008: Diabetes: Too Much of a Sweet Thing Part 2

Here is it... PART TWO!! This week we discuss diagnostics and client communication. 

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 

 

• Technician Treasure Trove with Freestyle Libre info, how to do at home glucose curves, and more. Sign up on this page for your password: 
  • https://www.internalmedicineforvettechs.com/join-us.html
• 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!

Contact Us! 

• Check out www.internalmedicineforvettechs.com  
• If you want to get involved, leave us a comment! 
• Visit us and give us a ‘like’ on our Facebook page!
  https://www.facebook.com/internalmedicineforvettechs 
• Email us at podcast@internalmedicineforvettechs.com  

Thanks for listening!
-Yvonne and Jordan

---

Continuing Education Certificate

Want to earn some RACE approved CE credits for listening to the podcast? You can earn between 0.5-1.0  hour of RACE approved CE credit for each podcast episode you listen to. 

Join the Internal Medicine For Vet Techs Membership to earn and keep track of your continuing education hours as you get your learn on!

Join now! http://internalmedicineforvettechsmembership.com/

---

008 Diabetes: Too Much of a Sweet Thing Part 2 transcript powered by Sonix—the best audio to text transcription service

008 Diabetes: Too Much of a Sweet Thing Part 2 was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

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:
Hey, welcome back, you guys. I hope everyone is recovering from food coma that you probably had from Thanksgiving. If you haven't listened to Episode 7 yet, we did kind of split diabetes in two because once we recorded it, it was much longer than we anticipated. We like to try to keep our episodes around forty five minutes and it was about an hour and a half. So, we're splitting it in two. This is going to be the second part. And I am very thankful this week that I am still joined with Jordan.

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

Yvonne Brandenburg, RVT, VTS SAIM:
Hey, girl. Hopefully, hopefully you got some peace and quiet with kids and family because I don't have kids in like much family around me. So mine's usually chill. I don't know about yours.

Jordan Porter, RVT, LVT, VTS SAIM:
I'll so quiet. That's a funny word, what is that?

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly. And I am Yvonne. So, if you have not figured out who we are yet, definitely take a listen to our episodes. So, we're a continuing with part two of diabetes. And I just wanted to do a quick shout out from our pancreatitis episode, which was pretty cool, which is Episode 6. Laura Rosewell. She commented on our Facebook page. She said, "Great episode, guys. I have two really awful pancreatitis cases in our ICU at the moment. So this is a well-timed episode. One necrosing, SIRS, MOD's, acute lung injury, and a pancreatic abscess. He's on fentanyl, lidocaine, ketamine, and gabapentin at the moment and still struggling with pain." It's sad because I did kind of ask her about it. And unfortunately, you know, the sad outcome that did come from that one, which was a bummer.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Tough case when you get into all those.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And you know, and this is something that I've heard from technicians and we can talk about this in the different episode. But, you know, we do the best that we possibly can with some pretty horrible diseases sometimes. So, you know, we appreciate everything everyone does. And for our patients and know that you do make a difference, which is huge. So, keep going though sometimes it doesn't end well. But thank you, Laura, for talking about pancreatitis. I'm sad it did not have a good outcome, but we are very happy to hear from you. We also if you have not joined our podcast, Internal Medicine For Vet Techs Podcast, group you can definitely go there. We share the podcast episode there and we talk about it. So that's definitely a place to find us. Another little housekeeping thing, we do have our Technician Treasure Trove. If you have not signed up for the newsletter yet to get your password, we definitely recommend that. So you definitely find that link on our Facebook page as well as if you go to InternalMedicineForVetTechs.com, you'll see the join us button there, that is how you get your password and you get all sorts of fun goodies for that.

Yvonne Brandenburg, RVT, VTS SAIM:
As we continue to update things, we'll put that in there. We also have our CE certificates. So, if you're listening to the episode, why not just add some CE certificates to your arsenal? They are gonna be a half unit. So, half hour of CE. Depending on your you know, your licensing body, they may count. In California, I believe they count for self-study. So, you can use that, it just depends on the state. And then remember, we do have transcripts. So, you do need to answer some questions to get your CE certificate and the transcripts are a really good way to kind of help search for answers. Anything else you can think of, Jordan, before we dive back into part two of diabetes?

Jordan Porter, RVT, LVT, VTS SAIM:
Nope. I mean, that pretty well covered it. So, I think this well, this part two, we start off getting back in to diagnostics. So that's where we're gonna kind of restart our episode.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. So definitely if you have not listened to Episode 7, I would I would definitely recommend listening to that one first and then coming into Episode 8. Otherwise it may seem a little bit awkward because we do talk about the definition of the disease and everything. So again, we apologize that we broke things up. But you know, an hour and a half for Thanksgiving, you know, we don't need to do.

Jordan Porter, RVT, LVT, VTS SAIM:
Well and who can really discuss diabetes in only forty five minutes. Let's be real.

Yvonne Brandenburg, RVT, VTS SAIM:
Very true. Yeah. All right, cool. Well, we're going to dive right back into the episode, and we hope you enjoy and have fun listening to the podcast on your way to work or maybe, you know, on a slower, slower day at the clinic. I don't know, I don't think those exist. But sometimes you have time to listen to something, right?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Let's dive back in.

Jordan Porter, RVT, LVT, VTS SAIM:
Kind of where we were leading to after your tech obtains your samples, what do you run off these samples? So, full chemistry, electrolytes, CBC, T4 because they are showing/they are exhibiting weight lost, ravenous appetite. SpecCPL or FPL just to kind of determine if we are positive or abnormal or I think I prefer a number. So, if that number is high for pancreatitis, I know the snap test just says abnormal or normal, but that way too, you know, just your patients probably a little uncomfortable if those are high or abnormal.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And also, that's good from further monitoring, right? Is the pancreatitis getting worse? Is it getting better? So, we like to have the number versus just abnormal.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah, us too. And then, of course, ruling out the, you have the stressed cats with those borderline high or high blood sugars have 250. You want to rule out diabetes by checking your analysis sample. So, glucosuria in dogs occurs, so, where they spill glucose into the urine occurs, in dogs when their blood sugars between 180 and 200. In cats, it's greater than 300. So, you rule out that stress induced hyperglycemia in cats if they're not losing glucose into the urine. So, you do want to do that dipstick and see the dipsticks negative.

Yvonne Brandenburg, RVT, VTS SAIM:
The only thing is, as I recently was told, which is funny because it says greater than 300. I was recently told that some stressed cats can actually spill glucose in their urine to make it even more difficult. And I'm like, well then how the hell?

Jordan Porter, RVT, LVT, VTS SAIM:
What the hell?

Yvonne Brandenburg, RVT, VTS SAIM:
Right? I was like, that's, that's not fair. That's one of my diagnostics.

Jordan Porter, RVT, LVT, VTS SAIM:
Right? That's my tool.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. So, they said Fructosamine really is kind of the best way. And I was like, okay, we'll talk about that.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, I know we've had some clients that we'll send a cat home with steroids and we know it's going to be long term. We have clients buy those glucose strips that they can monitor daily for a couple days or like once every couple weeks to see if they're consistently spilling glucose.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, sometimes my doctors will have them buy those at like, I think you could just get them over the counter like your local pharmacy, like CVS, Safeway, or whatever.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And I think you can get them, I'm pretty sure you can get them on Amazon now too. The ketone strips and the glucose strips. So, good old Amazon. And then a urine culture too just to rule out that UTI because glucose in the urine does predisposing to infections.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Sugar is a great medium in urine for growing bacteria. Some of the other things too, of course this is all like gold standard stuff, right? Like if your clients can't afford it, then do what they can afford. We'd rather treat and use money for treatment than diagnosis. But ideally, we would get an abdominal ultrasound too to look at, you know, the liver. Most times their livers are gonna be big because of the glycogen storage and just inflammation and that kind of thing. We're going to look at the pancreas. Does it look like we have pancreatitis going on? We're gonna look at the kidneys and the bladder. Do we see pyelonephritis, where we see infection, you know, dilating of that? Do we see stones in the bladder? What do we have going on? So, that's all with ultrasound, we would be able to evaluate that to. And make sure there aren't concurrent diseases that we need to deal with.

Jordan Porter, RVT, LVT, VTS SAIM:
Hmm-hmm.

Yvonne Brandenburg, RVT, VTS SAIM:
Oh, the other thing, too, about this, more with dogs is we're going to look at the adrenal glands, right? Do they look huge like up? We're also Cushiongoid because that causes insulin resistance as well.

Jordan Porter, RVT, LVT, VTS SAIM:
But when I was studying, I learned too that Cushing's does occur in cats, obviously not as often, but that causes insulin resistance.

Yvonne Brandenburg, RVT, VTS SAIM:
But I've seen one Cushiongoid cat.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. I don't think I've ever seen one.

Yvonne Brandenburg, RVT, VTS SAIM:
I saw one in it and it did not end well for that cat. They usually do not do well with Cushing's. Unfortunately.

Jordan Porter, RVT, LVT, VTS SAIM:
No. Sad.

Yvonne Brandenburg, RVT, VTS SAIM:
So, we talked about Fructosamine. Fructosamine is kind of like the equivalent of the human A1C kind of thing. So, fructosamine what it's gonna do is it only gets elevated if the blood has been elevated consistently and in the Fructosamine looks over a two week period. So, if we see an elevated Fructosamine, that means it's been consistently elevated the last two weeks. So, if you have a one off high B.G., it's not going to really affect the Fructosamine. But again, consistent. So, we like this one for monitoring cats because cats in a clinic to do a B.G. curve, most of times you're gonna have skewed results because they're stressed out. Whereas like the ketone again, or excuse me, Fructosamine can check to see how they're doing at home. Hopefully in a not so stressed environment.

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

Yvonne Brandenburg, RVT, VTS SAIM:
And then the ketones. You could use serum ketone or you could do urine ketone to see, you know, are we using our fat stores instead of our glucose for energy and are we having issues. So, we checked that as well. And those are the special tests for diabetes.

Jordan Porter, RVT, LVT, VTS SAIM:
Ketones, bad.

Yvonne Brandenburg, RVT, VTS SAIM:
Ketones are very bad.

Jordan Porter, RVT, LVT, VTS SAIM:
It's nice when we have a DKA in the hospital, then we check ketones every day and it goes from large to small to trace.

Yvonne Brandenburg, RVT, VTS SAIM:
To none!

Jordan Porter, RVT, LVT, VTS SAIM:
Yay!

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
It's so rewarding.

Yvonne Brandenburg, RVT, VTS SAIM:
Yes. And so, we're gonna talk about treatment options for diabetes. We're going to focus mainly on outpatient care because hospitalization, to me, that's more of your diabetic ketosis or a diabetic ketoacidosis. So, we're going to talk about that in the next episode, kind of more in-depth, because that's that is very labor intensive and very specific to the hospitalization protocol. Whereas your you know, your typical just diagnosed diabetic most of the times can just be outpatient care. So, things to talk to your clients about is going to be diet, right? We want to minimize the effect of diet on blood glucose. And so the theories for cats, we do a high protein/low carb, or like if you have kidney disease as well and you can't do a high protein, you do a high fiber with a moderate carb and that can help regulate their blood sugar. And then with dogs, not only are we doing consistent twice a day feeding, we like a high fiber diet. So, when I think high fiber, I think of W/D, it's common for our diabetic patients or diabetic dogs to be on W/D. But, if they don't eat it, they don't eat it. So, we also have to figure out what they're going to eat.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, it seems like a constant battle and they're like my pet doesn't like W/D and I'm like, I know I'm sorry.

Yvonne Brandenburg, RVT, VTS SAIM:
I wish I could make it good.

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

Yvonne Brandenburg, RVT, VTS SAIM:
Some dogs love it and they're all about it and others are like, "no." And so, you know, the other thing, too, we'll talk about this when we talk about client communication. But with dogs and cats that are diabetic, when they're on insulin, we have to be very consistent about how much we're feeding. And we make sure it's every twelve hours as best as we can. Obviously, if we have a free feeder, that makes things difficult, but we want to keep it as consistent as possible.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah. And I know when we have like diabetic appointments coming in just for us to do an ultrasound or something like that, we don't have them fast for these procedures. We have them give insulin as normal. And typically, what we'll do is we'll just I mean, we kind of talked about how quickly the stomach empties. So, we tried to schedule those a little bit later in the day so they don't have to fast.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, that's kind of what we do. We definitely tell them not to fast because we want the food and the insulin like usual. Don't mess with that. And I thought this was really interesting because I don't think I do this enough. But when we're talking about anesthesia on diabetic patients, they do need to be fasted. So, according to both the books that I was looking at, which was cool, is basically you want to give the day before you give the normal evening meal and the insulin. You want to say no food after 10 o'clock at night, no food or insulin the morning of the procedure. Once that pet gets into the hospital, we're going check their blood glucose. We're going to give somewhere between a quarter to a half of their normal amount of insulin. Obviously, the vet's going to tell us how much to give. And then right before anesthesia, just check their BG see where they're at. And then during the procedure, every 30 minutes, you just want to check their glucose to make sure we're not having too high or too low. And ideally during the anesthetic procedure. We're maintaining our blood glucose between 150 and 250. And then we can use like a glucose CRI. So, you know, our 5% solution or 2.5% depending on what's going on. And then we can do either regular insulin injections or CRI to help maintain them at the 150 to 250. I know we don't do that as much as we probably should. And I was like, oh, that might be something I talk to my clinic about or my hospital about to see if, you know, we should look under anesthetic protocols for our diabetic patients.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, I can't the last time I actually did anesthesia on a diabetic, though. Because normally we have a DKA, so they're not stable enough for anesthesia.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, we have a couple of them that come in because they have concurrent stuff. So, we you know, like we're right about GI lymphoma or the other big thing is if they're also Cushingoid.

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

Yvonne Brandenburg, RVT, VTS SAIM:
And now they have a gallbladder mucocele. That's my favorite.

Jordan Porter, RVT, LVT, VTS SAIM:
I saw that yesterday.

Yvonne Brandenburg, RVT, VTS SAIM:
See it happens! Yeah. So, that you know, we just have to take that into account, you know, for anesthesia.

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

Yvonne Brandenburg, RVT, VTS SAIM:
I would say it in a general practice. You know you're probably going to be doing some dental cleanings on these patients.

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

Yvonne Brandenburg, RVT, VTS SAIM:
So, keep that in mind.

Jordan Porter, RVT, LVT, VTS SAIM:
So, I think for this disease, just diabetes in general, client education and just really communicating with the client, what they should expect at home is huge. This is a really big part of these cases is just client education. So, clients really should understand that there is no cure for diabetes. So, quality of life for both the patient and the client is important. Clients need to feel comfortable with what they're doing to their pet. And I think that's pretty important. I'm not sure I wouldn't say euthanizing a pet just because a client doesn't want to give injections. That's a little absurd. But I do think that they need to realize it's pretty monotonous and pretty routine, that they need to be like twice a day, every day, giving injections to their pet and then maybe even checking blood sugars pretty frequently. That I think that just needs to be communicated.

Yvonne Brandenburg, RVT, VTS SAIM:
Well, and I think, you know, the educating that this isn't a one and done kind of thing with like this is for the rest of the pet's life. You know, they really need to be committed to doing that. So, if you've got, and it's more so like your DKA's where you're about to drop a bunch of money for hospitalization.

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

Yvonne Brandenburg, RVT, VTS SAIM:
And you know, they have to understand that we're not fixing this. You need to be committed to doing the injections and the feedings and an understanding that you have to be home at a certain time every day to give the food and the insulin. Like you can't just be like whatever. I'm going to go party after work or you know, it does, I would say for some, you can get caregiver fatigue with diabetes.

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

Yvonne Brandenburg, RVT, VTS SAIM:
And that is something that they need to also be aware of.

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

Yvonne Brandenburg, RVT, VTS SAIM:
I would say for your straightforward diabetics, you know, I wouldn't necessarily say yeah, euthanize them now. But like if you've got co-morbidities going on, you've got a dog that, or a cat for that matter, that gets extremely aggressive for injections. That might be, you know, a reason to euthanize. We had a pet, he was DKA and the owners went forward with it. And he was a caution in the hospital for us. And then, you know, within a month of being at home had, thankfully, was a tiny dog. It was probably like a 15# dog, but severely bit the owner while giving insulin. So, you know, those might be some limitations on an animal if they're aggressive for the injections. And the clients can't do it at home. You know, that needs to be something to talk about the client with.

Jordan Porter, RVT, LVT, VTS SAIM:
Or I feel like, too, even if the whole entire home situation is just stressful for the pet. So, like checking blood sugars or just giving the insulin. You're inducing stress, trying to help manage blood sugar. But you're never really going to fully control that diabetic patient. If every time getting insulin or checking blood sugar is extremely stressful.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
That needs to be considered, too, because dogs it's forever. Cats can go into remission. It doesn't happen as often as I think people would hope.

Yvonne Brandenburg, RVT, VTS SAIM:
I've seen it.

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

Yvonne Brandenburg, RVT, VTS SAIM:
It's interesting they say about 25 to 50 percent of cats go into remission. Yeah. I've definitely seen it. But it's not as frequent as, you know, we hope. I've had one dog go into remission.

Jordan Porter, RVT, LVT, VTS SAIM:
I've never had a dog into remission.

Yvonne Brandenburg, RVT, VTS SAIM:
And it was really funny because it was an employee owned dog and he had been diabetic for like five years. So, we keep looking for the insulinoma.

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

Yvonne Brandenburg, RVT, VTS SAIM:
We have yet to find it. But we swear it's gotta be in there, it's been like two years now and we're just like?

Jordan Porter, RVT, LVT, VTS SAIM:
What do they say for cats?

Jordan Porter, RVT, LVT, VTS SAIM:
Like if cats are diabetic for a year or longer than they're likely to never go into remission.

Yvonne Brandenburg, RVT, VTS SAIM:
I think it's something along those lines because of the damage to those beta cells.

Jordan Porter, RVT, LVT, VTS SAIM:
To the pancreas. Yeah, exactly.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
And then. So, I think it's also important to just to inform clients like if you have a diabetic patient, your vacations are gonna be different. You need to find either pet sitter who's qualified or skilled enough to do it or able enough to come twice a day at a specific time. But boarding facilities especially. Again, this goes back to stress. If your pets get stressed out in a boarding facility, their blood sugars are going to be all out of whack. I mean, even you going on vacation can kind of throw them out of whack. We've had several diabetic, previously diabetic patients, come in DKA because their parents were just out of town or they were just boarding or they had a pet sitter and the dogs got super stressed out.

Yvonne Brandenburg, RVT, VTS SAIM:
Oh wow, yeah, yeah. And you know, going along that we recommend, especially in households where you have multiple people that are there dealing with the animals. So, food and maybe giving the insulin, you want to be very careful about tracking the insulin dosage. So, the Pet Health Journal is great for that. You can, you know, you could put the insulin in there. And then somebody gives it, puts an initial or just a checkmark or something. Because I've had it a couple of times where a pet comes in with insulin overdose because, you know, a client, mom came home and fed the dogs and gave the insulin and then dad came home and fed the dogs and gave insulin. Right? Cuz dogs don't tell you all the times they've already had dinner or breakfast.

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

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. So, that's something to make sure that we keep track of. And they can also track, you know, how is the thirst and the urination and the hunger, you know, and see if we can keep that quality of life good. So, keeping track of that way and then they can bring it with them to their appointments and discuss it.

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

Yvonne Brandenburg, RVT, VTS SAIM:
You need to be discussing that appointment.

Jordan Porter, RVT, LVT, VTS SAIM:
And follow ups are important. And this is important for clients to understand, too, that the first few months of a new diabetic are not just like, "you're going home on five units of insulin twice a day. See you back in a year." It needs to be informed to them that we'd like to start out low on the insulin dose. We'd like to check this once your pet is more stable, relaxed and back in their normal environment. And we're likely going to have to make adjustments to these doses. So, rechecking until that glycemic control is well established, ideally rechecking that once a week. And then, of course, like I said keeping track, or Yvonne said keeping track of the PU/PD. If they think that their pet is gaining back some weight that they may have lost. That their appetite is normal. And then once we kind of reach that point, it's still not over. There's still going to need to recheck every couple weeks to every couple months, hopefully is ideally where you'd like to land: every couple months. But sometimes that's still too much for clients.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Yeah. It was interesting when I was reading it in the endocrinology book. They were saying once a week until the control happens, then at about 6 to 8 weeks after. And then 10 to 12, then 14 to 16 and then every four months. And I'm like: "I work in internal medicine and I don't think I do it that frequently." Now, some of them, yes. But, you know, I think that's a gold standard treatment. If you've got a client who has pet insurance or has a lot of money or they just want to make sure they follow it to a tee, that might be something that's recommended. But if not, you make adjustments, right, to what they're able to do. And also, you know, monitoring for that control that needs to be there. So, we have the journals, we talked about that. So, tracking her insulin dose, especially if there's adjustments, right? You can have the owner keep track of how their pets are doing after an adjustment. We have the options of the syringes, which is most times I think what we're used to. There's also the new insulin pens. So, I think Vetsulin makes the insulin pens. So, that's an option especially I just had this last week, I had an older lady, you know, she's like in her 80s and this is her little friend dog that she likes, but she doesn't feel comfortable with syringes. So, she wanted the insulin pens. Cool. We'll get you the insulin pens ordered up. Sometimes we just do what we need to for them. We're monitoring water intake, urination, energy level, right? Once they get feeling better, hopefully their energy comes back and we feel like be more normal.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah. And then we talk a lot with our clients about if they're comfortable checking blood sugar at home because like you said at the beginning, that pets are just more comfortable at home. Their blood sugars are going to be falsely elevated, but stress related, elevated in the hospital and trying to do those blood sugar curves in the hospital. So, I made a couple hand out sheets for a spot checking before Freestyle Libre. We will modify those and try to get those up in our Technician Treasure Trove to use. And then, of course, the continuous glucose monitors, which are extremely helpful. But from what I read, they are more useful in dogs or more accurate in dogs and cats. And they stay on longer.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. I know for now, I think they're working on it, but technically they're just humans. So, they're working on getting the visionary one, which I think is gonna be huge once it actually happens. But we've been using them on our both, we've done for hospitalized patients as well as outpatient. And the one thing that I will say about them is: if you've sent them home with a client, but you've never looked at the packaging that comes in there. I'll upload the handout that I just created for it. There is a booklet in there that talks about how to manage your blood sugars using the information you get from the Freestyle Libre. The problem with that is it's geared towards humans and it talks about adjusting doses and keeping it in a specific blood sugar range. When you're when you're talking to your clients about this, just either take that information out, or just let them know, "do not change doses. This is geared towards humans. Don't use this information." Because we had, when we first started using them, we had these clients calling and they're like, "oh, my God, my dogs' sugar is above 280. What do I do with his insulin?" And we're like, "well, nothing. That's a great number." Well, the problem is, in the in the literature that came with the monitors. It talks about that's too high and that you need to adjust dosages. So, just be aware of that. And like I said, I'll put it in the Technician Treasure Trove the handout that I created for the Freestyle Libre specifically.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And I do think those are great, especially for clients. I mean I feel bad as a technician just poking a pet every two to three hours in the hospital, let alone being an owner who has to poke them twice a day normally and then poke them every two hours for ten hours, twelve hours. So, I think it's pretty good. I will say that it's pretty important to inform people that when you get the "14 day sensor", to inform them that it doesn't stay on for 14 days because it's geared towards humans. But they're not made for dogs and cats to really stay on for 14 days completely. So, I try to tell people that those are good, usually between 5 and 10 days. However, I have had one last for twelve days.

Yvonne Brandenburg, RVT, VTS SAIM:
Really? I very rarely get them to come off early.

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

Yvonne Brandenburg, RVT, VTS SAIM:
And so here's the thing. Yeah. So, I'll put some pictures because I put pictures of the show some of my coworkers. But, you could you click the area, you prep it, and there's like a little alcohol swab so you get the oil off of it. And then we took a little tiny bit of skin glue.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, that's what we did too.

Yvonne Brandenburg, RVT, VTS SAIM:
And we put little drops on there and then put it on. You hold it for a minute. But then, do you put a wrap on them?

Jordan Porter, RVT, LVT, VTS SAIM:
We have like a little like surgical sock thing.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. So, we either do that or because we've been putting it like on the lateral neck for some of these patients.

Jordan Porter, RVT, LVT, VTS SAIM:
I think what happens most of time is the owners will take it off. And I think what our one client who did take it off, just put a bandana on. And so, it's just,

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, that's not good.

Jordan Porter, RVT, LVT, VTS SAIM:
It's just one of those things where it just stops working after twelve days or 10 days.

Yvonne Brandenburg, RVT, VTS SAIM:
We say 10 to 14 days is usually like the time period on those things.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. I don't think I've ever had one fall off as early as five, but I know I've heard about them coming off early or stop working that early because dogs just rambunctious or rolling on the floor and it slips.

Yvonne Brandenburg, RVT, VTS SAIM:
I think you I think you mentioned this earlier in the episode. We talked about cataracts. So, dogs are going to get cataracts. It's just unfortunately, it's one of the things that clients need to be aware of. And the reason for that is the insulin can cross the blood aqueous barrier in the eye and then it deposits within the eye and causes lipids to attract to that area. So, that's unfortunately, we're going to get cataracts for these guys. You can, depending on the client, they're really concerned about it, it's really bad, they can go to ophthalmologist. I did have one of my clients actually do that and have surgery to get the cataracts removed. But it's not cheap. They're also diabetic, so, you know, you do have some higher risk with anesthesia. But I mean, it's an option, especially, you know, if you've got insurance again and things are covered with a great option just because, you know, it is cost prohibitive for a lot of clients. But it's something that can be done. I'm just throwing that out there.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, I think we've had several clients do it just mostly with the patients who just don't do well being blind. But unfortunately, we did have one like after she had cataract surgery, just we could not get her back to like being regulated, well regulated. And so, she was euthanized shortly after.

Yvonne Brandenburg, RVT, VTS SAIM:
Ahh. Huh, interesting.

Jordan Porter, RVT, LVT, VTS SAIM:
And she developed pancreatitis and it just got really bad. Her eyes looked good.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Unfortunately, anesthesia can sometimes upset the pancreas.

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

Yvonne Brandenburg, RVT, VTS SAIM:
The other thing, too we talk about the strict regimen with that diet. I talk to clients that, you know, if you're not going to do the prescription diet, whatever diet you pick hopefully it's one that's recommended. You want to do the same quantity of food every day, the same type. You're not switching it up. You can include treats in your diet plan. Make sure you're accounting for them in the calories. And I say give the same amount of treats every day. So, don't go no treats one day and then 15 the next. And you're gonna want to do every twelve hours if they're on insulin. And so that's just, you know, with diet. That's something with me pretty cognizant of. I tell clients, too ice cubes for dogs make great treats because it's crunchy, but there's no value to it other than water.

Jordan Porter, RVT, LVT, VTS SAIM:
I've had to have the talk with several clients about: "But I give my dogs like vegetables for treats," and I'm like, "well, what vegetables?" And they're like: "carrots." And I'm like, "carrots have a lot of sugar in them." I think it's just trying to make clients aware that if you're gonna do a treat, yes stick with the specific treats. Not all vegetables are good. I do like the ice cube plan.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, just like with people. Celery. Celery is good. Lettuce is good. Ice cubes. My dog called our refrigerator an automatic treat dispenser.

Jordan Porter, RVT, LVT, VTS SAIM:
All my dogs get so excited for ice cubes.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, like they hear it and they come running from in the room, you're like, "OK. Good Lord. It's just an ice cube." Yes.

Jordan Porter, RVT, LVT, VTS SAIM:
I think one of the big things that I like to talk to clients about is just sign of hypoglycemia. So, what to look out for and what to do about it. Obviously,

Yvonne Brandenburg, RVT, VTS SAIM:
Supercritical that they understand that.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. So, I tell people, look out for weakness, lethargy, vomiting, especially after like if they eat, they get their insulin, then they vomit their entire meal. You'd need to be aware that hypoglycemia could happen here soon. We've had I had one cat who was in like a diabetic coma, just lateral, but the owner noticed it fairly quickly. The cat was like sitting in a corner, just like dazed and confused, just staring at the wall. And then by the time she actually was able to get to us, like was lateral and diabetic coma. Cat came back and was still alive, I'm pretty sure. And that was like six years ago. So. So, I think trying to warn clients about what to look for and then what to do. They want to, I like to have people check a blood sugar, give Karo syrup or maple syrup applied to the gums and then call or just come straight to the clinic. If they're able to check a blood sugar. It's obviously not as important as just trying to get something in. And if the pet is still coherent enough, just try to feed them. So, but I do try to make sure that all my diabetic clients know to have Karo syrup or maple syrup on hand.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, and it doesn't need to be a lot. And you want to make sure that they're like just basically putting it on the gums because the capillaries will absorb the sugar versus, you know, trying to syringe it down their throats because at that point they're probably not swallowing. So, you want to make sure that you're not going to like choke them with it. So, apply it to the gums, let it absorb kind of thing. And usually that's enough to get them coherent. And then, you know, we kind of get them in and see what's up.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Exactly. And hopefully it's just a simple like there's just too much insulin. Maybe the pet just doesn't need as much now.

Yvonne Brandenburg, RVT, VTS SAIM:
Or hopefully it's something as simple as mom and dad both gave insulin and you're like well don't do it ever again.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Right? And then I think to a lot of clients don't understand how to handle their insulin. And it threw me for a loop, by the way, when Vetsulin changed it, and now you shake it. I just.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. It's funny because I was reading that in the endocrinology book because it's the most recent one. And they're like, well, there's studies now that say that you can shake it for Vetsulin, but not be others yet. And I'm like how about we just not shake that?

Jordan Porter, RVT, LVT, VTS SAIM:
Why'd we have to study that?

Yvonne Brandenburg, RVT, VTS SAIM:
And the reason behind it, in case you don't remember, this is the insulin protein. It's a protein. So, when you take it, it can actually break down that protein and deactivate it. Same being said of you don't want to freeze it. You don't want it in a hot car because it can actually deactivate the insulin.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. But yeah, the whole shaking the Vetsulin threw me, like it just.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
Luckily, we don't use that as often as we used like, Humulin N. So, I still give them instructions for gently mix. It's good for three months. So, after you open the bottle, we do tell our clients to discard the bottle after three months. It's kind of cost consuming for clients, especially those ones who are only giving maybe like three to five units twice a day. They're not gonna go through the bottle and yes, they're going to waste some.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, and it was interesting, isn't it, because we say after three months puncture, which is crazy, because if you're getting insulin from a human pharmacy, our pharmacists in this area tell them after a month to throw it away.

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

Yvonne Brandenburg, RVT, VTS SAIM:
And they call us freaking out and I'm like, "no, no. Our doctors are OK with three months". And in the endocrinology book and actually said that you can use it longer until the expiration date, as long as you're not noticing symptoms. And I was like,

Jordan Porter, RVT, LVT, VTS SAIM:
But why do we want to go there?

Yvonne Brandenburg, RVT, VTS SAIM:
Like, really?? So, you know, and that's something that is important to ask your client. If you're seeing a pet that's been well-controlled, you know, all of a sudden they're not being well controlled. 1) Did you get a new bottle of insulin recently or 2) is it an older bottle of insulin because you know that to be part of it as well. So, like if all of a sudden, they're hard to control, well, how old is their insulin? So, that's just something that clients should be aware of.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. So, we will switch clients from Vetsulin to Humulin. And then so we do make it extremely well noted to the clients. We'll even write it down for them. I'll tell them to put their insulin syringes elsewhere, because Vetsulin uses the U40 syringes and Humulin uses U100. And there's a big difference on using those. So, we tell people if you don't want to throw them away, just put them in a different room, different areas, somewhere completely separate from your normal insulin routine.

Yvonne Brandenburg, RVT, VTS SAIM:
Right. You can even, it's a good idea to have it in a Ziploc bag with a note that says don't use these, you know, Cuz, yeah, sometimes we do switch back and forth depending on how that patient's doing. And it's good for them to remember, too, that when they're ordering insulin syringes, depending on where they're getting them from, like a human pharmacy is only going to have U100s. They're not going to have U40 syringes. So, they need to be aware of that. If they're doing that. When you say Chewy.com or, you know, one of the other online pharmacies, they're gonna have the U40s because U40 is veterinary only. So, that's just, you know, it's one of the things that they have to be aware of. Because if you're giving the, let's say you're using a U100 insulin and then they accidentally use a U40 syringe, you're gonna give about two and a half times the amount of insulin for the same unit number. So, you're gonna give two units with a U100 that's actually closer to like nine units of insulin with U40 with the volume. Right? S, you want them to understand that they're going to overdose their pet if they go from a U100 to a U40. Or the opposite being true if they're using U40's insulin and then they all of a sudden give U100, they're going to be under dosing their pet. So, just making sure that they know to look at the insulin syringe and make sure that it's the right one. Ideally, they're doing what time they get new syringes.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And I think training sessions are important, too, especially when you have those like not well regulated ones. What I would like to do is I have a client show me how they give the insulin. I'll show them first and then I have them show me. But I had a client once who the dog just wasn't well regulated at home. When we would do in clinic blood sugar curves, the curves were great. But the dog was still very PU/PD at home. So, what she was doing when she showed me, she would pinch the skin and then she would go straight down with a needle. So, it was almost like a, the needle just wasn't getting subcu, it was more of like a dermal dose of insulin because you just pinch it and then, yeah, just go straight in. But she also preferred the shorter needle. So, it was very, it was very interesting. It took a lot of a lot of demonstrations to kind of show her how to go in at an angle and not go straight down like into, because it was it was very unusual, I think. And then I think to a lot of people I know when I learned how to give insulin times has changed because we would we would give it up in the scuff a lot. And now I like to give it between the shoulder blades and the hip bones, like on the flank area. I feel like it's absorbed better versus up in the scruff it doesn't get absorbed as well.

Yvonne Brandenburg, RVT, VTS SAIM:
Hmm. Interesting.

Jordan Porter, RVT, LVT, VTS SAIM:
I don't know if there are studies on that. I should look that up.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. I'd be interested in seeing that. The other thing that the book was talking about is to kind of rotate spots so you don't want to give the insulin injection in the same spot every time because you can cause scar tissue if you're doing in the same place. And the potential for sensitivity or abscesses and stuff. So, that's interesting that they mention that. Because I think I'm not good about telling clients to rotate where their giving it. I'm probably not as good as I should be. But you can do several training sessions. You know, when they're first diagnosed and maybe at the next check in appointment we can be like, "hey, do you have any questions about giving the insulin?" And some people do great with it and others will struggle. And so sometimes they just need the okay that if they're struggling, they can ask you.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah, I agree. And most pets, I think, they do tolerate it really well. They're really good for the injections. Most of them.

Yvonne Brandenburg, RVT, VTS SAIM:
I think clients freak out.

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

Yvonne Brandenburg, RVT, VTS SAIM:
Way more than they need to. And a lot of times I tell them I'm like, "you're probably more nervous about it than your pet is about it. And they're gonna notice that you're nervous. So, try to relax, try to get into that happy place." And I always tell them I'm like, "pretty soon you're gonna be better at this than I am." And I was like, so, you know, it's a learning curve. Just be OK with that. But there are some patients that aren't so good for it.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah. I do think it's OK for you to tell your clients if their pet might need a muzzle or e-collar or some other way to not get bit while giving the insulin, but then that kind of goes back to a good quality of life for the client and the pet. But at the same time, I have, one of my own dogs, she's wonderful except for trimming her toenails. So yes, she gets muzzled for trimming her toenails. Mind you, I've stapled this dog and suture her and she's never bitten me trimming her toenails. So, I think if it were one of those situations where I just needed to muzzle hard to give her an injection, it wouldn't be an ordeal. It wouldn't be, she'd be like, "ugh, okay."

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. It just depends on the animals and the owners to see what's gonna be best for them. But another thing too to remember is like just like with us in clinics, it is how your body language is, too, as you're approaching them, because you know, if a client's are sweating profusely, they got that stress sweat going on, they're freaking out and they're like shaking with the needle, their owner is gonna, Err their owner? Their pets are their owners. The pet's going to notice that their owner is freaking out and they won't understand why. And so, you know, getting in that happy place, you know, is a good thing. And just making it not a big ordeal is, it's good for both.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, I think what's important, too, because sometimes this gets forgotten and I kind of forget here and there, but it's okay if, I try to tell clients this, it's okay if you miss if you give an insulin injection, but if you see it comes out, the other side is like, oh, the fur's wet. Inform them, do not redose like just,

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, no.

Jordan Porter, RVT, LVT, VTS SAIM:
Just make a note of it. Just let them write it in your journal saying like hey, insulin site was wet so probably missed the dose. But do not redose. Because I've had several clients call and be like, "Well I missed because it was wet or I think I missed. And so, I redosed and now he's hypoglycemic." And so, it's just one of those things where I try to really let them know that it's going to happen. It can happen. It's not a big deal. Just move on to the rest of your day and then try again in the evening.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And just let them know, "OK, well that day they're probably going to drink more. They're probably going to pee more, or they're probably not going to feel as good."

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

Yvonne Brandenburg, RVT, VTS SAIM:
But that's better than being hypoglycemic and potentially seizuring.

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

Yvonne Brandenburg, RVT, VTS SAIM:
So it's okay. You know, just move on. And I think you know, talking to clients, letting them know the long term goals of this disease is comfort for both the pet and the owner. We're not curing anything. It's just making sure they have good quality of life. We're talking about follow up. We don't really have too many options as far as diabetes, it's not like we can cure it with surgery or anything yet. Maybe someday, but not now.

Jordan Porter, RVT, LVT, VTS SAIM:
We just really want to reduce the symptoms that the owners are saying at home. So, I think that's important for them to understand that you're gonna have good days and bad days. But as long as the majority of the days are good and you've reduced symptoms in your pet's feeling good, then that's important.

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly. Some of the cautions with diabetes. So, insulin overdose. We talked about that. So, making sure that, you know, if you have multiple people that are that are handling the insulin, that they have a way to communicate, like with the Pet Health Journal or some other way, whatever it is that they may want to do. We also talk to our clients that if a pet doesn't eat, we give a half dose of insulin. And the reason for that is they may not be eating because their sugars are too high. So, if they're too high sometimes they don't want to eat. So, we don't want to not give them any insulin in case. Unless, you know, you can check a glucose then check a glucose and see where they're at. And then, you know, wait until the next meal, hopefully they just eat and it's not a problem. But if they don't eat at the next meal, do not give insulin. Again, if you check glucose, great. If not, then you want to make sure that you get in and visit your vet to see if they're too high or too low. Obviously, you're going to monitor too.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And to see if something else is going on that's causing your pet to not want to eat. So, maybe they are developing,

Yvonne Brandenburg, RVT, VTS SAIM:
Pancreatitis!

Jordan Porter, RVT, LVT, VTS SAIM:
Pancreatitis is going to come up so much. There's a reason why that episode was an hour long.

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly.

Jordan Porter, RVT, LVT, VTS SAIM:
I think one interesting thing is the Somogyi effect. But it took me probably a while when I was working in GP to realize that that was a thing.

Yvonne Brandenburg, RVT, VTS SAIM:
I did not know about Somogyi when I was in GP. It wasn't until I worked in a specialty practice that I even heard of the word. And I was like, "What are you talking about?".

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

Yvonne Brandenburg, RVT, VTS SAIM:
So, I don't think it's a common thing that's talked about.

Jordan Porter, RVT, LVT, VTS SAIM:
No, I definitely don't. Because I think the go to is to just treat it and say you don't really realize like what's happening. You're like, "oh, shoot the blood sugar just spiked like crazy." So, it's the body's response to low blood sugar, so then you have that rapid increase of blood sugar. I studied this forever.

Yvonne Brandenburg, RVT, VTS SAIM:
I was gonna say that we talked about it in the beginning where, you know, we produce glucagon, right? Which releases sugar. So, what happens is if the body gets too low, the body's like, "oh, geez, I need to do something about this." It releases the glucagon which then goes the liver and then glycogen is released. And so, we see a spike in the blood glucose. Well instead of looking like that pretty bell curve all of a sudden then it goes it dips down, it goes up, and then it dips down. That usually happens if the nadir, and if you remember the nadir is the halfway mark of the drug. So, at the halfway point we should see it be at the lowest. But if all of a sudden you see it go down and then spike back up and then go down and come back up, you're probably Somogyiing that pet. So, that's why it's very important, when we're doing a glucose curve, know that we get more than just like, oh, we have our beginning number, we have our six hour mark, and then our 12. Because you could get a high, but you're missing the dip down.

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

Yvonne Brandenburg, RVT, VTS SAIM:
Which is why we do the curve to make sure that, you know, we're not Somogyiing our pet.

Jordan Porter, RVT, LVT, VTS SAIM:
I think that's where those continuous glucose monitors come into play too, because they are really good. We do, like I said, our blood sugar curves we do every two to three hours when we're checking. But you can still miss it. Like we might have a really good number. That's like 150. And we're like, this is great. It's a perfect curve. And then maybe it just dips a little bit lower, but slightly not scary. And then all of a sudden, we're back up at 400 and we're like, "what the heck? It's only been two hours." But it's just it's the Somogyi effect.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And so basically what happens if you see this Somogyi? That means we're giving too much insulin. So, that means we need to back off. So, the problem is if you're not catching that dip down and you just see the higher number, doctors may say, "oh, we need to increase our insulin dose.".

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

Yvonne Brandenburg, RVT, VTS SAIM:
Instead of decreasing it. And then that's when we a lot of times we'll get them in our clinic. They've been difficult to regulate. But really what's happening is we're Somogyiing. So, a lot of times what we do is we back them off their insulin.

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

Yvonne Brandenburg, RVT, VTS SAIM:
And then kind of creep back up to see where's a good level. So that's just, it's just one of those things that you kind of have to be aware of. And clients, not so much, but most of the times it's us in the clinic.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah. And I think that's just like the technician side of it. Like we've definitely seen that where we have like a 5 kg Dachshund come in and they're on 11 units. I'm like, "why?" But they're unregulated and then we do the same thing. We just back them off a little bit. It turns out the real dose should be around like seven. And it's because they were Somogyiing.

Yvonne Brandenburg, RVT, VTS SAIM:
Well, and the other thing that we need to remember is insulin needs can vary over time. If you've got more stress, if you've got inflammation, if you've got a concurrent disease going on, you may need more or less insulin based on what's happening within the body.

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

Yvonne Brandenburg, RVT, VTS SAIM:
And that's part of the reason why when we first diagnosed them, we have to start off low because the body needs to be like, "oh, hey, there's insulin in my body again. What do I do with it?" And so, it is the body's way of figuring out what needs to happen. Plus, you know, other things that are going to affect how much blood sugar there is. So, it's not a static set it and forget it. It really is: it's an art.

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

Yvonne Brandenburg, RVT, VTS SAIM:
It is an art to be able to manage that.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And I think, too, it's just a matter of like those blood sugar curves, you just don't always see where the low really is. I think that's where, yeah, a continuous blood glucose monitor really comes into play. And like you said, even when they get out of the hospital if they're a DKA and then they go back home, we start them low. Because once they get into their normal routine, there's less stressors on their body. So, we know that their dose adjustment might not be as much as it would have been in the hospital.

Yvonne Brandenburg, RVT, VTS SAIM:
It's the tip of the week.

Yvonne Brandenburg, RVT, VTS SAIM:
So, this week's tip of the week, we kind of a couple of them just because we can't make up our minds. So, the first one is going to be the Technician Treasure Trove on the web site. There, again, if you haven't joined our newsletter list, we definitely recommend it. Once you sign up, you'll get the password for the Technician Treasure Trove because it is password protected because we don't want just anybody getting all this amazing information. But it is password protected to sign up for the newsletter, you'll get the password. You can use it as many times as you want to definitely save password, save the website. And that's where our client handouts are going to be. We'll make sure that we get up there, for the continuous, the Freestyle Libre, so the continuous blood glucose monitoring. Jordan, we're going to create a really cool hand out as far as like getting blood glucoses on pets at home. The other part to that is part of the tip. I don't know if we talked about this, but if you have not visited the Vetsulin web site, so vetsulin.com, I definitely recommend it. There's really great information for pet owners on there for dogs and cats specifically. There's also, I believe they have an app where clients can track insulin and blood glucoses on there, which is really cool. And then Alpha Track has a really interesting website as well that has information. So, just using some of that for your pets and your clients. So, tip of the week is, I guess, using your online resources wisely.

Jordan Porter, RVT, LVT, VTS SAIM:
Yes. The Tech Treasure Trove is, I feel, it's going to constantly evolve. So definitely sign up for it.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And we'll just add as we kind of go.

Yvonne Brandenburg, RVT, VTS SAIM:
And now for the Question of the Week.

Jordan Porter, RVT, LVT, VTS SAIM:
So our Question of the week this week is: Is there something about diabetes that you'd like to know more about? Or even something that you learned today that you didn't know about diabetes? I know upon research we've learned a lot recently.

Yvonne Brandenburg, RVT, VTS SAIM:
I feel like it's an ever evolving learning curve.

Jordan Porter, RVT, LVT, VTS SAIM:
So much so. Everything's changing so frequently because like I said since I've been to tech school, it's very different than what I learned seven years ago.

Yvonne Brandenburg, RVT, VTS SAIM:
Right? I feel, you know, it's funny that you say that, as I remember in tech school, my lowest grade was in body systems, which is ironic because that's what I basically do now, like it was all endocrine.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, that's how the website is formed.

Yvonne Brandenburg, RVT, VTS SAIM:
And kidney disease and everything. And I'm like, huh? Really funny that that is what I know the most about now.

Jordan Porter, RVT, LVT, VTS SAIM:
It's pretty. I got to say though, since tech school, I've definitely become more apt to learning about just more details about anatomy and physiology that I didn't really care to know about before. But now that we see so many intricate diseases, I think. It's interesting to know.

Yvonne Brandenburg, RVT, VTS SAIM:
It was SO overwhelming in tech school.

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

Yvonne Brandenburg, RVT, VTS SAIM:
I was like, "feedback loop? I was like what the heck is a feedback loop?".

Jordan Porter, RVT, LVT, VTS SAIM:
Well honestly, in tech school I was like, "I just want to start helping dogs. Why do I need this?".

Yvonne Brandenburg, RVT, VTS SAIM:
Can I start with the basics?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah right?! I just want to do cool things like draw blood.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Now I can read the Small Animal Internal Medicine For Vet Techs and Nurses book and feel like, "oh yeah, I saw that dog that had that disease. Oh yeah. I saw that cat that did that".

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

Yvonne Brandenburg, RVT, VTS SAIM:
So, that helps too.

Jordan Porter, RVT, LVT, VTS SAIM:
Oh definitely. To put a patient with a disease makes it way easier to understand things like, "That's why they're PU/PD.".

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly. "Oh, that's why that happened." Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Those are my favorite moments.

Jordan Porter, RVT, LVT, VTS SAIM:
I had so many of those moments when studying for my test.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
And it makes it easier to study. Like if I could put a patient with a disease. It made it so much easier.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
So the question of the week was, is there something about diabetes that you'd like to know more about or something that you learned during this episode that you didn't know before? And if you would like to answer the question of the week, you can go to imfpp.org/shownotes or InternalMedicineForVetTechs.com/podcastshownotes and you can look for episode 7. Also, go back and look at any of the previous episodes to answer those questions of the week. We do like to see those comments and we'd like to shout you out.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And remember that since you did listen to this episode, all you have to do is answer five questions. You can get a CE certificate too. So, we've got a lot of options for you. Please let us know if there's anything else that you'd like to see from us. We are trying to do our best to make this the most valuable it can be for you. And we'd love to get some feedback from you and I think is there anything else that we need to talk about, or is this a wrap for diabetes?

Jordan Porter, RVT, LVT, VTS SAIM:
It's a wrap!

Yvonne Brandenburg, RVT, VTS SAIM:
Sweet! Alright, guys, have a wonderful week and we will talk to you next Tuesday.

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 InternalMedicineForVetTechs.com. Talk to you next week. Bye!

Quickly and accurately convert audio to text with Sonix.

Sonix uses cutting-edge artificial intelligence to convert your mp3 files to text.

Thousands of researchers and podcasters use Sonix to automatically transcribe their audio files (*.mp3). Easily convert your mp3 file to text or docx to make your media content more accessible to listeners.

Sonix is the best online audio transcription software in 2019—it's fast, easy, and affordable.

If you are looking for a great way to convert your mp3 to text, try Sonix today.

---

---

Question of the Week