The latest in pet diabetes - An interview with Linda Fleeman.

Dr Linda Fleeman runs Animal Diabetes Australia, which is a clinical service that specifically caters for diabetic dogs and cats in Melbourne. Linda is an internationally renowned expert on the treatment of diabetes in dogs and cats and is regularly invited to speak on this topic at international and national forums. Throughout her career, she has worked in both university and private referral practice, and her primary focus for more than 20 years has been on all aspects of diabetes in dogs and cats. For more information, visit Animal Diabetes Australia

The Interview

WHAT ARE SOME OF THE BIGGEST CHALLENGES THAT GENERAL VETERINARY PRACTITIONERS FACE WITH DIABETIC CASES?

The thing that is unusual with diabetes is that the treatment and monitoring have to be done by the owner which is a challenge. The standard approach in general practice when the animal comes into the practice and the vet does the treatment, monitoring and diagnosis is different when it comes to a diabetic pet. This does not work with diabetic pets. Monitoring is best usually done by the owner. This is where the difficulty lies.

WHAT IS THE LEAST UNDERSTOOD ASPECT OF DIABETIC MANAGEMENT?

There is a lot of day-to-day variability in diabetic pets. The idea for diabetes to be stabilized in diabetic pets is not realistic. Symptoms and management vary day-to-day. Therefore it is necessary to check and monitor diabetic pets to see what is changing on a daily basis for the pet. This is a confusing problem for vets and owners. Vets and owners often get scared as to why their pet is changing on a daily basis however this is the case for most diabetic pets as they often do have day-to-day changes.

WHAT ARE THE TOP CAUSES FOR AN UNCONTROLLED DIABETIC DOG?

1. The animal has more than one underlying disease

2. The owners find it very difficult to match food consumption with insulin action

3. Not understanding the day to day variability in diabetic dogs

4. Inadequate monitoring information

WHEN IS THE BEST TIME TO REFER A DIABETIC CASE TO AN INTERNAL MEDICINE SPECIALIST?

It is different for every case and for every pet. There are three parts to the management of diabetes in a pet. And that is the pet, the owner, and the vet. All three have a role and thus there are differences when referring pets to a specialist. For example, in some cases, the vet may decide that it is for the best that the diabetic pet goes to a specialist immediately to get started. For that specific pet, it may be more efficient to go to an expert right at the start so all questions are asked and are implemented into place from the very start. In other cases, the vet may monitor the owner and the pet and see they are both comfortable with managing diabetes. Not every diabetic animal is complicated and some are easy to manage and thus referral is not required immediately. In addition, when it is a complicated case or a case that is just beyond the vet’s capacity to manage the pet in the general practice setting it is also a time to refer the pet to a specialist.

ARE THERE ANY RECENT UPDATES IN DIABETIC MANAGEMENT THAT YOU CAN SHARE WITH OUR VETERINARIAN MEMBERS?

• The new insulin treatments on the market makes diabetic control easier and safer

• Different ways of monitoring (flash glucose monitor) allows the owner to have quick and easy continuous glucose monitoring done at home. With this, a simple disc on an animal can allow for continuous glucose confirmation makes it innovative, easy, and fast which changes everything.

WHAT ARE THE KEY HOME CARE RECOMMENDATIONS FOR PET OWNERS MANAGING THEIR DIABETIC PETS?

It is important that every case is different. For diabetic pets having one treatment doesn’t fit or work. To make it simple for diabetic pets is important for the owner and vet to have a goal where the diabetic pet has the same quality of life as an animal that does not have diabetes. This includes paying a lot of attention to the animal’s quality of life, and overall well-being is the key to identify how well the diabetes is going.

WHAT IS YOUR ADVICE ON HOW TO MONITOR DIABETIC CASES LONG-TERM?

In the long term, the goal is for the diabetic pet to have the same quality of life they had before they had diabetes. The way that is best achieved is if it is a three-way process that involves the animal, the owner, and the vet. All of the needs of those three need to be taken into account and different approaches depending on the owner and animal must be considered to see lots of options.

Top VetCheck templates for managing diabetic conditions and getting the pet owner on board.

We've put together the top VetCheck resources to help you handle these conversations that you face in practice every day

1. Diabetes mellitus - General
2. Diabetic remission - Cats
3. Diabetes - treatment plan
4. Diabetes continuous monitoring - Flash
5. Understanding diabetic and cushingoid pets
6. Understanding the glucose curve and its results
7. Weight management plan

There are over 2000 VetCheck templates that also help veterinary teams save time in explaining treatment options, duration of treatment, potential outcomes and prognoses.