The lateral thorax, which you can see on the the cat in the top right hand image, has been shown to have the lowest attachment rate. But you can put it anywhere, just not directly over any bony areas, but you can put it on the lumbar muscles, on the flank, and you can see it on this, this dog down at the back.
I've put it on some of the muscles between between the shoulder blades. So have a good feel of the patients and decide where you think is best to place it. And again, we know the stress hyperglycemia is big in cats.
We want to minimise that to get the most accurate reading. This allows us to get that with the lowest amount of stress, interference, and also pain. If you think of a blood glucose curve, one little pinprick may not have, but by the time you've had 8 or 9, it's really tender.
And it can be quite painful for the pets, which will then start to increase the glucose every time they come back into that situation. Now there are some downsides as well, the device will read high above 27.8 because it's a human device and humans don't often go much higher than that.
And then it will just read as low, anything below 2.2. So there are some limitations, especially for the brand newly diagnosed who can sometimes sit in the the high 30s.
And as I said before, if there are any signs of hypoglycemia, blood glucose should be checked because it is, it does have a slight time lag of, we believe about 15 minutes. Now this is an example of the data that you can see on the Leb review account. So you can make a practise account and then you just sign the owners up.
You need their name, not the pet's name, so it's a human device. The 1st and 2nd name, their date of birth and their email address, and then it will just link up every time you place a new Libra, as soon as it's scanned by the owner, we will then see all of that details. So you can see on the left-hand side of the screen there's many different screens that you can look at to assess the data.
My favourite is the daily log, and this is an example of the daily log. So don't pay too much attention to the colours because this again is a human device, but you can see the white numbers here. So this is the highest and lowest within each hour of the day.
And you can see where they are within the teens because they're the white numbers. Anything higher or lower than that is in orange. You can see there's a small apple.
I don't know if you can see my pointer on the screen, but there's an apple and it says 4.5 units and 3.5 units.
So the owner has added in this information, so the apple is where they fed the patient and then that's how many units of insulin it's had as well. And then there's also an area where they can leave notes so you can see underneath she's written 80 grammes of chicken, 80 grammes of chappy, and 5 grammes of kibble. But then if you go down to the bottom area, you can see around 4 p.m.
The patient's gone down to 3.4. And again, she's left some notes and there's an apple there, so exercise.
So we know the likelihood is the patient's gone out for a walk, it's utilised more glucose than it usually does, and it's caused a bit of a hypoglycemic episode. And then underneath she's written, sorry, walk, sorry, I thought he would be OK as he was 16 plus. She's given cucumber, 5 grammes of kibble, 80 grammes of chicken, chappy, and some more kibble there as well.
And then you can see the trend heading back up. And when I spoke to the owner, I could then praise her to say, Well done, you've identified the hypoglycemia, you've identified what caused it, and you've acted appropriately. So pat on the back, brilliant work, well done, because this is scary for them.
For us it's something that we see daily. For them it's their pet that they love and they, the last thing they want is thinking that they've done something wrong. So they need that reward as well to say, you know what, next time a hypo happens, you know exactly what to do because you've acted accordingly.
So it gives you so much information more than what a glucose curve can do, and it's non-invasive, the pet's going out walking, it's eating, and we can just see it all from a distance. So we mentioned about quality of life earlier. I've had a look at a few different journals and articles, and one that was quite interesting.
Obviously this is from, this is data collected from owners, so take it with a pinch of salt. We know that what we say and what they hear can sometimes be very different things, but it is useful to see what they have taken home from a a consult after a diabetic diagnosis. So there were 750, just under 750 questionnaires, and some of the info that came from that was at diagnosis.
46% of vets discussed the signs of an unstable diabetic. If they don't know what they're looking out for when we're history taken to see are they drinking more, they won't have really paid attention to that. So we won't really get an accurate picture.
40% discussed home blood glucose monitoring. 49% supervised the first drawing up and injecting, which I think is is quite astonishing. And even just drawing up, we, you know, that's completely simple and easy for us, but it's something that the owners really struggle with getting that dosage correct and the use of a needle and syringe.
And then 76% of owners found the most useful information on websites and forums when learning about diabetes. So that tells us we may need to give them more handouts so that they don't have to go on Doctor Google as much. I know we can't prevent it, but 76% is huge.
45% were confident identifying hypoglycemia, so less than half. But then if you look at the average vet consult in the UK it's 10 to 15 minutes. So how do we expect vets to cover all of these things in 10 to 15 minutes, as well as the insulin therapy, what diabetes is, lifelong management, it's absolutely impossible.
And that's why it needs to be a team approach, because your nurses can have that bit more flexibility. And we can spend the time with the owners to talk about all of these things in a diabetic nurse consult. And when the owners were asked if there was anything that could have improved the quality of life for both them and the cat, they wished the veterinary team were more knowledgeable on the role of diet in treating diabetes, and I do agree on that.
I often think that the diet comes second and the focus is on the drug, but actually, It's, they both play a really vital part. You shouldn't really have one without the other, or the treatment just won't be as effective as we as we wish. And the most significant factors to the owner were insulin, switching to a low carb diet and home blood glucose monitoring.
So take from this, the nurses involvement and if you don't currently have nurses involved in diabetes in your practise, try your best to promote them, get the nurses involved and see if you can have a more team approach because. There's a huge gap between what the vet is able to deliver in 10 to 15 minutes of a consult and what the owner needs and where they're going to get that information. We have a qualified professional RVN who can give them that info so that they don't feel the need to get all of that information from the from Google.
And there are a couple of tools that are really useful. There's a Quality of life tool which you can get from the RVC. It's just called RVC Pet Diabetes app.
And this feedback they can fill in the quality of life tool and the, it's then emailed over to us. So if we tailor our consultation or our phone consults to say, OK, I've received the quality of life questionnaire from the owner, I can see that actually they're really concerned about going on holiday with their pet. Well, the next time we call them, we can say, why don't you place a freestyle Libra so that you can still see the glucose control, and we can still see it while you're on holiday.
Your friends can have the app on their phone or whoever's looking after the pet, and you can come in and we can teach your your friend or your family member to how to inject as well. There's many different things that this questionnaire allows us to have an insight into what the owner deems as worrying. Because what is worrying to us may not be the same for them, and what they may worry about now with the initial diagnosis may change 12 months down the line.
So it's a really useful tool for us to use so that we can continue that journey and continue to try and improve the quality of life. And when looked at, when I looked at the quality of life feedback, the owners would like to have more control and be more empowered to manage their pet's diabetes. And we can do that through education, education so that they feel more empowered.
And then finally, nurse clinics check-ins and support of absolute paramount importance. Diabetic handouts are really useful so that the owner can absorb the rest of the information that you've given them once they're at home, relaxing and not in that clinical environment. It's a hell of a long time to take in all of that brand new information.
I've been in RVN for over a decade and I still don't know everything about diabetes, so to expect them to know exactly what to do confidently in a matter of a 15 minute consult is unrealistic. We can continually monitor the glucose on the devices regularly, call weekly to begin with, and again, this can be a nurse just to check in, see how they're getting on. Is there anything that we can drip feed any more information?
And then once they are stable, you can obviously reduce these check-ins and reiterate the dangerous symptoms of hypoglycemia and how to act on them. So the prognosis depends on the client, their commitment, the concurrent diseases and how well the patient responds to the to the diabetic treatment. The mean survival time is around 3 years, but it can be up to 5.
And the 1st 6 months is the most critical period in determining the outcome, both for whether the owner is bought into this lifelong, whether the pet is going to respond to the treatment, and also remember that 1st 6 months is when remission is most likely to occur if it is going to. That's all from me. Thank you very much.
I hope you've enjoyed it and found some useful tips. If you do like internal medicine, please go on Facebook or Instagram and follow my page, veterinary nurse Medicine Geek, where I regularly put on reviews or tips on all things internal medicine. Thank you very much and have a good evening.