007: Diabetes: Too Much of a Sweet Thing; Part 1

This week is a two-parter, you know, because diabetes is never just a simple 45 minute conversation. Join us through the holiday while we cover the topic of "Too Much of a Sweet Thing". 

Show Notes:

Join Yvonne Brandenburg, RVT, VTS SAIM and Jordan Porter RVT, LVT, VTS SAIM as we talk about:

• Diabetes Mellitus; sometimes you really can have too much sugar.
  
  
   Resources We Mentioned in the Show 
•  Diabetes information page:
  •  https://www.internalmedicineforpetparents.com/diabetes.html
• “Small Animal Internal Medicine For Veterinary Technicians and Nurses”, edited by Linda Merrill, LVT, VTS SAIM, CP 
  • https://imfpp.org/saimbook 
• “Canine & Feline Endocrinology”, edited by E. Feldman, R. Nelson, C. Reusch, J Scotti-Moncrieff, E. Behrend.
  •  https://imfpp.org/endocrinebook 
• “Pet Health Journal: A 6 Month Journal For Medications, Exams, & Healthy Living (Internal Medicine For Pet Parents Series)”, by Yvonne Brandenburg, RVT, VTS SAIM, and Ashley DiPrete, RVT, VTS SAIM 
  • https://imfpp.org/PetHealthJournal ​
• Vetsulin info:
  •  https://www.vetsulin.com/
• Alphatrak website: 
  • https://www.zoetisus.com/products/dogs/alphatrakmeter/alphatrak-home.aspx
• Alphatrak on Amazon: 
  • https://amzn.to/2CoPYmO
    
    
    Thanks so much for tuning in. Join us again next week for another episode!
• Listening Options 
  • Direct Download from the website. 
  • Subscribe on Apple Podcasts or your favorite podcast player for free! 
  • If you enjoyed this episode, rate and leave us a review wherever you can!

-Yvonne and Jordan

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Yvonne Brandenburg, RVT, VTS SAIM:
Welcome to the Internal Medicine For Vet Techs Podcast. If you haven't joined us before, we're passionate about all things internal medicine and helping you become the best tech you can be. We'll be discussing interesting internal medicine diseases, how to work closely with pet parents, and how to become the go to tech in your practice. Now, let's start the show.

Yvonne Brandenburg, RVT, VTS SAIM:
Welcome back. We're so excited that you guys are still with us. We are in episode seven today. Thank you so much for listening. Making commitment to your learning, which is awesome. We hope that you are doing well in your clinics. We've heard from quite a few people that are listening, which is really cool, by the way. So I am, I'm Yvonne. I'm one of your hosts. And I'm joined by Jordan.

Jordan Porter, RVT, LVT, VTS SAIM:
Hi.

Yvonne Brandenburg, RVT, VTS SAIM:
Hey. So congrats. We are on episode seven. Whoop-whoop!

Jordan Porter, RVT, LVT, VTS SAIM:
Yay! And we've had so many downloads. I really appreciate that. So.

Yvonne Brandenburg, RVT, VTS SAIM:
I know it's kind of fun and crazy to see it. Well, so many downloads for us. We're like we have 50 per episode, which is really cool, by the way.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
I was really worried there'd only be ten of you listening and you'd all be my friends and family.

Jordan Porter, RVT, LVT, VTS SAIM:
Right?

Yvonne Brandenburg, RVT, VTS SAIM:
So, we'll just do a little bit of housekeeping. It's a little bit longer because this is actually our first episode that we are recording after the launch of the podcast. This is kind of exciting for us. We do have the Question of the Week. So, last week's Question of the Week, which was the episode regarding pancreatitis, is: "what was the most rewarding case of pancreatitis you've seen or one that you learned the most from?" So, we don't have a ton of answers to our question yet. And Jordan, we're trying to figure out why, actually. And we realize, we've done a kind of a bad job of letting you know where to go for this. So, we created the show notes page on our web site. So, if you go to InternalMedicineForVetTechs.com/podcastshownotes. That is where you're going to find all of our resources and the information that we share with the podcast or on the podcast. So, you're going to want to scroll all the way to the very bottom, and then there's a comment section. So, go ahead and just answer the questions in the comments section. We'll make sure to start shouting you guys out during the episodes for those answers to the questions. Other things that we want to say. Thank you. Thank you very, very, very much about: is we have 6-5 star reviews on i-Tunes! Which is amazing, by the way. We have two people that have left comments, which is awesome. So, JackStormNBF and SharkFaceKiller, which I love. That's kind of amazing. SharkFaceKiller. And so one of them is: "love learning about animals. They are great at helping." Which is awesome.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, I really do hope people are taking away some stuff from this. Especially now that we're getting into the cool diseases and stuff.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. We're not just talking about tech week. We're actually talking about like internal medicine things. So, another really cool thing is on our Facebook page, we had Sonette Bales, we want to thank you for referring the podcast to a friend on Facebook, which is awesome. And for saying that we're a really great resource. We really appreciate it. Hope it helps you throughout your day. Also, I think Caitlyn Lindblad, she commented on Episode 3 that she "loved this episode, and also great microphone updates! The sound was much better this week!" Yeah. So, hopefully going forward, we'll have similar sounds throughout the episodes. I will say fair warning. I hope mine sounds okay on my end. Oh, I won't totally get into it. But if you know me, I am displaced from my house at the moment is due to poop water, which is hilarious. And I'm staying at my friend's house. And so currently I'm recording in a closet.

Jordan Porter, RVT, LVT, VTS SAIM:
Your house needs a butt catheter.

Yvonne Brandenburg, RVT, VTS SAIM:
My house does need a butt catheter. Oh my god. Oh, yeah. I'm kind of done with dealing with poop, really for a while.

Jordan Porter, RVT, LVT, VTS SAIM:
Right? Yeah. I think lately you sound fine. I can't seem to get my dogs to cooperate when I try to record. But whatever.

Yvonne Brandenburg, RVT, VTS SAIM:
That's because you have six of them. Let's be real.

Jordan Porter, RVT, LVT, VTS SAIM:
Five.

Yvonne Brandenburg, RVT, VTS SAIM:
Oh, you have five. Sorry. Five. Yeah. So.

Jordan Porter, RVT, LVT, VTS SAIM:
It sometimes sounds like six.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. It's funny. My husband commented, he's like, "you should definitely warn people that there's gonna be cats and dogs in your podcast." And like I definitely did. So, here's the warning again. Occasionally, small children, cats, and dogs may make appearances on the podcast and we try our best to keep them to a minimum. So some of the other quick housekeeping things. We do have a Facebook group now and it's just for a podcast listeners. So if you love our podcast and you want to interact with us a little bit more, definitely check out the Facebook group. If you go to Facebook, look for Internal Medicine For Vet Techs. It is the group associated with that. So, if you have any trouble, please let us know. I'll try to also put a link in the show notes. So you can find us.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And invite your friends to the group, too. And then of course, you can communicate with us through that group.

Yvonne Brandenburg, RVT, VTS SAIM:
Yes.

Jordan Porter, RVT, LVT, VTS SAIM:
Which we have had like several a few comments on there about like someone. I think another like Caitlin or Kate or someone commented about like getting to know our personalities.

Yvonne Brandenburg, RVT, VTS SAIM:
Yes. Yes. We have a couple of people that are that are pretty responsive in there, which is which is really cool. And thank you. It's been fun. If you are curious about why we are laughing about butt catheters, definitely go check out our Facebook group. There may be a blooper in there.

Jordan Porter, RVT, LVT, VTS SAIM:
Which it was very difficult to get through for me.

Yvonne Brandenburg, RVT, VTS SAIM:
Yes. And then also we've created a couple of things as we've gone along the last month, just realizing we need a couple of things. We created what's called the Technician Treasure Trove. It is on the Web site. So, what you need to do to access the Technician Treasure Trove. Well, actually let me just tell you what it is. So the Technician Treasure Trove, what we did is we created a page where we have downloads that you can snag it for yourself. There's both clinical downloads as well as client education downloads. And so you can go there, anything you want it's totally up for grabs. So, we have I think we talked about the questions like your history questions. There's the forms there. We haven't talked about hematology yet. But I have hematology differential page that I use in my clinic. You're more than welcome to use that. So that's on there. Also have some the client hand out. So we have the pain score on there, quality of life kind of thing. The CSU pain scores that we talked about in, I think that was the pancreatitis? No, that was the pain episode, correct?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. The pain episode to episode five.

Yvonne Brandenburg, RVT, VTS SAIM:
So, we have that as well. So, we have a bunch of that stuff. And as we create things, we'll be updating that for you guys to check out. And then we also on the show notes page, we realized your time is precious. So, we have created two things. The first thing being transcripts. So, all the episodes are transcribed. So, if you want to look at what we've been talking about or some of the resources, you can read it. Fair warning. The way that it is written is is how we talk, which is not how we normally write. So it's not as easy to read, but the information's there. And then we also have CE certificates that are added for each episode. So one of the things about that is it's a half hour CE credit. You do need to check with your governing body to see kind of where it falls in. For example, in California, you can do self-study hours. So, the different episodes would be considered self-study. So, you just if you want to. The other thing, too, is like for your work. I don't know if you guys collect your CE certificates for work. It always looks nice when you can do that. But you just answer five questions about the episode and then you can download your CE certificate. So, we have that as well. Anything else you can think of, Jordan, that we need to touch on before we dive in?

Jordan Porter, RVT, LVT, VTS SAIM:
Oh, speaking of I know last week we said we were gonna record a episode on esophageal foreign bodies or G.I. foreign bodies and endoscopic procedures. We decided we are going to push that off right now and we will be discussing that at a future date. So, we will definitely get there. But for now, we're gonna kind of move forward with a different plan.

Yvonne Brandenburg, RVT, VTS SAIM:
Anything else you want to cover before we get into it?

Jordan Porter, RVT, LVT, VTS SAIM:
No, I don't think so. Just if you could try to find a way to give us some reviews that way, just so we know that we're doing or what you want to hear from us. Plus, we like reviews and it makes us feel nice that we're actually doing something well.

Yvonne Brandenburg, RVT, VTS SAIM:
Well, and I will say from the other other side of that is, you know, some of the pod catchers, so like i-Tunes. The more reviews there are, the higher it is in their showing. So, you actually can get found a little bit easier. But, you know, we technician's we're few and far between.

Jordan Porter, RVT, LVT, VTS SAIM:
Right. Yeah. It's easier for your friends to search us if you rate us. So, this week I'm excited for.

Yvonne Brandenburg, RVT, VTS SAIM:
I know. So, this week we're diving into a meaty topic. So, we'll have to kind of make sure we don't run too long for you guys. So this week we are discussing diabetes. We do have a page on the Pet Parents website. So www.internalmedicineforpetparents.com/diabetes, that is a great resource both for clients as well as for you just to get a little bit more information. I feel like this is one of those topics I think general practice manages these cases, pretty well.

Jordan Porter, RVT, LVT, VTS SAIM:
Oh, yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
Pretty well, and for the most part, it's very much a GP thing.

Jordan Porter, RVT, LVT, VTS SAIM:
Yes, I would agree.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, I remember working in general practice we unfortunately had a lot of diabetic patients.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. I don't think it occurs very often where we just are diagnosing normal diabetes vs. like we have a DKA that comes in and they're like, "we didn't know." And that's what we see more of, I think. But just general diabetes, when pets are just drinking and urinating more than normal and they go in for that ritual. I think, yeah, that's definitely more of a GP thing.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Yeah. We'll see the ones that are difficult to control. I think the straight forward ones, is definitely a general practice thing, which is which is great. It's awesome. You guys see these as well. So, the disease name, the one we're gonna be talking about today is gonna be diabetes mellitus. So, we're not talking diabetes insipidis today. We're talking diabetes mellitus. So, what people think of traditionally with diabetes, right. So the definition of diabetes mellitus is it's a condition in which the pancreas no longer makes enough hormone, the hormone insulin, for proper health. So, we will talk about what insulin is responsible for in just a little bit. But, there's two types of diabetes mellitus that we traditionally think of. So, there's type 1, which is the pancreas is no longer producing insulin. And then there's type 2 where the pancreas is still producing some insulin, but it's not enough. And it was kind of interesting for me when I was researching for this one, I thought I remembered more about the disease than I actually did. But, you know, dogs and cats do respond differently and, you know, we'll talk about this a little bit in a few moments. But, you know, dogs and cats are more likely to have one or the other, which I thought was interesting.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, and it is funny. When I was studying for my VTS test, you're more of a cat person and I'm more of a dog person. So, when I was thinking of diabetes, I was like, type 1 is dogs because dogs are number one.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. It's so funny that you call me a cat person versus a dog person, because I used to not be a cat person.

Jordan Porter, RVT, LVT, VTS SAIM:
Well, you know, we all play our roles, right?

Yvonne Brandenburg, RVT, VTS SAIM:
I know.

Jordan Porter, RVT, LVT, VTS SAIM:
Plus, have you noticed how on our pages you do post more cat things, and I'll post more dog things. I've noticed this. That's maybe because I'm more of a dog person.

Yvonne Brandenburg, RVT, VTS SAIM:
Huh? It's because you're such a dog person that I'm having to pick up the slack.

Jordan Porter, RVT, LVT, VTS SAIM:
Exactly. Equal rights for cats. I got it.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. So, type 1, that is the insulin diabetes, or insulin dependent diabetes mellitus. We'll talk about the different cells, but the beta cells are being destroyed. A lot of times this can actually be autoimmune. Which I was, "what?" So, diabetes can be an autoimmune thing. So, type 1, we think of like juvenile diabetes. That's kind of the one that we think of. But it doesn't have to start when they're young. It could be at any age. And then type 2, this is where we don't have to give insulin. So, you know, a lot of the other things that we can do can help control it. There is insulin resistance that happens. And we'll talk a little bit about that as well. Oh, God. So we're gonna dive into some anatomy and physiology. And I realize as going through this, I will work on creating a page for the pancreas that talks about anatomy and physiology, because I don't have one. We don't have one yet. So.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
That may be something that I try to work on relatively soon, but it's not done yet. So, I apologize for that.

Jordan Porter, RVT, LVT, VTS SAIM:
We've talked about that, we've got to work on like a couple other things that we're going to discuss here soon too. So yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
So it's it is a work in progress. It's just Jordan and I, and we still have full time jobs, but we want to get as much information out for you guys. So, when we're talking about diabetes and the pancreas, this is the endocrine function. So we talked about exocrine with pancreatitis. This is gonna be the endocrine. So with in the pancreas, there's tissue that is the endocrine function of the pancreas. Those tissues, you guys probably remember this at some point from tech school, is the islets of Langerhans. I always thought these were like the coolest things. The islet the Langerhans.

Jordan Porter, RVT, LVT, VTS SAIM:
It just like screams Lord of the Rings for me for some reason.

Yvonne Brandenburg, RVT, VTS SAIM:
It does! The islets of Langerhans!

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And then so it's broken down into like four different types to. I didn't actually watch Lord of the Rings. I don't want to get into that, but I'm sure there was like several rings, right? I don't know. So.

Yvonne Brandenburg, RVT, VTS SAIM:
Oh my God. Okay. Jordan. Like the line is one ring to rule them all.

Jordan Porter, RVT, LVT, VTS SAIM:
Oh, okay. Well anyway, it sounds like Lord of the Rings.

Yvonne Brandenburg, RVT, VTS SAIM:
It's because she hasn't watched guys.

Jordan Porter, RVT, LVT, VTS SAIM:
It's because I haven't watched it. Yeah, it sounds like that. But then, yeah, it's broken down into.

Yvonne Brandenburg, RVT, VTS SAIM:
Okay, so this is how we're gonna dork out with this. It's because there were four hobbits.

Jordan Porter, RVT, LVT, VTS SAIM:
Oh okay. That's totally what I meant. 100% what I meant. Yeah. The four Hobbits, we'll joke than the four hobbits are what regulate the blood sugar and the glucose in the bloodstream. So, alpha cells are first alpha, beta, delta. We'll get through that. The alpha secretes glucagon. So, it's the blood sugar is low, the glucagon is produced to bring that blood sugar higher.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
And then our beta cells, they secrete the insulin so if blood sugar's high then obviously, insulin will reduce that blood sugar.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Alpha and beta cells really are kind of the most important when we talk about diabetes. The other ones, they have other endocrine function but that really don't relate to diabetes. But if you remember feedback loops?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, we'll get into that soon.

Yvonne Brandenburg, RVT, VTS SAIM:
Because I mean, when we talk about endocrine, most of these are feedback loops. And so, you know, if the sugar the blood sugar is high. Right? The the pancreas goes, "oh, I need to make some insulin and bind to that sugar to get it out of the system". Because sugar is toxic to cells in large quantities, which is why we get a lot of, you know, like diabetes neuropathy and all this other stuff. But the opposite is, you know, if your shirt is too low, then things can't function because the cells do need sugar within them to do their normal daily operations.

Jordan Porter, RVT, LVT, VTS SAIM:
Yes.

Yvonne Brandenburg, RVT, VTS SAIM:
But then it produces the glucagon, which stimulates the liver and does all the stuff and kind of helps regulate. So, those are the two that we're really going to focus on. Well, we'll focus on for a minute with diabetes. And then, you know, we have the other two islet slash hobbits.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. F cells, which are pancreatic, polypeptide, again, not really super related to diabetes right now. And then delta cells, which is just they help, it's a growth hormone inhibiting hormone.

Yvonne Brandenburg, RVT, VTS SAIM:
Somatostatin.

Jordan Porter, RVT, LVT, VTS SAIM:
Somatostatin.

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly.

Jordan Porter, RVT, LVT, VTS SAIM:
But that again, doesn't kind of really go with our diabetes talk right now. So, then we kind of get into, well, what does insulin do to the body? And insulin has several metabolic effects, which include just carbohydrate metabolism, suppressing hepatic glucose production. So, that's where, you know, the liver's producing glucose and then your insulin is going to tell it to slow down and then promoting glucose uptake by the liver and then storing that too as glycogen for use for the body to break up later. That's you really start getting into nutrition if you start really diving into diabetes. Which I found that wormhole when I was studying. Now I'm learning about how the body just breaks down all these carbohydrates, and fats, and proteins, and glucose. Yeah. So we'll try to briefly skim over that. So anyway, promoting glucose uptake by the liver and then stimulating glucose uptake by the tissues.

Yvonne Brandenburg, RVT, VTS SAIM:
When we get our BG, that's our blood glucose. So, how much glucose is running around in our blood. And in our tissues, it's a little bit different, right? So, we have our cells in order for our cells to do anything, we have ATP and we have glucose. Those tissues need to the cells need to grab the the glucose into them in order to function. Well, in order to do that, remember that lock and key mechanism, the insulin has to bind to the glucose and then the insulin is basically the key that opens up the cell and drives the glucose into it. So, without insulin, you're not going to get glucose to your tissues and then your tissues are going to starve and die. So that's where it becomes a problem with diabetic patients is, you have all this glucose available in the bloodstream, it just can't get to where it needs to go. So, insulin really is the driving factor for that. So, that's one of the big things that we deal with with diabetic patients.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
The other part of that is if there is no glucose for the body to use, it needs a fuel source from somewhere. The body says, "wait, I can't get glucose. So, I'm going to get a substance that I can use, that I can burn." So, what happens is the body will start using fat and breaks down the fat and uses the fuel source from that. Which when that happens? That's where ketones come from. Right? The byproduct of breaking down fat to be used as a fuel source, is ketone production. So, we'll talk about that a little bit more on the the DKA, the diabetic ketoacidosis, episode. But, you know, your blood sugar is going to be really high. I can't use it. Break down fat. Produces ketones. Ketones are very irritating and everything. So it's a big problem within the cells and within the body and causes all sorts of havoc. So. We want to make sure that there's enough insulin. And it's a fine balance. Right? Enough insulin to get the glucose out of your bloodstream and not form ketones, but not so much insulin that we're tanking them and there seizuring.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Right? So yeah, it's all about that negative feedback loop. If it's hindered somehow then your body just goes crazy.

Yvonne Brandenburg, RVT, VTS SAIM:
So, I thought this was interesting. So, you guys are aware a lot of the stuff that I was researching I was using two books really for most of it. There's the Small Animal Internal Medicine For Technicians and Nurses by Linda Merill. If you do not have this book and you work in internal medicine, just get it.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, you'll need it eventually.

Yvonne Brandenburg, RVT, VTS SAIM:
You'll need to study for your boards. Just get it. And it's just a great resource to have in your clinic because the way it's written is geared towards technicians, which is really cool. So, there is a breakdown of what the disease process is. And there's also sections that talk about like our role in managing these cases and managing, I'll just say, managing our clients as well. Right? So we talk about how to deal with diseases and so the book is really, really good for that. So, I use that book plus, and then the second book that I use is the Endocrine and excuse me, Canine and Feline Endocrinology. It's by Feldman. If you haven't seen it, it's probably on your doctor's shelf if you work in internal medicine. We'll put links to both of these in the show notes as well. But both of them are great. I'm definitely going to dive more diabetes because I have a lecture I have to do for work. And so I'm going to learn more after this episode because I realized how much I didn't know about diabetes, which is crazy. But the cool thing about both of those is they give us statistics on dog and cat diabetes. So for cats, there are different studies out there depending on what group of pets or animals they were looking at. Some of the studies show between somewhere between 1 in 50 and 1 in 400 cats, will be affected at some point in their lives by diabetes mellitus, which I thought that was kind of an intense number. Like that's a lot of cats.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
And then the good thing is most cats are gonna be type 2 versus type 1. Type 1 is pretty rare and cats. Which is why if you guys have dealt with cats, they can go into remission because the insulin resistance in that kind of thing is what causes their sugars to be high. And so once we get some of those things that cause insulin resistance under control, they can be managed with like diet and exercise. So it's kind of interesting. They also say that Burmese, which was kind of surprised by that, but possibly that Burmese breeds are a little bit higher susceptibility to diabetes.

Jordan Porter, RVT, LVT, VTS SAIM:
Interesting. I don't. I can't really recall many Burmese diabetics that I've seen. I like it's always like a fat orange cat or something that I have.

Yvonne Brandenburg, RVT, VTS SAIM:
I know. I'm waiting for my fat orange cat to become diabetic. I'm waiting.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. So, yeah, I do agree kind of with the rest of your notes here. That typically older like we're seeing greater than 9 years of age usually when we're diagnosing this in cats. I do tend to see more males affected than females.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, I thought that was interesting. I was like neutered males and we don't really know why. But we see it a little bit more with them.

Jordan Porter, RVT, LVT, VTS SAIM:
Decreased physical activity. So those lazy cats are more susceptible to it. Steroid therapy or glucocorticoid therapy always puts cats at risk. And that's one of those kind of conversations that you should have with a client when your doctor is prescribing a steroid medication. This is why we taper these medications. This is why your cat shouldn't be on it long term is because cats do have a higher risk of developing diabetes when on that type of therapy. I think that's a conversation to be had. If that's ever prescribed.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, we have a lot of our IBD cats or our lymphoma cats, GI lymphoma, because they are on steroids, we caution owners, you know, long term is not a great idea. Try to get other drugs on board to prevent them becoming diabetic because unfortunately I've seen quite a few of them flip.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah. And it's pretty rapid too. It's like they're good, good, good. And then you'll get that phone call like, well my cat's drinking a lot right now. I'm like, man.

Yvonne Brandenburg, RVT, VTS SAIM:
It's not just the steroids. Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. So and then obesity, that kind of goes along with a decreased physical activity. Those cute, adorable, I had this one adorable cat and he did become diabetic the older he got, but his name was Nudge and he was like a big, fat. I mean like twenty four pounds cat. With his, he was like a grey tabby, and he had the shortest little legs and he was adorable. Yeah. I did feel really bad that he lost a lot of weight. He became diabetic.

Yvonne Brandenburg, RVT, VTS SAIM:
He's like, "oh there goes, there goes my fat stores.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. But I kind of mentioned at the top how dogs have the more the type 1 diabetes. So that's more of like an immune disease is what's speculated. But it doesn't affect what you have notes here. 1.5% of the population. That's kind of mind-blowing.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. I was surprised by that statistic that 1.5% of the dog population will become diabetic. Which, I mean, it explains why we see so many diabetic patients.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
And why it's such a common disease. It was interesting, there was also notes of familial diabetes. So, it definitely having genetic component. Where parents, grandparents, that kind of thing, which I thought was interesting.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. I feel like, I don't know, because I know we have the specific breeds like Australian terriers, Schnauzers though do come to mind because I feel like in my mind Schnauzers, are prone to pancreatitis and then they're also prone to diabetes. So miniature and Schnauzers, or miniature and standard. Samoyed, fox terriers, which I was, I have a fox terrier and I was a little concerned at some point that she become diabetic. Bichons, Cairn terriers, miniature, toy poodles, Siberian huskies. And then the same thing that you do kind of tend to see it in the older patients. But they unlike cats, it's more geared towards females yet, which is a little interesting to me too.

Yvonne Brandenburg, RVT, VTS SAIM:
It's funny how it's like the opposite. They also, it was interesting, they were talking about dogs can get gestational diabetes. Yeah, it was interesting, but cats tend to not get it. Which I guess it makes sense when we're talking like type 1 and versus type 2 because being pregnant causes your immune system to do crazy things.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
So it makes sense when I think about it.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. It's just one of the things you don't really think about like, "oh, I have a diabetic dog."

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, steroids. Steroids gets everybody. Progestagen helps to maintain pregnancy. I don't honestly, I don't know when we're using this in medicine, in internal medicine. So, that might be something that we find out later and let you know about.

Jordan Porter, RVT, LVT, VTS SAIM:
It's probably one of those things. Maybe we'll get like a repro specialist or a tech be like, yeah, we use this therapy and yeah, I see diabetics sometimes, but. And then obesity, you know, chubby dogs.

Yvonne Brandenburg, RVT, VTS SAIM:
It's one of those things where when you're talking to a client, you have to be pretty cognizant of the fact that there are going to be very sensitive to their dogs being fat. When you're having that conversation with a client, you want to be gentle about it. And don't be like, "you're fat, your dog's fat. You need to do something!" Because they're not going to listen to you at that point. Right? You have to approach them from that direction of, "hey, you know, here's some things that we can prevent. If we, you know, get fluffy to, you know, maybe lose a little bit of weight and be more active and he can live longer for you." You know, those kinds of things. So, just because people equate food with love with their animals. So, we just have to be very careful of it. I joke in a clinic when I see our diabetic animals, or our chubby animals I'm like, "it's not your fault. It's your parents fault." Like, it's not their fault. Like, they're animals. They're gonna eat what's put in front of them. So if an owner gives them cheeseburgers, you know, it's not the dog's fault. So just be gentle with our clients.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Client communication I think is key. You just got to explain the risks to your dogs at risk for, your dog or cat is at risk for, diabetes. It hurts their joints. Then work with them too, just be like, let's feed a little bit less food and do a little bit more exercise, you know. So I think it's just kind of communication about why not just: "your dogs fat, lose weight."

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And I think I've also seen those programs that you can do at your general practice where it's like the losing weight, like the pet weight loss challenge or something like that, where you make it fun. You kind of gameify it.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. I think Hill's has an app for it. Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. The app. I think I've seen that. We'll have to talk to our nutrition peeps because I'm know.

Jordan Porter, RVT, LVT, VTS SAIM:
We need to have like a nutrition episode at some point, like we all nutrition episode.

Yvonne Brandenburg, RVT, VTS SAIM:
I know we really do. We do, we probably need multiple nutrition episodes.

Jordan Porter, RVT, LVT, VTS SAIM:
Probably. Probably. There's so many diseases that go along with nutrition.

Yvonne Brandenburg, RVT, VTS SAIM:
Yes. So, to kind of go along with talking to your clients, we we do have to get a history from them. One one of those things that you're looking for in history of diabetic patients, whether that's newly diagnosed or not diagnosed yet, is you're gonna see extreme thirst and urination. And the reason for that is the body says there's too much sugar and sugar is a diuretic, right? So, they're drinking a ton and they're peeing the sugar out because the body wants to get rid of this excess. So, they're just drinking a ton. Urinating a ton. It's kind of an interesting, the body tries to regulate it, but it can't.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
One of the other things to go along with that is weight loss, even though there are usually ravenous. And part of that being ravenous, the extreme hunger is that, again, their cells are not getting the nutrition that they need, the glucose they need, because insulin is not binding to it. So they feel hungry and their fat stores are being used. So, they're losing weight. They're not getting the nutrition that they need. And so they're, you know, they're wasting away. Like that's what clients say, my dog's wasting away. And you're like, okay, well, let's see what metabolic thing is going on that that's happening.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah. And then you're noticing two accidents in the house because they are drinking and urinating so much. So you have those normal dogs and the client comes in and says, you know, he never urinates in the house. But he's been having accidents lately. But large volumes, not small frequent volumes like with the UTI. And then just general like lethargy or weakness. Dogs are more prone to well, 100% of dogs will develop cataracts from diabetes. I read that, and I was like, "whoa." So it's very, very common that they do lose their vision. And then the side effects of becoming diabetic, you can develop or if you've had a patient who had pancreatitis maybe a month ago and now they're drinking and urinating large amounts or they been on steroids for maybe use some sort of severe allergy or something like that or a cat with IBD that you're trying to just kind of manage and you see these symptoms occurring. It's worth looking into a little bit further.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And it's kind of interesting when when I was reading about diabetes and pancreatitis. It's one of those chicken and egg questions.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. What comes first?

We don't always know which one was first. Was it the severe pancreatitis?

Jordan Porter, RVT, LVT, VTS SAIM:
Especially in cats.

Yvonne Brandenburg, RVT, VTS SAIM:
Or was it the diabetes because, right? We're talking about the pancreas. We've got exocrine, we've got endocrine function. So which one malfunctioned first, right?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

If you've got a severe pancreatitis, that inflammation in the exocrine portion of the pancreas can cause damage to the tissues that are endocrine. Right? Or you have the endocrine that's not functioning well. You have this extreme high sugar and then the sugar is irritating to tissues, including the pancreas. So when you've got these numbers in the 500-600, you're causing tissue damage to the pancreas. Now we get pancreatitis because it's inflamed. It's mad. So it is this vicious circle. So sometimes it's hard to determine which one came first. So, just keep that in mind. You're probably going to get.

Jordan Porter, RVT, LVT, VTS SAIM:
Oh, definitely. And like I said, I feel like it that seems pretty common with cats, especially. Where you've just recently treated them for pancreatitis or they come in for pancreatitis. And then you're kind of incidentally finding diabetes at the same time. So I feel like that seems pretty common in cats.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Which I mean, if you think about it, it makes sense with cats because cats are type 2.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
So inflammation causes insulin resistance. So when we've got pancreatitis, it definitely makes sense that these cats are going to be more predisposed to getting diabetic because their insulin isn't being used appropriately. So it's crazy when you start looking at it from an anatomy and physiology standpoint, you're like, "Oh, that's why, cool!"

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, right? So, I think upon like intake when after you obtain your history, so many I feel like there can be a lot of differentials that kind of come to mind. Urinary tract infection, like I said, that small frequent urination versus large volumes frequently. Pancreatitis, obviously, because we will probably never really figure out which one came first. So, Cushing's disease, because they can kind of exhibit similar symptoms where they're kind of muscle wasting, PU/PD, neoplasia, they can have some underlying disease that you just really need to investigate further. We briefly touched on DKA, and we'll touch on DKA a little bit more, but that's just the diabetes wasn't caught quick enough. And so now the body is kind of going haywire, but they can exhibit those symptoms, too. And then cats can be stressed.

Yvonne Brandenburg, RVT, VTS SAIM:
Yes, yes. Cats stress. Yeah. So it's hard because some in dogs as well with stress, because of the the hormones released with stress, so cortisone and those kinds of things- it can drive your blood sugar numbers up. So if the doctors see a glucose blood glucose that's high, you know, it's hard to tell, is that blood sugar high? And we're not talking 500, right? Like 500. That's diabetic.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
That kind of weird range and cats where it's 180, 220, 250, kind of in that range, you're like, "Are they diabetic? Are they stressed out?" You know sometimes it's hard to figure out which one it is. So you can do some diagnostic tests to figure out, you know, is it stress or is it truly we're getting insulin resistance and we're becoming diabetic. So we'll talk yet in a few minutes, but like a fructosamine can let you know. So sometimes you just have to figure out, you know, are we stressed? Or are we really getting to diabetic stage? So cats, because they're type 2, it can be that weird, tricky, tricky area. Where is it stress? Is it diabetes? Where we at?

Jordan Porter, RVT, LVT, VTS SAIM:
The borderline of like I'm not really sure. But that just ultimately just means you need to do a few more tests.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Yeah. And prevent it becoming diabetic in the future. So that's really key.

Jordan Porter, RVT, LVT, VTS SAIM:
So I think technician skills on these cases are pretty important because blood draws need to be pretty accurate. Same with like if you're spinning down a serum sample for fructosamine level, it's pretty important to spend those down in the adequate timeframe. So you don't have that false low hypoglycemia or where it was high and you let it sit out for three hours.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. The other part of that, too, because diabetic patients, a lot of times, they usually have high cholesterol as well. So like especially Schnauzers, right? So your samples are gonna be really lipemiac. And we talked about this a little bit previously, I think in the pancreatitis episode is if you let that lipemic blood sit for too long before spinning it down, we're breaking down red blood cells, which causes hemolysis. But hemolysis will mess with the fructosamine tests.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
Which is a pain. So you have kind of have to balance it when you're doing fructosamine, you want to make sure you have an a traumatic blood draw. Right? If you see lipemia, do your best to spin it down as as quickly as possible, as gently as possible to not get that funky fructosamine level, if that's what you're going with.

Jordan Porter, RVT, LVT, VTS SAIM:
And then I think too, like tech's can do cystocentesis, techs do do cystocentesis. I feel like cystocentesis is pretty important in these situations just because you do want to roll out a urinary tract infection. So, voided samples tend to have that, not false bacteria, but bacteria shed from free catch collection. And then so I think cystocentesis is pretty important. Also too, because if you do have a diabetic or a Cushinoid patient, they're prone to UTI's. So they're more susceptible to get those, so trying to get a clean, sterile sample adequately is is pretty important in these situations just to see what you need to treat this pet for.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, yeah. And Jordan and I both we both love ultrasounds.

Jordan Porter, RVT, LVT, VTS SAIM:
So much.

Yvonne Brandenburg, RVT, VTS SAIM:
They're so amazing. So, yes. And I personally, I do all my cystocentesis with my ultrasound because we have an ultrasound. And I just feel like I want to see where all the blood vessels are. Just as an example, just recently, one of my doctors was doing an FNA, so a fine needle aspirate of something, and the cat moved a little bit and we poked the aorta. Thankfully, the cat was fine. But, you know, we sat for about a half an hour holding pressure on the abdomen, watching the hematoma get bigger. But, you know, the aorta is right below the bladder. So as a technician, I want to make sure I'm not going to poke that. I don't want to go to my doctor and tell them that I just poked the aorta in an animal, because they can die from that. So I use my ultrasound. I make sure that I can visualize it. I, you know, I'm one of the dorks in my clinic where if a doctor can't hit a bladder, they usually come get me because I am the bladder whisperer, apparently. And you can develop those skills. And it's a really good skill to have in your back pocket. And, you know, you can, do you use ultrasound for all of yours? Or do you do like palpation and guiding?

Jordan Porter, RVT, LVT, VTS SAIM:
I used to do palpation. And general practice, even though we had access to an ultrasound, which I do firmly believe if you have it, you should use it.

Yvonne Brandenburg, RVT, VTS SAIM:
Mm hmm.

Jordan Porter, RVT, LVT, VTS SAIM:
But in cats we would do like especially palpation.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
Or if our ultrasound is being used or something.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. I get freaked out by it. But I know plenty of technicians are really good at that. And I just am paranoid and I have tools at my disposal that I can.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Exactly.

Jordan Porter, RVT, LVT, VTS SAIM:
Ok. I think this is where we should probably break for part one just due to it being such a lengthy episode because you know, no diabetic conversation is ever just forty five minutes. So, I think we all end part one here and pick up part two next week. Back with you guys. So, we appreciate you listening.

Yvonne Brandenburg, RVT, VTS SAIM:
Oh, before we forget, it is Thanksgiving week. So our wish for everyone is have a great Thanksgiving. So, happy Thanksgiving, everyone. Jordan, I hope you spend some time with your family.

Jordan Porter, RVT, LVT, VTS SAIM:
Yes. I'm thankful for my new friends like Yvonne and our podcast.

Yvonne Brandenburg, RVT, VTS SAIM:
Ahhh!

Jordan Porter, RVT, LVT, VTS SAIM:
So, I know? Wasn't that so cheesy?

Yvonne Brandenburg, RVT, VTS SAIM:
No, that was awesome.

Jordan Porter, RVT, LVT, VTS SAIM:
It was great.

Yvonne Brandenburg, RVT, VTS SAIM:
I am also thankful for our, the new friends that we've made through the podcast. So, through our Facebook group. Hanging Out with Jordan, which has been really fun. I feel like good things will be happening. But we're working on conquering the tech world, which all of you out there should be doing as well. But, thank you for coming along with us on this journey. Happy Thanksgiving! Since it is the diabetes episode: Don't eat too much pumpkin pie or sweet potato pie.

Jordan Porter, RVT, LVT, VTS SAIM:
Don't develop diabetes during Thanksgiving.

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly.

Jordan Porter, RVT, LVT, VTS SAIM:
Or pancreatitis. We'll go backwards.

Yvonne Brandenburg, RVT, VTS SAIM:
Pancreatitis, diabetes, don't get it for Thanksgiving! Happy Thanksgiving, guys. Have a great week. We will talk to you next week. Try not to get into a tryptophan coma. We'll see you soon. Bye, guys.

Jordan Porter, RVT, LVT, VTS SAIM:
Bye.

Yvonne Brandenburg, RVT, VTS SAIM:
Thank you for listening to today's episode of the Internal Medicine For Vet Techs Podcast. If you like what you heard, we'd love for you to share with someone you think might enjoy the podcast. And make sure to subscribe so you never miss an episode. Want to give us a boost? Please leave a review on i-Tunes or your favorite pod catcher and we'll be sure to say thank you. Find out everything about us at www.InternalMedicineForVetTechs.com. Talk to you next week. Bye.

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