From Glucose Curves to Insulin Dosing: Understanding Pet Diabetes Care
Tune in to this informative Vetsplanation episode as veterinarian Dr. Sugerman is joined by Dr. Z to shed light on the complexities of diabetes management in cats and dogs. From discussing the intricacies of glucose curves to outlining the various insulin options available, this episode equips pet owners with essential knowledge to navigate the challenges of diabetes. Don't miss out on valuable tips and recommendations from professionals dedicated to animal well-being.
What You’ll Learn:
Understand the key signs and symptoms of diabetes in pets.
Learn about the importance of glucose curve monitoring and its role in diabetes management.
Explore the different types of insulin available for treating pet diabetes.
Gain insights into at-home blood sugar monitoring techniques for your furry companions.
Get expert advice on when and how to seek veterinary guidance for diabetic pets.
Hear real-life case studies and success stories of well-managed diabetic pets.
Acquire actionable information for enhancing the quality of life for pets living with diabetes.
Ideas Worth Sharing:
"And there can be complications that come with poorly regulated diabetes too, like infections can get worse, liver problems, muscle wasting, skin infections, eye problems, all of that can over time add up to decrease their quality of life." - Dr. Xenia Zawadzkas
"But at least it's something easily treatable. At least giving an injection twice a day is not as bad." - Dr. Tyler Sugerman
Watch On YouTube:
Read The Transcript:
Tyler: [00:00:00] Hi, and welcome to Vetsplanation. I'm your veterinary host, Dr. Sugerman, and I'm going to teach you about veterinary medicine. In this podcast, we can dive deeper into the understanding of what our pets are going through. and break down medical terms into easier to understand chunks of information. Just a quick disclaimer, this podcast is for informational purposes only.
This is not meant to be a diagnosis for your pet. If you have questions about diagnostics or treatment options, please talk to your veterinarian about those things. Remember, we are all practicing veterinary medicine, and medicine is not an exact science. Your veterinarian may have different treatment options and different opinions.
The information I provide here is to help pet parents have a better understanding about their pets. If you like our podcast, please consider sharing this podcast with at least one friend or just somebody else who has pets as well. Now let's jump into this week's episode.
Dr. Sugerman: All right , welcome back to Vetsplanation. So I have Dr. Z back with me again today. So for those of you who [00:01:00] don't know Dr. Z, she works during the day as a general practitioner and I call her the diabetes expert. So she, she is definitely really good at diabetes and my go to resources when I have questions about them.
All right, so we're going to jump into what is diabetes?
Dr. Z: Hi, yeah Excited to be here and I listen to lots of podcasts. This is like super exciting for me to actually be on a podcast.
Dr. Sugerman: You're like famous now.
Dr. Z: Anyway, what is diabetes? So diabetes mellitus or mellitus is what we're, talking about mellitus or mellitus. I don't know. I think the British say mellitus.
Dr. Sugerman: Yeah, exactly. I see the two different ways.
Dr. Z: Anyway, it means sweet. That's what mellitus means. And actually, it goes back to when people first discovered diabetes, like as a thing, they diagnosed it by tasting the urine.
Yeah. Gross. Yep. And it was sweet. And they're like, Oh, this is diabetes mellitus. So yeah, sweet urine is what [00:02:00] it means basically. There's also diabetes insipidus, which is totally different. We're not talking about that today, so I won't even go into it. So we're talking about the DM or diabetes mellitus and it all comes down to the pancreas and that's the little organ that lives next to our first part of our small intestine. It has two main functions first to digest our food, especially fats. It helps secrete stuff into the intestines to help digest that food for us. And it also has these little islands that live in it, they're called the islets of Langerhans.
Dr. Sugerman: It's a great name.
Dr. Z: Fun, yes. Some dude named Langerhans discovered them. And that's where the insulin is produced, inside the pancreas. And in those islets are these specific cells that produce the insulin called beta cells. And I'll be talking about those a little bit.
Dr. Sugerman: Okay. So remember that name.
Dr. Z: Yes, the beta cells.
You don't have to remember the islets of Langerhans. Although I like saying it. Great. But anyway, the pancreas makes our insulin.[00:03:00] And the insulin, what does it do? It drives glucose into our cells. And I don't know if any of you remember the Krebs Cycle back in science class. But that's our main source of energy, right?
Glucose is like the smallest part of sugar. And it's not gluten. It's totally different. Glucose is sugar. And it's our main source of energy. And so once it gets from our food into our bloodstream and then into our cells. That's where we start to use it to make all our cells work and make all of our various organs do everything.
So it's, it's essential for life, right?
Dr. Sugerman: It's a very important tiny organ.
Dr. Z: Yes. Yes. Tiny molecule, I guess you know.
Dr. Sugerman: Yeah that's true. I was thinking the pancreas.
Dr. Z: Oh the pancreas is also important. Yes. So that insulin helps, um, you know, get that glucose into our cells so that it can work. So if we don't have insulin, those little gates on our cells aren't working to bring the glucose into our cells. And then that's where the whole problem [00:04:00] with diabetes happens is we can't use that glucose anymore. It's just in our blood, but not getting into our cells.
Insulin also helps our liver metabolize fat properly and it helps us maintain our muscle mass. So besides being like used for energy, it also helps with those things. So those things also start to malfunction a little bit when we have really bad diabetes going on. So I was going to go into where glucose comes from again.
It's sugar, but there's different kinds of sugars, like in fruit, there's fructose and the table sugar that we put in our coffee is sucrose. But all of those basically break down back into glucose once we digest them. So if the glucose stays in the bloodstream.
Then we have too much glucose in our blood not going anywhere and our kidneys can only handle so much glucose and so when there's too much glucose in the blood it starts to spill into the urine like it overflows those kidneys and then we get all this [00:05:00] glucose going into our urine and I don't know if you also remember osmosis Yes, that's another thing that is important when you're thinking about diabetes because glucose is like It's a molecule that water wants to follow because it's it's big.
Yeah, it's big. And the water just always wants to dilute things and moves where lots of those molecules are. So when we have all that glucose in our urine, water follows it into our urine. And then we have to pee a lot because suddenly we have all this water going into our pee more than usual and then, we pee all that out and then we're like I'm thirsty I just peed all that water out and so then you're just chug chug chug chug chug chugging drinking water and then. You're doing the same thing.
It's all just going into your pee because it's following the glucose that you can't get into yourself. And so those are the main symptoms of diabetes is you're super thirsty and you're peeing a ton. And that's sometimes the first thing that people will bring their pets into me for. It's like [00:06:00] my dog's peeing all over the house or my cat's peeing out of the litter box and, or I'm starting to scoop the litter and it's got these huge heavy balls of, clumped litter instead of the regular size, normal urine clumps.
That's like one of the first things we see. And then we also lose muscle. We lose weight because we can't use that glucose, that energy.
Dr. Sugerman: It's a lot of muscle weight too, right? Not just regular...
Dr. Z: Because the glucose helps, make our muscles work properly, stay bigger. And then we can't store our fats properly, and I think that's when you end up seeing a diabetic
Dr. Sugerman: yes, exactly.
Dr. Z: Patients that are completely out of control, and our livers are trying to find an alternative source of energy, and so it starts punching out all these fats, and and then patients can get ketoacidotic from that, and then they get very sick, and then they die.
Dr. Sugerman: And we'll do DKA on another one.
Dr. Z: Okay.
Yeah. That's your realm. After you've fixed them, then I take them over.
Dr. Sugerman: You do all of the long term [00:07:00] management that I definitely cannot do.
Dr. Z: Yeah. So then that's when I take over and try to keep them from going back into that keto acidotic state.
A couple more symptoms of diabetes besides weight loss and muscle wasting, and of course drinking and peeing a lot their hair coat tends to have problems.
You get a thinner hair coat. We have all this extra sugar in the blood, and so if there's a cut or a wound, it's really slow to heal because there's bacteria loves sugar too, and so it's more likely to fester and get infected .
Dr. Sugerman: Same thing if there's bacteria in the urine, right?
Dr. Z: Yeah, so there's also all this sugar in the urine, so you can imagine if you're peeing a ton, leaking urine a lot, and it's sugary urine, you're going to be a little more prone to getting urinary tract infections.
Bacteria just has a good time up in that bladder,
In dogs specifically also they can get cataracts in their lenses, in their eyes, and they can go blind almost suddenly, like it can happen in a matter of days. [00:08:00] Sometimes it comes on more slowly and you notice like cloudy eyes, but then boom, they're usually blind.
Even, even well regulated dogs tend to eventually get cataracts when they're diabetic, unfortunately. Yeah. If it's a young dog that's diabetic, which we see sometimes, maybe, 5 to 7 years old and suddenly they get diabetes and suddenly they go blind, it can really deteriorate their quality of life a little bit because they're, not used to suddenly not being able to see.
I think dogs can still live a happy life being blind, but if you're a younger dog that's well regulated. There is eye specialists out there that can remove the cataracts, just like in people who cataract surgery. And then they can see again. Yeah. So we can fix all of these things.
Dr. Sugerman: Do you do like eye medications for the cataracts or do you usually send them to an ophthalmologist for that?
Dr. Z: Good question. So if I'm suspicious of a problem, like cataracts in themselves aren't painful. You just can't see very well, but sometimes, especially when they come on suddenly, there can be a secondary inflammatory response, either inside the eye or around [00:09:00] it. And so they can get glaucoma or uveitis like one or the other.
It can be lens induced from the cataracts. So uveitis is inflammation in the fluid inside of our eye. Okay. So behind the cornea and sometimes when you're looking with the light you can see things floating in there That's like pus basically and inflammatory and blood sometimes.
It's terrible. Yeah, it's very painful and then also glaucoma is when the pressure increases so you have maybe so much inflammation that maybe it stops up the normal flow of the fluid inside the eye and then the pressure can just build and build and the eye gets bigger and very, very painful as well.
And
Dr. Sugerman: a lot of times you see them coming in as like squinting their eyes, right?
Dr. Z: Squinting, red eyes, bulging eyes pawing at their eyes. All of those sort of things are indications that they're uncomfortable and painful. So we can test those pressures. We can look in the eye. And there are drops that can help but it's always good to go to an eye specialist.
Dr. Sugerman: Yes. I feel like eyes are like a very special thing. You're just like, [00:10:00] you should really see an ophthalmologist.
Dr. Z: Yeah. I'm like, here, let's try this drops while you go and make an appointment. Usually what I say. Plus, it's good to, when you're, when you're diabetic and have cataracts, it's good to maybe just get a consultation and be like, see if the eye specialist thinks that the dog is a good candidate for surgery.
Sometimes they're not, like if they're too old or they're really sick and have a lot of other problems on top of the diabetes, it may not be worth putting the dog through a cataract surgery. And it's expensive. It's probably like two, three thousand an eye to do it. Yeah, it's expensive. Yeah.
Dr. Sugerman: Yeah, so if it's a young dog, I definitely could see how that will help improve their life.
Dr. Z: Yeah, if you have insurance. Yes, exactly. And you bought it before they became diabetics and you're golden.
Dr. Sugerman: Do you happen to know, just off the top of your head, do you know why cats don't get... cataracts.
Dr. Z: You know I dont, I'd have to look that up, there's something about.
Dr. Sugerman: I thought it was a way they store lipids, or something like that.
Dr. Z: Yeah I think you're right, vaguely remember that. I didn't actually look it up.
Dr. Sugerman: That's okay. I'm just curious if you knew. [00:11:00]
Dr. Z: I don't remember. Okay. Just seems to be a dog thing. Weird.
Dr. Sugerman: Okay. So what animals can get diabetes?
Dr. Z: Okay any animal that has a pancreas. And lots of animals have pancreases actually, so it's mostly mammals are the ones that we deal with, like dogs and cats humans obviously, but also birds and reptiles and amphibians have pancreases, and I was actually skimming, Googling about that.
Yeah. And there are reports of like lizards with diabetes and that sort of thing. Yeah.
Dr. Sugerman: It's super interesting because like we don't, we just don't do a lot of testing for it, yeah. 'cause usually somebody comes into the ER with a lizard, it's do I wanna spend $200 for this lizard to be seen?
For like minimal diagnostics and stuff. But I feel like there's probably a lot more diabetes in things like lizards and birds and stuff that just aren't reported yet.
Dr. Z: Yeah. They just probably, die. And that's why they died.
Dr. Sugerman: Yeah, exactly. Nobody ever knows. You just die. And you're like it was an exotic.
Dr. Z: Maybe like half of them that die actually died of [00:12:00] diabetes.
Dr. Sugerman: You should start researching this. You should start seeing all the diabetic lizards.
Dr. Z: I know. No thanks, you go ahead.
Dr. Sugerman: So are there different types of diabetes? Like people always talk about they're like I'm a type two diabetic or I'm a type one diabetic.
Yeah. Are there different ones in animals?
Dr. Z: Yeah, absolutely. So let's review the types so that we can understand them a little bit. Type one is complete dysfunction of those beta cells in the pancreas. So there's just no more insulin ever. That's type one. Type 2, there's some beta cell function, so you can make a little bit of insulin, but it's, it's pretty impaired.
And you plus or minus have what we call insulin resistance, like that insulin just doesn't work as well anymore in our bodies.
Dr. Sugerman: So it's there, just not working.
Dr. Z: Yeah. First, for many reasons that I'll go into. It's just our cells are becoming resistant to that insulin and it's just not, even though it's there, it's not getting into the cells.
The glucose isn't getting into the cells despite [00:13:00] the insulin. So yeah, it's like a, in between diabetes type three is you have a perfectly normal pancreas and normal beta cells. But you just have sudden and extreme insulin resistance. Like even though you're making it, it's just not working on yourself.
So it's pretty unusual. Yeah. But that's a thing. There's type three. And in my opinion, there's a bit of overlap among all these types like sometimes it's not always black and white
Dr. Sugerman: Is there like a test you can do to be like this is type 1 diabetes? This is type 2 diabetes.
Dr. Z: I wish there was but not really.
Dr. Sugerman: Yeah, I could see a lot of overlap there
Dr. Z: Yeah, yeah and cats especially I wish there was a test because there's that new medication which I'll go into But yeah, no, it's always, you're uncertain but in general, dogs are type one. Like we don't ever really see type two in dogs. They usually always need to have insulin treatment because they just can't, they don't ever make any again on their own.
Cats if we're lucky, they can be type two and sometimes they [00:14:00] can even go into remission, and not need insulin anymore. If we jump on it right away and are really careful with our monitoring.
Dr. Sugerman: Nice.
Dr. Z: I was going to say insulin resistance is usually caused by some sort of chronic inflammation happening or infections anywhere in the body. So urinary tract infections, severe dental disease with an abscess tooth, terrible skin infection, flea allergy, dermatitis, or something in their whole body is just a big hot mess.
Then that can increase your insulin resistance. It doesn't work as well. And so you have to give more for it to do anything.
Dr. Sugerman: So some other sort of illness essentially, or something that's causing some inflammatory response.
Dr. Z: Absolutely. That can all cause insulin resistance. Yeah. For type three, think really short term insulin resistance. So it's usually caused by hormones. There's gestational diabetes. You've probably heard of that.
Dr. Sugerman: Yes, absolutely.
Dr. Z: I think that can happen in dogs and cats too. It's just so transient that we probably just miss it or, and it resolves on its own.
Dr. Sugerman: I'm sure if the dog was drinking a lot while I [00:15:00] was pregnant, I wouldn't think anything of it.
Yeah. My wife drank a lot and peed a lot when she was pregnant, too. Yeah.
Dr. Z: Yeah. I imagine they want to treat people that, I don't know, but, Yeah. Because I remember they were screening for it when I was pregnant.
Dr. Sugerman: They still screen for it now. Yeah. They do always constantly screen for it.
That's definitely not something we really do for animals. Yeah. Which is interesting.
Dr. Z: Yeah. It's just real transient. And I, I was thinking when I was looking up this stuff those cats that come in that are super stressed. Yes, I actually think that's like a really short term type three diabetes.
Cause like definitely cortisol can influence the insulin resistance. And so it's basically, I think it's their body's way of getting ready to fight or flight,
Dr. Sugerman: Exactly. They need that glucose ready.
Dr. Z: Yeah. Although they're not letting it go into the cells. I don't know. So it's counterintuitive there, but it's, it obviously gets better and then they will revert back to normal insulin.
Non resistance and and they'll start going back into their cells. So it's it's a very temporary thing just basically forget type 3 We're really just talking about type 1 and [00:16:00] type 2
Dr. Sugerman: Okay, I don't even think that people talk very much about type 3 just in like for people even in general
Dr. Z: Other than the gestational one.
Yeah, that might be the one that people who are have heard about right so yeah, dogs are type one, cats get type one or two. And if we're lucky, they're type two and then won't need insulin anymore.
Dr. Sugerman: So with animals, like we've been talking a lot about sugar and like people, they always talk about how it's like the sugar disease.
Yeah. So does this really have anything to do with sugar and animals?
Dr. Z: No. For one, they don't usually eat that much sugar anyway.
Although in kitties, if they're overweight that can predispose them to diabetes because it does cause some insulin resistance just by having more fat cells.
Keep your cat lean. That helps. Yes. Prevent diabetes.
Dr. Sugerman: Specifically. We should have that as a poster. Like prevent diabetes, keep your cat lean. Yeah. Yeah. So I know we talked a lot about like insulin stuff so far, but is there anything other, like anything else, like foods or anything that can help with diabetic animals?
Dr. Z: So for [00:17:00] dogs, unfortunately, no. Again, they're type one. They always have to have insulin treatment. Although Yeah. The food can help as far as like not spiking that blood sugar up too high and then you don't need as much insulin to get it back down. Yeah. So in general we recommend like higher protein, higher fiber less carbs, less simple sugars.
Yeah. So avoid like fruits and white rice and white bread. Mm-hmm. when you're giving your dogs treats and there's
Dr. Sugerman: more like higher protein type stuff.
Dr. Z: Yes. Higher protein. Mm-hmm. . So a piece of meat is totally fine. That's not gonna jump their blood sugar up. Yeah. And there's prescription foods that target that kind of idea as well, both for dogs and cats.
For cats, they're carnivores. They're meant to eat meat. So I don't think the high fiber diets are really that good for cats. Yeah, I recommend more high protein foods for them to help manage their diabetes and
Dr. Sugerman: it helps manage their weight too.
Dr. Z: Yes, it helps them stay lean
So for cats again, there's sometimes type two and they have some residual beta cell [00:18:00] function and some insulin still that they're making on their own. So usually if we start insulin right away, they have a better chance of going into remission and those beta cells can recover and go back to normal more easily.
But there's a new medication actually that came out for them. It's called Bexacat. And it's just an oral pill. You don't have to do insulin shots anymore. And this drug is really weird. It works on the kidneys to prevent them from keeping that sugar in the blood. So basically they just pee all that extra sugar out so that they normally have high blood sugar in their urine, right when they're diabetic, but now they have even more sugar going into their urine and then it stays down in their bloodstream.
So it's cool. It's a new, it's a new drug and I haven't yet prescribed it.
Dr. Sugerman: Does that mean they are more likely to get more urinary tract infections because now there's more sugar in their blood?
Dr. Z: Yeah. So I thought that would be a thing, but there's been, there's one big study that came out on the Bexacat and they did it on 84 cats or [00:19:00] something, and they did not see an increased incidence of UTIs.
Which was interesting. That is interesting. Yeah. And their PU/PD, the excessive drinking and excessive urination actually improved, which doesn't make a lot of sense to me because I feel like the osmosis would still be happening and you would still have to pee more, but I think it's because they started recovering and their beta cells started. producing more insulin. And so they over time have less sugar going into their urine, actually interesting. And so also I think there's something about having high blood sugar that makes you thirsty as well. So the fact that the blood sugars were returning to normal, even though we had a lot of sugar in the pee.
It was improving over time and they were less thirsty in general, so the PU/PD improved and then they didn't tend to get more UTIs. It was just one study so far. Yep. We got a lot more studies to do. Right. So I still think over time I'm gonna be screening these guys for UTIs for sure.
Dr. Sugerman: Yeah, for sure. Yeah. Yeah. And so this will only work [00:20:00] on our type two diabetic cats, correct? Yes. Not type one.
Dr. Z: Yeah. And it's, that's one big thing that the, Elanco I think it's who came out with this drug. They're saying we have to select our patients very carefully. The cat can't have had any insulin treatment has to be a new diabetic, has to be otherwise pretty healthy cat.
Because those are the ones that are more likely to be type 2. And more, more likely to have a chance of making their own insulin again. Because if you give it to a cat that's type 1 and it's gonna probably go into DKA with normal blood sugar. And that's gonna be really hard for you guys.
Dr. Sugerman: Yes, it'll be very difficult for us. Yes, I know I've been waiting for that Bexacat cat to come in and be like, are you diabetic? Yeah. Are you going into DKA? What's happening?
Dr. Z: So there's this new ketone test that we, we have, we just got. Yeah. So it's an earlier detection of those ketones. So before they go into DKA you can see that number getting abnormal and then you can realize that this might be a type one cat and we have to give it insulin.
So the two big things for you to remember are number [00:21:00] one, this is a thing now you can have DKA with euglycemia or normal blood sugar. And then number two, these patients need insulin. So even though their blood sugar's normal, you got to give them insulin and maybe supplement some dextrose until the drug wears off or whatever.
And it does only last about 24 hours. So the blood sugar would expect to start climbing again after stopping Bexacat.
Dr. Sugerman: Yeah. It's a super interesting drug. Yeah. Super interesting. All the things that yeah. That we need to know about it now too.
Dr. Z: Yeah. Oh, I know. It's fun. I'm excited about it. . Yeah.
Dr. Sugerman: I'm glad you are.
I'm not as excited on my side, but , I'm excited for the cats that will, that will help.
Dr. Z: And some it's not for every cat and then the ones that, it just doesn't work. You just have to go back to insulin, and they can still be treated pretty successfully with it,
Dr. Sugerman: And can they go and they can go back into remission on the Bexacat correct.
Dr. Z: Yeah, that's the thing. It's okay, when do we know that they're in remission because their blood sugar is always normal, right? But it does only work on one part of the kidneys. So like they can never get hypoglycemic, which is [00:22:00] cool. We're not worried about the hypoglycemia so much with these cats.
The only way to know, they will always have sugar in their urine too, like that never improves because that's what the drug is doing, even for a normal cat, it's making sugar go into the urine. So we can't be like looking at that to decide if they're in remission. The only way to know is to stop giving the Bexacat, maybe six to 12 months after you start it and watch and see if their blood sugar climbs up again they still need it.
Yeah. If it doesn't, Hey, they're in remission, we can stop.
Dr. Sugerman: That's super interesting.
Dr. Z: Yeah. Yeah. Diet is important though. Yeah. It does help decrease those swings of the high blood sugars. So you don't need as much insulin.
Dr. Sugerman: Can you do, when you're doing like the Bexacat do you do the diet as well?
Dr. Z: Then it doesn't matter. The little bit of CE I've been to on it are saying it's not as important. In general though, I, again, I like high protein diets for cats. I like canned diets for cats. Cats that are on insulin, I recommend them being on a [00:23:00] canned only diet, at least initially, because it just has lower carbs usually in that food, and higher protein, plus moisture is really good for cats.
They don't usually drink as much as they should, and it helps them stay lean and hydrated. Yeah.
Dr. Sugerman: What, what diet do you usually ask them to go on to?
Dr. Z: Oh, there's a few prescription ones out there. The Purina DM actually is a really good one. The canned has got nice high protein and low carbs. There's also Royal Canin GlycoBalance, which I don't like quite as much.
And then I think Hills makes one, they have a WD for dogs, but the MD is better for cats because that's the higher protein one, right? It's more like just think Atkins diet. Yeah. That's what cats should be eating.
Dr. Sugerman: Do you, do you ever have people who like make their own diets for them at home?
Dr. Z: Yeah, certainly.
You can do home cooking. I like BalanceIt.com for that. It helps you keep the food nutritionally balanced. They give you like a supplement to add to your recipes. And then the. I can go in on my, I have my own [00:24:00] login for BalanceIt.com and I can request a specific disease diet. So like I can look for a diabetic one and send the owner recipes that are for that specific problem.
Dr. Sugerman: That's amazing. Yeah. Very cool. I knew that they could go in, but I didn't know that we had somebody go in as well .
Dr. Z: The public can go and get recipes just for like normal dog and cat food. But like for a disease process, I think they require a bit to get involved. So I have to go in and either approve one that they look at, or I can just send them recipes on my end.
Dr. Sugerman: Very cool. Okay. That's awesome. All right, so I know we've talked a lot about what diabetes is and stuff, but how do you diagnose diabetes in the first place?
Dr. Z: Oh yes. Good question. So basically lab work, that's what it's there for, right? So blood testing and urine testing are how we would diagnose it.
You would see high blood sugar on the blood panel. And then
Dr. Sugerman: How high do you, how high are we talking like just a little bit above or?
Dr. Z: Good question. So the normal range is probably somewhere around 70 to 180 ish or so, probably for both dogs and cats. Cats can get [00:25:00] stressed. And again, that can cause a higher blood sugar.
Yeah. I'd say 250 to close to 300. I could cop up to stress. 300 would be my cutoff. If it's higher than 300 in a cat, I would be suspicious for diabetes. For dogs, absolutely. They don't usually get that stress response. Not as much as cats anyway. And so if they were over 250 to 300, I'd be very concerned about diabetes.
But usually you also want to see it in, you don't want to see it, but it will go into the urine. So when you're testing that urinalysis, you'll also see glucose in the urine. Cats that are stressed, it'll transiently go into the urine, and then it'll resolve. When their blood sugar goes back to normal so it's not always 100% in a cat.
There's another test called a fructosamine test. Yeah. That test is like the average blood sugars over the past few weeks. It's what it does. I think it's similar to the A1C in people. I've heard people talk about that test.
And then. They, I think they've actually tried testing that on dogs and cats too, but it's not as reliable, like it's not as good [00:26:00] information. So we, we usually just use the fructosamine for dogs and cats. So if that number is high, like if it's over... I think 300 or so, that's usually indicative of diabetes.
A normal patient without diabetes would probably be in the two, two hundreds, less than 300.
Dr. Sugerman: So what if you had a, let's say a cat that came in was over 300, let's say, say 350, on the regular blood sugar. And then would you do fructosamine that day or would you have them come back to recheck the blood work later on to see if their glucose was normal later?
Dr. Z: I guess it depends on the situation, like the clinical signs. Yeah. If they were telling me that their cat pees out of the box, I'd be like, Oh, this is probably diabetic. I would just do a fructosamine right then and there. It's easy. Cause we have it in house, so we can just know right away. So I would, I would probably, in all of those cases, probably run it unless it was like a really young cat. I was here for its neuter, and it had a 280 blood sugar, and it was like screaming its head off when we sedated it. I'd be like, no, That's probably stress.
I'm not going to bother with the fructosamine.
Dr. Sugerman: Got [00:27:00] it. Okay. Perfect. Yeah. Real quick too with the, I know you were talking about like in the urine. If you see ketones in the urine, will you do fructosamine right away?
Dr. Z: Oh. Ketones and glucose, like both of them are there.
Dr. Sugerman: Ketones and glucose.
Dr. Z: Sure, I could probably do fructosamine at that point, but
Dr. Sugerman: I talk a lot with my technicians about looking at the urine because if the urine is discolored and it shows ketones in there, a lot of times it's because the urine was discolored, like it's like a false positive. Okay. Yeah. When it's like a really bloody one or like an orange color, like it'll actually.
Give you a false positive.
Dr. Z: Yeah, if it's not a sick animal, I'm not so worried about it.
Dr. Sugerman: That's all I see. So yeah,
Dr. Z: I'm usually sending the pee out a lot more than you too. So I trust the results a lot better.
Dr. Sugerman: Absolutely. A lot of times I think at the lab, they spin them down. And then they run it, if I remember correctly.
Dr. Z: Yeah, or they double check it. Yeah, I did say it's confirmed or whatever. And there's been some where there's no sugar in the urine and the ketone is [00:28:00] positive. And then they actually put a note saying, this is usually not significant in a patient that doesn't have glucoseuria.
I don't know. I always take that with a grain of salt.
Dr. Sugerman: Absolutely. Yeah. Okay. And then, so we talked about like the treatment of diabetes about insulin, but can you tell me more about insulin, like types of insulin, how often we give it, things like that?
Dr. Z: Yeah. So basically dogs need injections of insulin every 12 hours and then the diet together with that.
So low carb, high fiber, high protein food for cats unless we're doing the Bexacat or trying that they also need insulin every 12 hours. Okay. And then. The, the diet again, I usually go to canned food only. Mm-hmm. , high protein, low carb, and usually if we're gonna go with a canned food, any pate style is better than like the slices and gravy or whatever because those gravy usually have a thickener, like some Ah, so there's some higher carb content right in those kind of sliced up ones.
Yeah, that makes sense. Yeah so pates are better. [00:29:00] And I meant to say, when we were talking about the types of food for cats, yeah, there are plenty of over the counter canned foods that are good for diabetic cats. Namely the Fancy Feast Classic pate flavors. There's a ton of them out there. You can buy them at Fred Meyer and they're really good for diabetic cats.
Dr. Sugerman: That's so interesting! Most of the time, like when I was in medical school, they were like Fancy Feast is terrible. It has so much fat in it. No. It's really interesting.
Dr. Z: Yeah. Yeah. I think I remember hearing that. Yeah. I remember thinking like canned food was bad for cats, but I feel like I've learned so much since then, and canned food is actually really good for cats.
Dr. Sugerman: Yeah, we used to say that always feed them dry food because that was better for the teeth.
Dr. Z: There is something to that. I do think the physical chewing on harder stuff logically cleans their teeth. But if we have a cat with dental...
Oh, you're getting me on a tangent here. But that's okay, because I'll just tell you. I really like the dental diet for cats made by Royal Canin. Because that kibble is actually [00:30:00] bigger than most cat food kibble. And it's got stuff in it that fights tartar and plaque, and it's spongier and they really have to chew on it.
And I feed it to my cat and I'm like, yeah, brush your teeth. And he's like just chewing on those big kernels. But I, I just limit that. I give it a little bit just to brush his teeth. Yeah. And then mostly what he's eating is the canned food because that's better for him. Yeah. Yeah. Nice.
Dr. Sugerman: Oh, and then what are the types of insulin?
Dr. Z: Oh, yes. There's quite a few out there. And it's always more to learn. I feel like there's short acting ones. There's intermediate ones and then there's long acting ones. I think when they come in on DKA, do we have regular insulin? Yep, we have regular insulin.
Yeah, so that's really short acting. It starts working right away and then it stops working right away. And I think that helps you get them out of their crisis when they're acidotic.
Dr. Sugerman: Which I think is very misleading for people because they're like, regular insulin? Is that That's the regular insulin we would give, right?
Dr. Z: Yeah, why is it called regular insulin?
Dr. Sugerman: I don't know. I don't know. But we've had, we definitely have had a lot of people who have accidentally given the wrong insulin because somebody said, Oh, can you give the right, their regular insulin?
Dr. Z: Ah, yeah. So they give [00:31:00] regular insulin. That's a bad word for that.
Exactly. It's a bad name. Yep. But yeah, the regular insulin is actually the shortest acting one. And we only use it in, for a short term when we're trying to get them out of a crisis. Once they're doing better and they don't have ketones anymore then we want to go to a longer acting insulin.
And so I usually recommend for dogs NPH which I always have to look it up. That means neutral protamine Hagedorn. That's another dude.
Some person named Hagedorn made up this insulin, it's a synthetic insulin. It's, it mimics human insulin.
And there's a couple of brands, Novalin, Humalin, and usually has the N on there. Those are the brand names for NPH insulin. And I think those has first choice anyway for dogs really well. Okay.
For cats, I like Glargine insulin. It's brand name is Lantus, I believe. There's one other one as well.
But Glargine is a very longer acting insulin, and it just seems to work really well in cats. Yeah. And it, like studies have shown, [00:32:00] they have a higher chance of going into remission if we start them on that one right away. So I really it for cats and they come in different strengths and different concentrations.
You'll see on the bottle U40 or U100. All that means is 100 units per mil, milliliter, or 40 units per milliliter. So as you can imagine, the 40 units per milliliter is a lot less concentrated, it's more dilute. insulin versus the U 100 is a little more concentrated. There's also these U 300 ones which I went to the, yeah, I didn't either, but we went to the AVMA conference a couple months ago or weeks ago.
And there was this one internal medicine specialist doctor that was using both U 300 and U 100, like balancing them at the same time somehow, like it was pretty complicated, but it was intriguing as well. Yeah. But I don't,
Dr. Sugerman: It's so confusing too the clients to, I feel like
Dr. Z: It's very, specific.
I think you need an internal medicine specialist guiding you [00:33:00] on that plan and be able to like monitor. Yeah. So I don't use the 300. I just use mostly U100s. I don't really like the u40 insulins especially for big dogs because it's so dilute. You have to use a lot of it and insulin is pretty expensive across the board.
And so you go through those vials really fast on a dog. So I like the U100 ones you don't need to use as much. Yeah. There's pens too. I honestly, I've never used them. I think some owners have just went and done it on their own.
Dr. Sugerman: Apparently it's supposed to be cheaper to get it with the pen. Yeah. And they just I haven't seen anybody use the needle to give it yet because I think the, the units are just so small, like it's just two or three.
Does it come with a needle? It does. Yeah. It does come with needles, but instead they'll buy a regular insulin needle and then they'll just draw it up from the pen and then give it them.
Dr. Z: Cause it does have a rubber stop. It has a rubber stop. You can just. Pull it out there. Yep. Yeah. Yep. So just use it like a vial.
Dr. Sugerman: Yeah, just use like a vial. Yeah. Yep. That's it. Yeah. It's very interesting, like apparently there's way cheaper than getting in a regular [00:34:00] insulin vial.
Dr. Z: Fine. Wherever you can find it. Yeah. It's like I, I give you the prescription and you go shopping. You, you fine. Yeah. . Yeah. So lots of types there.
Also Vetsulin is the, is one of the U 40 insulins. I don't like it because it's dilute and also, back in the day, it went on backorder like indefinitely and suddenly, and I had all these patients on it, and we had to change them over to a different insulin and kind of start all over with their diabetes, and it was really painful for a lot of people.
Dr. Sugerman: Yeah. Do you know why they went on backorder by any chance?
Dr. Z: Something with the facility where it's manufactured I don't know, broke down or some tragedy happened at the plant, and then they just took a while to come back from that.
Dr. Sugerman: I feel like, that could happen to any insulin company
Dr. Z: but I feel like Vetsulin is a smaller company.
And so I don't know. And they've claimed it's never going to happen again.
There's protamine zinc or PZI is another type of insulin.
That's also, now human, and it's also U 40, so I [00:35:00] just don't usually prescribe that one.
Dr. Sugerman: So I do a lot of the short term stuff and then I get to hand it off to you. So what, what do you do for like their long term care?
Dr. Z: Yeah. Good question. So basically it comes down to monitoring. Like we have to do a whole lot of watching and adjusting of the doses. And then I'm also constantly searching for infections in these guys.
Yeah. Because. Again, insulin resistance is usually triggered by an infection. So especially in the little dogs, they get bad teeth, right? And that's pretty common. And right. And so if we can do frequent dentals on these patients and jump on those bad teeth, they tend to be better regulated on their diabetes.
Yeah. And then I like to like, at least every six months do a full panel and I even if their urine looks okay, I always culture it because sometimes there's infection hiding there, especially because they usually have dilute urine. They're peeing all the time, or at least frequently
Dr. Sugerman: Real quick, for a full panel.
You mean like basic 17, CBC, urinalysis [00:36:00] type thing, right? Yes. If we think of a full panel on er, we think we're doing coags as well.
Dr. Z: Oh no. We don't need to do coags. Okay. No, I just wanna make sure I, I mean a senior panel. Perfect. So like I'll send it out 'cause it's not urgent. They're, they're not dying
Yeah, so I, I do the chemistry CBC, T4. Usually I'm looking at that in the older patients and then a urinalysis, and then I always add on a fructosamine just to watch that number over time. And then a urine culture. So that's what I mean by full blood work every six months, and that's after they're well regulated.
So initially, when I first see them after you're done saving their lives I usually do a blood glucose curve. I like to do curves initially just to see how their initial insulin dose. And so what is a curve? That's basically checking a blood sugar about every two, three hours over, preferably about a 12 hour period between one insulin shot to the next.
Okay. So I can see, ideally you would see it start high, maybe three, four hundred and they get [00:37:00] here and they get their insulin. I usually recommend they give insulin at home because I like them to eat when they get their insulin shot. And they don't usually want to eat when they come here because they're stressed out.
So I have them do that and then right away after that bring them in. So I'll check and usually they're still pretty high when they first come in. And then I like to see that blood sugar drop down to what we call the nadir or the lowest point usually a few hours after that and then slowly creep back up before it's time for their next insulin shot that evening.
My goal is to have them be somewhere between 100 and 250 for at least a few hours. If I can get there, that's great. And 250 is like a magic number for these diabetic patients because there's something about the kidneys that once it gets over 250, they can't keep it in the blood anymore and the sugar goes into the pee.
And then all the symptoms and mayhem starts. So if we can keep it less than 250 for even just a few hours, [00:38:00] we don't have those symptoms for that time. And then they're just overall a happier patient. Yeah. And it's hard to get perfect. If they're three to four hundred before their next insulin shot, that's probably as good as we're gonna get.
Yeah, I'm fine with that. I don't want them to get too low because that's where we run into trouble. It's a lot more life threatening to be too low than too high. Yeah, that blood sugar. So if they're like less than a hundred, I usually think that dose is too high and if they're never getting below three, four hundred the whole day, then that's obviously not enough insulin.
And we need to either go up with the dose or start searching for infections. Do we have something else causing insulin resistance? There's a whole lot of looking and watching and rechecking.
Dr. Sugerman: And how, like, how long after we've started the insulin do you want to do a glucose curve?
Dr. Z: Good. Anytime we adjust the dose or initially start the dose about two weeks later.
It's good to check a curve. And then I will recommend it every two weeks if we can after any adjustment on the dose. Until we have that good curve, [00:39:00] we're between 100 and 250 for a few hours. Then I'll stop there and just go to the every six month check.
Dr. Sugerman: At that two week point, let's say we have them seen on ER and then we're going to have them recheck with you in two weeks, should they expect to do that insulin, that glucose curve that day?
Or is it like you just evaluate them first, see what, if their symptoms and stuff have resolved and then schedule for a glucose curve after that?
Dr. Z: The latter is what I prefer because I like to touch base with the owner first and then come up with a plan for that first curve, because sometimes they don't even know that they're supposed to give it before they bring them in, or they come in at three o'clock and they want their blood glucose curve.
And I'm like, no, it has to be in the morning. So I would say just come talk to me first, get established with my care, and then we'll talk about the monitoring going forward. Ideally, I understand that's not always possible. Sometimes it's scheduled properly and they come in early and they have already given the insulin or they bring it with them and we can just try [00:40:00] and see how it goes.
But yeah, ideally I'd like to talk through everything. I have a whole discharge instructions that goes over all of this stuff that I like to sit down and talk to them about first and then go from there.
Dr. Sugerman: Yeah. And then when the receptionist scheduled that then. They should probably talk to 'em about the fact that it's gonna be like an all day thing.
The animal will be there all day.
Dr. Z: Absolutely. Yeah. Yeah. And then again, if, if I don't tell them about that myself, maybe on ER you can prepare them for that. Mm-hmm. , but I feel like that's too much work for you, .
Dr. Sugerman: It's, it's, I feel like we don't always know which testing is gonna be the test that's done.
You're like, yeah, you really like doing the glucose curves. Dr. Tobiassen really likes doing the nacho libre. But she loves doing those. So it's always hard to know which doctor prefers to do what and which one they're going to be making an appointment with, so I always think that having them just check with you first, do that exam first would be great and then schedule for whatever it is afterwards.
Dr. Z: Yeah. So I feel like you should introduce the Freestyle Libre a little bit better just for the podcast's sake. Yes. [00:41:00] So we have What about the Freestyle Libre?
Dr. Sugerman: Tell me, tell me, what about the Freestyle Libre? What is that?
Dr. Z: Oh, you mean the Nacho Libre.
Dr. Sugerman: The Nacho Libre. That's what I always call it during rounds. I can not remember what it is for the life of me, because it really, Nacho Libre should be its name.
Yes.
Dr. Z: I don't know. That's just the first thing I thought of when I first heard of this device. Yes. . Because I think that movie's pretty funny, but anyway. Exactly. . So the Nacho Libre is a device that we, it sticks to the skin and it tests the, not in the blood glucose levels, but between the cells.
Mm-hmm. and the interstitium glucose levels. Which kind of lags behind the blood glucose levels about five to 25 minutes. So it's not super accurate, but it's pretty cool because it's just constantly monitoring and if it stays on, it'll keep monitoring for about two weeks before it shuts off. So I find it very useful in the ER when you guys are, have these critical [00:42:00] patients that you need to be watching all the time, then you don't have to poke them all the time and you can just see where their sugar's at constantly as you need it.
I find it less useful for the home patient. for a few reasons. First, it can fall off. Like it happens a lot. Like it doesn't last the full two weeks. Sometimes it does, which is great. But a lot of times it falls off after a day or two. And then, then it's just like a one time thing, right? So sure.
Great. It lasts for two weeks, but then what, we still have to keep monitoring this patient, like for his whole life. Yeah. So we could just keep putting on more nacho libres like over and over and over. Or it might be useful to just have a glucometer at home to check a single blood sugar or even do curves at home anytime that you want.
And those machines, you have forever. You just buy the one, right?
Dr. Sugerman: And you, do you always talk to them about using the AlphaTrak? When the same one that we use
Dr. Z: I always encourage owners to get their own glucometer just to have that power to be able to check them whenever they can. And I usually recommend they come in so we can show them how to [00:43:00] use it once they get their own. And I talked to them about doing monitoring at home with it as needed. So I actually like that better than the freestyle Libre just because again, they always have it. But
Dr. Sugerman: Do you like them to do like a curve at home as well?
Dr. Z: Yeah. So it's a lot cheaper for them to do it at home if they have their own glucometer and they're comfortable getting it and they're not stressed. They're not stressed. And then, yeah.
But so it takes like a willing owner and a willing patient, like not all cats are going to be cooperative at home or, or here. And so sometimes it just can't be done, but I always try and encourage and let people know that's an option. And yeah but if they can do a curve at home with the glucometer, then it's cheaper and it's less stressful for the patient and they can just email me the curve.
You don't even need to come in.
Dr. Sugerman: Do you charge extra for doing?
Dr. Z: I do like for normal emails, I don't charge anything obviously, but for anytime I interpret a curve, like the owner does a full [00:44:00] curve, I'll charge a telemedicine consult fee, which is like a little less than an exam, I think. Nice. So yeah.
Dr. Sugerman: Okay. So it seems way cheaper than them staying here.
Dr. Z: Yeah, usually to do a curve in the hospital, it's around 300 now to spend the day with me and do it maybe a little more if I want to run a fructosamine or a urinalysis while they're here or something. And then if they buy a glucometer, I think it's like 150 now on Amazon and they can use it for the rest of the patient's life.
Dr. Sugerman: Yeah. And I think now they have the AlphaTrak3.
Dr. Z: Yeah. Oh yeah. It like connects to an app and stuff, makes it pretty easy.
Dr. Sugerman: Because they're actually, they're not even making the AlphaTrak2 anymore.
Dr. Z: I heard that. Yeah. So all of those. Test strips. Once they're out, we can't use those anymore. That's a bummer.
Dr. Sugerman: Exactly. But That's cool that it connects to something so they can send you that rather than writing it down for you and it shows them the curve and stuff on it if I remember correctly.
Dr. Z: That's cool. Yeah. I look forward to getting those. So I like the Glucometers. If they did the Nacho Libre, I believe it's 200, 200.
Dr. Sugerman: It's about [00:45:00] 200. Each time we put it on. Yep. Again, it connects to an app on their phone. Okay. So that they can like. I don't know if you can view it over that two week time period, but the thing was with the NaturaLibre, you have to have your phone next to the patient every, at least once every eight hours for it to be able to read that whole thing.
So let's say if they were gone for 12 hours at work, it's, you're going to miss a bunch of data points from the very beginning. Oh, interesting. Yeah. So they do have to be by it at least once every eight hours.
Dr. Z: Huh. Yeah. I didn't realize that. Aren't there some that come with a wand?
Dr. Sugerman: Yep. The wand. Yep. And the same thing.
Dr. Z: You can't just leave that with the cat?
Dr. Sugerman: Then it's not going to track all of it is the thing, like usually, I guess you can go into the history and probably that would be better, but yeah, I do know that the one is more expensive than doing the other one. And then I don't know what the one, I don't think that you can send it anywhere, so you'd have to write all of it down for you to be able to send it to you.
Okay. We'll have to ask Dr. Tobiassen for sure.
Dr. Z: Yeah. She uses those a lot more. Yeah. Yeah. Yeah. That's a, definitely an option. But again, it's 200 bucks every [00:46:00] time versus an AlphaTrak. You can do it whenever and you just have the one cost.
Dr. Sugerman: If they do it at home, when, how often would you do a fructosamine then?
Dr. Z: That I usually just do on the six month checkups if they're otherwise doing well. I've had a few patients where the owner just was unable to do curves whether it was the owner didn't want to, or the patient didn't want it to happen. So those ones I've sometimes just gone to checking for fructosamine because we don't have any other options.
Dr. Sugerman: Right. Especially if it's a real mean cat and they're not gonna stand being in the kennel for 12 hours for you to poke them
Dr. Z: I mean, we could try and bring them in and hold them down and put a Nacho Libre on them and But that's pretty stressful. Yeah, you got to shave them. Yeah, I guess getting a fructosamine is stressful, too And sometimes you just do the best you can you know what you got?
Yeah. I also use the symptoms a lot to tell me how they're doing. So if they're not drinking a ton and peeing a ton and they're not losing weight and wasting away, those are usually signs that they're pretty well regulated. [00:47:00] So we might just stay right there with that insulin dose.
Dr. Sugerman: So I will ask you a question that's not on our thing here real quick.
So I get a lot of diabetic patients from other hospitals and they're told to just give the insulin as they see fit. If you feel like the cat only needs two units, give it two units. If you feel like the cat needs three units, give it three units.
Dr. Z: Wow. They're told to do that?
Dr. Sugerman: I can't tell you how many diabetic patients I have seen that have been told to do this.
Not on our, not from our hospital, but from other hospitals.
Dr. Z: I'm just wondering what parameters they give the owner to decide if it needs two versus three.
Dr. Sugerman: If they feel like they've been drinking more water that day. That's. Mostly the excuse that I've heard that, Oh, he's drinking more water. Just give him more, more insulin that day and then go back down to the regular two units when it's okay.
Dr. Z: I think if it was a range that was reasonable, I'd be all right with that. Okay.
Dr. Sugerman: What about those patients that don't eat their full meal?
Dr. Z: Oh, then I'm a little more cautious, right? We wanna avoid hypoglycemia, right? So we don't want them to [00:48:00] get too low with the blood sugar. They can have a seizure and die.
So if they're not eating one, I'm like, why aren't you eating? That's not good. Are you feeling sick? Yeah. But I would probably do a half dose of insulin that day, and then if they are not eating by the evening I would not give insulin at all and bring them in because there's probably something wrong if they're feeling so bad, they don't want to eat anything.
And we need to probably figure that out before we keep going with their insulin. Yeah.
Dr. Sugerman: So what is the expected lifespan of a pet who's diabetic?
Dr. Z: So if we're well regulated, I would say a normal lifespan. If we're poorly regulated, like we just can't get a handle on that glucose, whatever, for multiple reasons and there have liver problems now too, and they also have a heart murmur. They sometimes have comorbidities that can influence their prognosis.
Those ones I would say, probably shorter than typical. And there can be complications that come with poorly [00:49:00] regulated diabetes too, like infections can get worse, liver problems, muscle wasting, skin infections, eye problems, all of that can over time add up to decrease their quality of life and then make it probably kinder to think about euthanasia at some point.
And if you don't treat it, it's fatal. Like I don't think they would live more than a few months probably. Yeah. Before they die from it.
Dr. Sugerman: Yeah. Yeah. But at least it's something easily treatable. At least giving an injection twice a day is not as bad.
Dr. Z: Yeah. I think it can be shocking at first, but you'd be surprised how many people are willing to give it a go.
Yeah. And I'd say, at least the ones that I see are up for trying. Yeah. Yeah. Absolutely. And then I'm here to help, guide the plan a little bit.
Dr. Sugerman: How long can insulin be left out of the fridge for? I feel like this is a very common question for our receptionists.
Dr. Z: It is. So 28 days, there was some study that showed it's still effective at room temperature for up to 28 days before it starts to lose its efficaciousness. Even after that, it probably still works, [00:50:00] maybe just not as well. We recommend that you refrigerate it just because it lasts so much longer when you do, and it's expensive. And I think in the human field, they recommend tossing it after a month, is that right?
But for veterinary medicine, we let you keep it for about six months before you toss the bottle.
Dr. Sugerman: I don't think that they even necessarily say that they need to keep it in the refrigerator. For humans, I think they say that it's better to keep it in the refrigerator for them, but that's part of it is like it only lasts for a month, but most of the time they're getting so much insulin.
Anyways, it's usually done by a month because they've already used up their bottle,
Dr. Z: Right. So it's almost gone anyway. Yeah. For cats, especially then you need such a small amount that one bottle lasts a very long time, right? So if you can keep it in the fridge, it'll last. Be efficacious the whole time.
Dr. Sugerman: Yeah, even for Glargine, I think we we sell it by the one mil, right?
Dr. Z: Yeah. Yeah, it's depending on the cat, because that would be 100 units, right? That's like almost So if you're only giving one unit, yeah. Some of the bigger cats, you're giving two or three units, [00:51:00] too. It'll go through faster. But yeah.
But yeah, but if you keep it in the fridge, if you buy a 10 mil vial or something from a pharmacy, then it'll last a cat like 10 years. Yeah. I think we're, we say generally six months you should top. Yeah. Okay. Oh, you had asked about some guidelines on the glucometer at home. Oh, yeah, yeah.
So if it's too high or too low, what do you do? So if you're checking and it's less than 100. 90 or something. I would just give them some food and then check again in an hour See where we're at. If we're going back up, great, we're fine. If it's ever less than 50, that's more concerning like that can that's where we start running into trouble.
And so I would get something super sweet like karo syrup and just squirt it in their mouth.
And then I probably just bring them in, just to check things, see if they need some supportive treatments. Cause if you gave too high of a dose of insulin or something, that, that could keep going on and on and they might need to have more treatments and dextrose or whatever you give IV, [00:52:00]
Dr. Sugerman: Especially because of the fact that these are usually long lasting insulins, right?
So it's meant to last for 12 hours, at least sometimes 18 hours.
Dr. Z: So I would just put the Nacho Libre on them and check, for a day or two in the hospital before you let them go home. Yeah. If it's always three to 400 or higher, that's not an emergency like the low blood sugar is, but it probably means that.
There's something we can tweak to make it better, because again, I like it to be below 250 most of the time if we can. So then I would say, if it's not already time for the six month checkup, come on in and we'll just run everything and try to recalibrate where we're at.
Dr. Sugerman: Make sure there's not some sort of infection or anything that's like making these things worse.
Dr. Z: Sometimes they'll just get a UTI and that's all it was. Or sometimes, like I had one owner, we were struggling and he finally, we just went over everything the dog was eating. He's what about these treats? And they were like really high in sugar. And I'm like, Oh, let's stop doing that. And everything got a lot better after that.
Dr. Sugerman: Yeah, [00:53:00] definitely the diet I feel like plays a lot into this. I definitely get a lot of diabetic patients that are like I just fed them Pedigree.
Dr. Z: Yeah, they can eat anything really, but it's going to make it harder to regulate them when they're not eating, not avoiding sugars really. That brings me back.
There was one patient also that I switched to a different kind of insulin that I forgot to talk about earlier. It's called Levemir or Detemir oh, yeah. It's a very potent insulin. So it's still U100, right? But it's like way more like 10 times more potent than regular NPH Yeah, so you only need like you start every animal on like point one like unit, hardly any units or 0.1 units per kg. I think that's what it is.
Dr. Sugerman: So definitely not something for cats.
Dr. Z: No, only for dogs. Only ones that are a little bit bigger. Yeah. This one I did was like maybe a 20 pound dog, so it wasn't huge, but she was, we were just maxed out with her insulin dose and I was, I was. At my wit's end. Like we, we'd just done a dental, she, we just [00:54:00] cultured her urine. It was negative. And she was eating the right foods and all that stuff. And so it's I think she just needs more insulin. Yeah. And I don't wanna keep going up with this one, so let's try this one. And boom, she was like, perfect. Nice. Yeah.
Dr. Sugerman: And this is something you can still write a prescription?
Yeah. Take it to a pharmacy. Yep.
Dr. Z: Yep. Yep. It's just another type of insulin. It's not for every dog. And I wouldn't probably start them on it, but some that are, you're just like, can't get a handle on it and they need a really high dose, maybe switching to this. Cause then, you wouldn't have to give as much either. And it works pretty nice.
Dr. Sugerman: Would you consider it for like a giant dog, like a St. Bernard or something?
Dr. Z: Probably still, even then I wouldn't start them on it, but might be more ready to switch to it. Yeah. If we were for sure. Cool.
Dr. Sugerman: Real quick. So I always do like a, like a funny story from my week, but I feel like I just never have a guest on, so I just want to ask you a question then. What is your favorite type of animal?
Dr. Z: Oh, that's a tough one. [00:55:00] I, I have to say cats because I just love them, but also horses jump to mind. I used to ride horses and I just think they're so beautiful.
One of my daughters is riding in Spanaway. There's a place that we take her to, so it's fun to watch her ride. Very cool. Yeah. Maybe one day I'll get back into it, but yeah, too busy
Dr. Sugerman: Should ride while she rides around.
Dr. Z: Yeah. I'm only, I'm only just like to look at them now.
Dr. Sugerman: I like to look at them from very, very far away.
Dr. Z: Aren't you allergic?
Dr. Sugerman: Very allergic. Yes. Yeah. So they're, they're really nice way far away from me. Okay. Yeah.
Dr. Z: I'm sorry.
Dr. Sugerman: It's okay.
Dr. Z: Yeah. I'm always impressed with vets that are allergic to their patients. I'm like, how did you ever start doing that?
Dr. Sugerman: Yep. Yep. I even actually was like, I'm still allergic to dogs and cats, but I, I've done all the allergen testing.
Okay. Sorry. All the allergen shots that you can do for all of them.
So I'm desensitized I'm pretty good at dogs and cats now. Still not as great with rabbits, but still. [00:56:00] I can at least be in a field with a horse now and not have an anaphylactic reaction.
Dr. Z: So it's that bad. Yeah. So have you tried desensitizing to horses too?
Dr. Sugerman: We did, yeah. We did the whole shots to desensitize to them. And it, that's pretty much as close as I can get now.
Dr. Z: Do you have an EpiPen with you?
Dr. Sugerman: I always have an EpiPen with me. Because especially we have a lot of clients that come in with their pets that have been around horses. And so it hadn't happened for a while.
The last one before the couple of weeks ago was with Dr. VanMaren. She brought in her dog who, or her dog that she had been fostering and she put like the horse halter around the dog to keep it in the back seat. Okay. Okay. The dog came into the office and it was fine, but then I, as soon as I pet the dog, I would started going into an anaphylactic reaction and I was like, I don't know what I touched, like something this feels like I've touched a horse and she was like, Oh shoot.
I put the horse halter on the dog [00:57:00] and I'm like, I got to step out for a couple of minutes.
Dr. Z: Gosh, it's that sensitive. I'm so sorry.
Dr. Sugerman: It's crazy. Yeah. So you can enjoy the horses for me.
Dr. Z: Okay. Yeah. Yeah. But yeah, I think I like cats and horses. I like dogs too, but something special about kitties. I don't know.
Dr. Sugerman: Yeah. I think cats are very much like horses. That's what people say. They're like they're very much like a horse.
All right. Thank you Dr. Z. I super appreciate you being on here for diabetes. I learned a lot already today, so that was fantastic.
Dr. Z: Good. Me too. Thank you so much for having me. It was super fun.
Dr. Sugerman: Awesome. And hopefully you'll be on the podcast again. I'm sure people are going to ask for more, more general practice stuff that I don't know about.
Dr. Z: I'm happy to help. Yes.
Dr. Sugerman: Perfect. All right. Thanks.
Dr. Z: Thank you.
Tyler: Thank you guys for listening this week. If you have any questions, comments, suggestions, or you just want to say hi, you can email me at Suggs, S U G G S @ Vetsplanationpodcast.com or visit the website at Vetsplanationpodcast.com or find us on Facebook, Instagram, or TikTok at Vetsplanation. [00:58:00] Thank you all for listening and I'll see you back here next week.