Feedback needed on handout

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achrisvet

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Hi! I'm back. For those who missed my intro I'm a veterinarian trying to improve my management of sugarcats (and dogs). I've written a handout to send home with owners. I ran it by Dr. Lisa on VIN and she liked it a lot. I wanted to get some feedback from lay people as to whether it is clear, helpful and encouraging. I plan to go over all the points in person, then send this home with them, and also email it so they can click the links. I have a separate handout with a shopping list, how to choose a glucometer, etc. So I'm just going to c/p the text of my handout. I haven't tried to make it pretty yet! I'm trying to keep it short to avoid the tl;dr effect. (If you happen to notice any typos, you could tell me that, too! ;-) ) Thanks for your help.

Diabetes and Your Cat
You have just been told that your cat had diabetes. If you are like most people, you are probably feeling anxious and overwhelmed. Diabetes is a serious and even life threatening disease. The good news is that in most cases it can be managed.
As with many medical conditions, protocols for treating diabetes have been constantly evolving, and new technology brings new possibilities. In the past, the goal of treating diabetes in cats was to control the clinical signs and keep the cat feeling well. We aimed to keep blood sugars (blood glucose) in a range that was just a little high out of fear of life threatening low blood sugar levels. That goal has changed.
Recent research and experience shows us that with stricter regulation of blood glucose levels, - keeping the blood sugar in the normal range - many cats can go into remission, that is, they can get to the point of not needing to take insulin anymore! While this will not happen with all cats, it is a good possibility with many. Good management involves:
1. A low carbohydrate canned diet
2. A particular type of insulin by injection
3. Home monitoring of blood glucose
4. A partnership between you and your veterinarian.
Diet:
In order to control your cat’s blood sugar, it is essential that a low carbohydrate canned food be fed. All dry foods have higher carbohydrate levels than canned foods. Not all canned foods have low enough carbohydrates for a diabetic. The good news is that you do not have to feed very expensive high end foods to get low carbohydrates! And more good news: someone else had done a lot of work collecting information on carb levels in commercially available canned foods. Follow the link below and choose foods on the list with less than 7% carbs:
http://binkyspage.tripod.com/CanFoodNew.html
Insulin:
Most specialists currently recommend a human product called Lantus (glargine) insulin. It is reported to have the best chance of bringing cats into remission. PZI is another form of insulin often used successfully in cats.

Home monitoring
Hand held glucometers designed for human diabetics can be used to monitor cats at home. This has many advantages. Cats often have “stress hyperglycemia (high blood sugar)”, meaning that their blood sugar shoots up when they are upset. This means that you can often get more accurate results at home than in the hospital. You can also test at any time of the day or night. Home testing is cheaper than testing in the hospital as well. Cheaper and more accurate – what’s not to like?

Partnership
We will work closely with you to get your kitty’s diabetes under control.
 

You are embarking on a new adventure – living with a diabetic cat! If you are like most people, the first thing you will do is run to the internet. The internet is a great resource, but as I’m sure you know, not all sites have reliable information. To save you time and to help you avoid sites that may be less than useful, we have compiled some links for you.

Excellent sources for information and support:
http://www.felinediabetes.com/
http://www.catinfo.org

Home testing links and tips, including links to several videos:
http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287
Important information on hypoglycemia (low blood sugar)
http://gorbzilla.com/treating_hypoglyce ... elissa.htm
 
I like that it's short and to the point. I think it would give a person who might be frightened a quick reference without too much input all at once.

I do have one question for you though... going forward will you be recommending canned only to all your cat clients, not just the diabetic ones? A species appropriate diet to start with could avoid many health issues including obesity and diabeties. When we switched to canned for my entire family, the ones who weren't FD improved, their coats were shinier, one girl who's whiskers used to break at the halfway point, her whiskers grew in completely. There were a lot of small changes, including their energy levels.
 
I wish my vet gave me something like this. Couple of things:
- I would also add the link to Binky's old canned food page. There's some stuff there that isn't on the new one. I also don't know how updated both are since manufacturers can change their formula on a whim, but it's the best info out there now.
- Might want to include what remission means in terms of BG numbers. I was treating Junior for 5 weeks before my vet told me that the goal was to get him to 150-200 (AlphaTrak #s). It wasn't until I found out on this board that it is possible for diabetic cats to be in the normal range as normal cats...50-100 (on human meters).

I have a separate handout with a shopping list, how to choose a glucometer, etc.
Click to expand...
It would be nice to see what you'll communicate on these too.

On your shopping list, I'd include information on how to dispose of your needles and a tips on remembering to order product before you run out. When you're frazzled and overwhelmed, you're hanging on hour by hour, day by day. Sometimes it's hard to see that you're going to run out of test strips a week down the road.

I don't know if you were planning a hand out on this, but I'd include one on what to look for if a cat is about to ____ (DKA, hypo, etc). My vet told me to call him if there's a problem. When you're frazzled, everything is a problem so it's hard to differentiate what's a new problem and what's normal. One night my cat started vomiting 11pm. I had no idea what to do and no one to turn to b/c I didn't know about FDMB at that time. Twelve hours later I found out my vet was on vacation and his partner called me back later and said to take him to the ER. It could've been bad. Had I known about DKA, I would've taken him to the ER that night.

Thanks for doing this! I really wish more vets did this.
 
I think it is wonderful that you are working with us to get our experience, being on the other side of this diagnosis and treatment.
I too liked that it was short and not overwhelming.
I must say, there was something in that first paragragh that gave me more fear than comfort and that I have'nt found true in our group.
It was the simple "in most cases it can be managed' because as good as that news sounds....upon hearing that I would still feel I only had like a 50/50 chance of saving my cats life. Ok, maybe better than 50/50 but still our experience here does not support that.
All of our cats diabetes are being managed. As a matter of fact, has any cat here actually died of diabetes?
I would feel less fear if told with 'proper treatment there is little reason that your cat can't live a very happy and healthy life with his diabetes'. Now you may feel compelled to warn them that a diabetic cat may run into other and different problems that may be exasperated by the diabetes.....but again, with proper care by the owner (haha, parent) the diabetics on this board do not have a track record of ANY kind of cats dying from diabetes. We do on the other paw, have a tremendous track record of cats living healthy happy and productive (mine anyway is still a stellar hunter) lives.
Just sounds more promising to me....and TRUE.
 
achrisvet said:
Diabetes and Your Cat[/b]
You have just been told that your cat had diabetes.
Click to expand...

Just a small suggestion to change the word "had" to "has".

And to also explain that their cat will always be diabetic (whether insulin or diet controlled). The reason I say this is we have seen people who think that once their cat is off of insulin that the diabetes is "gone". This can be dangerous if they go back to old ways; for instance feeding dry food, or getting complacent (like I did) by not checking BG's every so often (my cat is back on insulin).

This is so great what you are doing!
 
Don't forget about ketones and what to buy to test for them.

1/canned food only

2/ hometest before every shot, no matter the years. Will be 8 years for Mishka and I still will not give her a shot without a test, never.

3/test urine for ketones when possible and especially if cat is not feeling well. High numbers don't always mean ketones and low numbers do not guarantee ketones won't happen.

4/read, learn and educate yourself ........knowledge is power.
 
I actually LIKE saying "most cats can be managed." My vet made it sound like it was just a question of finding the right dose and it might take a few weeks or, if we weren't so lucky, a few months and it would be expensive (true) and require a lot of dedication from me (true) but otherwise not a terribly big deal. Here we are, 8+ months later, having started low and gone slow, now shooting 8 units of insulin b.i.d. and his diabetes is still not what I would consider "managed," or at least what I was led to expect. I test BG 3 times a day with a ReliOn meter that was tested against my vet's and appears to be reasonably accurate, and it's rare to get a reading under 300, though it happens just enough to make me hope (in vain) that we're finally starting to get somewhere. It's VERY discouraging for those of us whose cats are apparently insulin resistant or possibly have some other co-occurring condition to knock ourselves out, do all the right things (diet, insulin, home-testing), and feel like we were given too rosy a picture from the start.

The good news IS that in most cases it can be managed. But 99% is not 100%, and there are going to be those few cats whose situation is much more complicated than feeding properly, testing BG, and shots twice a day and the diabetes will be "managed."
 
carolyn & jesse said:
achrisvet said:
Diabetes and Your Cat[/b]
You have just been told that your cat had diabetes.
Click to expand...

Just a small suggestion to change the word "had" to "has".

And to also explain that their cat will always be diabetic (whether insulin or diet controlled). The reason I say this is we have seen people who think that once their cat is off of insulin that the diabetes is "gone". This can be dangerous if they go back to old ways; for instance feeding dry food, or getting complacent (like I did) by not checking BG's every so often (my cat is back on insulin).

This is so great what you are doing!
Click to expand...

Oh thank you, that's not a small suggestion, that's a typo that I might never have caught!
I will add a line to the effect that remission does not equal cure, good point.

As for the "most cats line"... we are sort of trained to be cautiously optimistic. I want to get across that it's worth treating, the cat will probably do fine, but you still have to leave that back door open to explain the few that don't do well. We're not supposed to say things like "Don't worry, he'll be fine" even for routine things, because one day you'll get the cat that something bad happens to and then you get "you told me he'd be fine!" Have you ever really read the stuff they make you sign in the hospital? It boils down to "this procedure probably won't kill you but it could. Sign here to say you understand that"

Maybe I'll change "most" to "the majority". Is that better?

You guys have given me some really good pointers. Thanks so much.
 
achrisvet said:
Another question - how are you guys getting urine samples to test for ketones?
Click to expand...


Awwww...well that depends !

The standard line around here is stalk your cat to the litter box, when she/he squats to pee, stick the
keto-stix into the urine stream. Ya, right---that does not work for every cat.

In my case, Smokey peed so much volume (Daily LRS for CRF), that I could just linger nearby and
wait until he lifted his butt. Then quickly dip the stix into the puddle that had not soaked in yet (be very fast ).

Smokey was not a digger....he just did his business then walked away. Some cats just won't let you anywhere
near until they've covered...too late then !

For some cats, you can use a small ladle underneath them as they pee. Some folks put a bit of
plastic wrap over the area they pee. That works if your cat does not mess it up.

Of course there's the 'No-Sorb' option. (I wash/dry and re-use it). Some use clean aquarium gravel.
But then, some cats won't walk in strange substrates). Elevate the box at one end so the pee runs to
the other end. This is especially useful if your cat always pees in one area of the box...that should
be the 'down-hill' side, and use a minimum of litter material.

There's the Smart Cat Litter box, which collects urine in a trap below the box:

http://felinediabetes.com/SCB/SCBindex.html
 
achrisvet said:
Another question - how are you guys getting urine samples to test for ketones?
Click to expand...

Dr. Kathy James (one of the VIN consultants on the Urology board) expressed surprise that I routinely collect my cats' urine to monitor their USG since they are all over 10 and I want to catch CKD early.

She asked me to make a video for the VIN library that discusses training a cat to pee on a spoon. I kind of laughed but did it anyway. I figured that my friends were already tell me that I had too much time on my hands when I made my "how to clean a litter box" movie...what's' one more thing to make them laugh at me.

So...I made this video which made it to the "new video" section on the VIN email that they send to us weekly. Gee...I felt like I had 'arrived'! :-D

http://www.youtube.com/watch?v=pIUBFF-VyRU
 
some additional thoughts:

1) you talk about canned food, how about changing this to wet food - I don't know your thoughts on a raw food diet, but that is also considered wet food and wet will encompass canned and raw.

Personally, I never heard of raw food diet until I came here, but I tried it out - both commercially purchased and now homemade and it's a great option - especially if the cat has IBD and/or allergy issues.

2) when you list PZI - there are many forms of PZI - several that are discontinued. The new one being used is Prozinc and it is a good option too. So maybe put prozinc in ().

3) when you "pretty it up" really make #4 (partnership) stand out. It's so vital to have a vet that one can trust and understands and many of us here didn't or don't have that.


thanks for being one of those good vets!
 
achrisvet said:
1. A low carbohydrate canned diet
Click to expand...

Hillary & Maui said:
1) you talk about canned food, how about changing this to wet food - I don't know your thoughts on a raw food diet, but that is also considered wet food and wet will encompass canned and raw.
Click to expand...


I suggest "low carbohydrate canned (wet) or raw pet food". When the average person reads "wet" they think of the stuff that comes in cans or pouches. Some people use "canned" and "wet" interchangably to mean the same thing: the food in cans or pouches. There are many people who are unaware of raw diets for pets. My cousin had never heard of raw pet food and initially thought it meant feeding raw hamburger meat from the supermarket as it without any additional supplements. I had to explain raw pet food to her but refrained from going into the whole "dry food is bad for all cats" spiel.

Maybe include a line to say something like "For more information on raw pet food, see these links below. Raw pet food can be homemade or commerically bought in many pet stores".

My two cents :smile:
 
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