A diagnosis of diabetes is one of the scariest things a pet owner can hear from the vet, yet it is all too common! Fortunately, diabetes in dogs and cats is manageable with diet control and insulin therapy. Porcine insulin is the top choice for insulin therapy and Vetsulin is the only FDA-approved product for management in dogs and cats. Dr. Richard Stone, a veterinary internal medicine specialist serving as the current VP of medicine for BluePearl Specialty and Emergency Animal Hospitals, joins Dr. Jen the vet and Dr. Jason to chat all about diabetes in pets. From clinical signs to treatment to managing snacks, the conversation covers everything a pet owner needs to know about their diabetic pet!
V's view is all about lying and cheating…and found at the 12:20 mark!
Helpful links about diabetes in pets:
From the American Veterinary Medical Association (AVMA): https://www.avma.org/resources/pet-owners/petcare/diabetes-pets
From Merck Animal Health, the makers of Vetsulin:
More on the SureFeed microchip pet feeder: https://www.surepetcare.com/en-us/pet-feeder/microchip-pet-feeder-connect
For more info on Dr. Stone: https://bluepearlvet.com/our-leadership-team/
This episode is certified to provide 1 hr of PACCC CEU’s! The unique code will be delivered during the episode, so listen up! Don’t know what PACCC is? And why would they be involved in CEU’s? Pet lovers can get more information at www.paccert.org
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Diabetes is not a death sentence!
KEYWORDS insulin, cat, diabetes, dogs, blood sugar, vet, pancreas, diabetic, pet, veterinarian, eat, treat, pet owners, jason, people, life, question, high blood sugar, diet, carbohydrates
This episode is brought to you by full bucket veterinary strength supplements the leader in digestive health for dogs, cats and horses,
Merck animal health, the makers of Nobivac vaccines. Welcome to Chats with the Chatfields. This is a podcast to expand your idea of what impacts veterinarians, pet owners, and basically all animal lovers in the galaxy as humans. We are your hosts. I'm Dr. Jen the vet. And I'm Dr. Jason. If you have not yet subscribed to our show, why not?! just go to Chatfieldshow.com and subscribe today. And if you want to reach us and you've got a message full of love, you can find me at Jen@ChatfieldShow.com
and for everyone else with messages that are actually real. You can reach me at Jason@ChatfieldShow.com
All right. We're gonna jump right into it, folks, because we have a very large topic to talk about today. We are incredibly excited to welcome back for his Encore visit to the chat room. Jason's classmate and our friend,
You almost said Jason's friend, like he would have been close to my only friend and you would have been correct. In the singular. I didn't want to say to the scene. Yeah, no, I appreciate you catching yourself. That's okay. Yes.
So Jason's friend and a friend of the show. Dr. Richard Stone, who is currently the vice president of medicine for Blue Pearl, specialty and emergency referral veterinary centers. Did I get right?
you were very close again, we're gonna we're gonna call that 0 for two.
Okay, he needs a bucket to carry his title. But he also needs a bucket to carry his credentials, friends, because lest we forget, Dr. Stone is also a smarty pants, because he is a board certified internal medicine specialist. Yes. Did I mention he's friends with Dr. Jason?
I know. It's weird, right? Whatever. I'll take what I can get and we move on.
That's right. That's right. Ah, but anyway, thanks for joining us today, Richard, because we're going to talk about a topic that I think you probably talk about a lot clinically. We're gonna talk about diabetes.
Yes, yes. important topic. And thanks for having me back. Yes, of
course. Okay, so number one. This is a simple softball question. Is diabetes really a thing? In pets?
Yes, absolutely. It is.
I don't ever get those kinds of questions. Give me a break. I could have answered that one. Right. Wasting this man's talent here. All right. I
know. I know. But you know, you know what I mean? Because so many people like when I when I have to let them know that. You know, I'm diagnosing their dog or cat with diabetes, they say, is that like, is that really a thing? Yeah, so it is and it kind of, like that day like changes the family's life.
What does that mean? Like the clients are like they know about in humans? And does it actually happen? Yeah. Okay. Is that what you mean? They don't they don't understand that they don't Recognize that it can happen in the Furry Animals also. that's interesting.
Yes, yes. And so is it the same as it is in people?
It's a great question. You know, there's some differences. So first of all, I think it's worth calling out that dogs and cats, they've got a lot of physiologic differences, right, meaning just the way their bodies work. There's a lot of similarities, you can see that their anatomy and all of that. And when it comes down to things like diseases and how they correlate to what people get, there's some differences there. You know, dogs are typically what we call a type one diabetic, where when they become diabetic, those little cells and their pancreas that make insulin, they're in general, they're pretty much gone, they're damaged, and they're not coming back. So they're insulin dependent, we can dig into what that means in a minute. Okay? Cats, however, they're interesting, because they do something similar to what humans can do, where they can become sort of a type two diabetic, they can have this ramp up phase, where their glucose starts to climb, their blood sugar climbs slowly, and they become less and less tolerant of carbohydrates over time, a lot like people.
Okay, so type II diabetes, like I'm going to be really generic here. Sure. type I diabetes is maybe more similar to like the, the, in the dog one, which is where like when people have it, like, early on in their lifetime, right? And it's unrelated to their size or their weight or anything like that. It has to do with like, just a problem with their pancreas.
Right? Something comes in and wipes out those cells in their pancreas called
beta cells. they don't produce insulin, right? They don't. The cancer
that cats that diabetes and a cat. I know this because like when I treat a cat, it's almost always a fat cat. Yeah. I mean, will it? I mean, it is like, Okay, if I have to be totally honest, it's usually a giant, fat orange cat that I see. Wow. Yeah, and, um, so the cat though, I usually am starting them on insulin that day. And then I, I always tell the people, and now we're gonna go on a diet,
right? Because you bring up some good points there. One, this whole concept that obesity and diabetes are interrelated is very true. You know, we've seen that the fat tissue in a patient that's obese like a cat, let's say that fat tissue produces certain molecules in the body, that can act kind of like hormones that you can sort of inhibit, it can block insulins effects a little bit, and it makes you what we call insulin resistant. And that's kind of where this starts is. Right on as well to our own insulin that we make it normally in a normal cat, normal dog normal person. When our pancreas releases insulin, it does so because it's been triggered to do that by say a meal. So I eat a meal, I've got some sugar in my blood, my pancreas is going to release insulin to help push that sugar into the cells keep my blood sugar down at a safe level, right? Well, if my body's not responding to insulin as well, because I'm I've gained weight, we've got more fat tissue, interfering with insolence effects, well, then my blood sugar stays higher, longer. And so your point that you brought up, which was sometimes I'll have them come in, and I'm having to start them on insulin on that first day, that's very much the case. And most cats that we, we don't know if it's going to reverse or not. And like, they might back out a little bit like other type two diabetics and get back to a more normal state, with weight loss, dietary management, so on, or be permanently insulin dependent. It's really hard to tell at the outset of diagnosis when you're dealing with a cat. I think
Jenifer's main point was that all orange cats are fat that had diabetes. That was her point. That's what she likes to know. Okay, maybe
listen to small generalizations.
So really quick. You said let's start and I think maybe for to cover the wide range of of listeners that we do have? Yeah, let's let's Can we just really quick review exactly what insulin does what you know, and what's the deal here? Just a really overall, you know, you bet, you know, first year veterinary student really quick, what exactly is when does just the mechanics of it? So let me start to dive deep. We kind of all are on the same page about what's happening. You bet. That's a great, I asked that question. So I don't have to answer it. So
that's very fair. That's very fair. So as we know, in our body, in our in our bloodstream, inside of ourselves, there's substances that are floating around that need to be at a certain level to maintain a healthy state, we call that homeostasis. And if you look at any like, if you if your cat or dog had bloodwork when you look at all the bloodwork values, there's a normal range, there's a low in and a high end, and what we've established is, that's the range where healthy patients would be okay. And that's true with blood sugar as well. And what we know is we want to keep that blood sugar at a certain level in the body so that you get plenty of fuel for all of your body's tissues, right? Because
that's all my sugar does. Yeah, that's right. It's your energy that you're fueled by. That's right. Right, you
got it, you've got it. I mean, if I'm gonna get a couple of things transported out to my tissues, it's gonna be fuel and oxygen. Right? Right, right. Now, how do we keep the blood sugar from going too high too quickly? Well, we've got to encourage that sugar in the blood to go into the cells to go into the tissues in a controlled way. Because if it doesn't go in, it just stays in circulation. And next time you eat a meal, more sugar pours into your circulation, and eventually it can get dangerously high. So what insulin does is when your pancreas senses that you've had a meal in your blood sugar does certain things. There's there's sensors in your pancreas. That No, it's time to release insulin. And insulin is that molecule that goes and tells all the tissues in your body. Hey, guys, it's time to pull in the sugar. Let's get the sugar out of the blood and pull it into ourselves. So that's part of the normal mechanism where I eat a meal, the energy goes into my bloodstream, and then I've got to pull that into my tissues. Insulin helps make that happen.
And the pancreas is that little organ that sits right there at the small intestine right by the stomach. Right? I know it's very important where it is right. Okay. All right. I just want to point out that I remembered a few things from anatomy. You nailed it
from anatomy and I'll I'll share from a friend of ours who recently reminded me the other day. One of the other things that we learned about the pancreas and vet school is if you touch the pancreas in surgery, what happens to you? The surgeon that touches the pancreas, well you just go straight to a chi double hockey stick.
That's right. Don't touch the pancreas. Don't increase the pancreas mad.
That's right. The pancreas is quick to anger. But anyway, okay, so good. So So insulin really helps us also to stave off the hanger. It helps manage our blood sugar. Okay, so diabetes is an inability to regulate your blood glucose or your blood sugar level. And usually that's because there's a derangement with insulin. Okay, so there we go. So ordinarily, you have to go on a very strict diet, because that's one of the major ways to control the blood sugar level.
And take lesson, right? Well, right. Yeah,
control, you're taking it. And if you're that fat, orange kitty, then maybe you don't have to be on insulin the rest of your life if you can lose some weight. Okay? All right. But as we all know, at least in my cottage food is love. So it becomes an issue with diet and our pets. We also know food is love, and many other households because obesity is a huge problem among pets. But I want to talk about that. And then I want to talk about the just, I want to quickly touch on the different kinds of insulin that are available because insulin is not all just insulin, there's, there's a couple of different kinds that your vet may talk to you about. We're going to do it on the other side of this break. So everybody, hang tight. We'll catch you on the other side of this break with more about diabetes in
Dr. Jenn the vet, and I'm here with my friend and colleague, Dr. Keith lassen, he's got an incredibly interesting story all about full bucket health,
my college roommate and that school, housemate, Dr. Rob Franklin and I were collaborating on some cases, both of us were struggling with diarrhea in some of our patients, whether it was after a procedure or after after an illness. So we created a formulation but we didn't want to just create a formulation. We also wanted to create a movement and animal health, for being able to help animals in need through the use of bar products that we developed that really has resulted in our one for one giving program, which we're really proud of, as much as we are our formulations for dogs versus cats.
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Merck animal health is committed to disease prevention in our animal companions. The nopi vac portfolio of industry leading vaccines empowers veterinarians to have a broader impact on pet and their owners. Merck Animal Health Philosophy is driven by innovation, continuous research and development ensure the latest technological advances are available to provide reliable protection. So ask your veterinarian about Noby back vaccines for your pets. All right, V. Not talking about diabetes. But what are you talking about? What's your view?
V's view from vet school brought to you by the AVMA trust, veterinarian inspired coverage protecting you through it all.
Hello, and welcome to V's view, I'm V and here's my view. So today's view is on lying, cheating and being dishonest. Don't do it. Plain and simple. As a previous law enforcement, professional integrity is something free that everyone can have, but many don't. And sometimes in life and law enforcement is all you have. If you don't have it, you're worthless. Once one enters professional school or life, I would think it goes without saying that cheating is a no no. Right? And so don't lie. And that means no line ever, period. Understand capiche for clarification, misrepresenting your background is lying. patting your resume. Not cool. And here's the reason in vet med as in life. It is wrong. You will be found out in that school that happens like this. Hey, Tina, go ahead and throw an IV catheter in that pup for me, will you? Oh, what? You can't. Tina, you led me to believe that you worked for years at a practice? Oh, you just shadowed your veterinarian on Saturdays for a couple of hours in the seventh grade. Wow. Okay, so that's a different ballgame, then. This also includes cheating. Yes, that's right. Cheating is lying. I feel we need this clarification. Because of all the recent issues in the world about students getting into schools by paying lots of money or by paying other people to do their work. And being confused as to the fact that this Why is cheating, not delegating? I was floored when I saw stories where people like, Oh, it's just delegating my work. No, that's cheating. Understand? Are we clear? No cheating? No lying. Life has taught me that integrity is everything. If you don't have it, good luck because I won't want to work with you. And neither will most other people. I'm V and that's my view. Thanks for listening. I want to share your view. Are you seeing what I'm seeing? Or do you have a question about vet school? Send it to me at info@ChatfieldShow.com. Thanks again, have a great day.
V's view from vet school, brought to you by the AVMA trust, veterinarian inspired coverage protecting you through it all.
All right back here in the chat room with Dr. Richard Stone, veterinary internist, talking all about diabetic pets. And I did promise that we would very briefly, because I think over the last like 15 years, there's been, at least in my perception, like a great diversification among the insulin products that are available for use in dogs and cats. And so you're that
means there's a lot of them. You're correct. There is a lot of them, right? All kinds of crazy.
Listen to Dr. Jason popping out with clinical stuff.
I just remember when I get confused on it, U100, U40 Whatever, right. And you can't Oh, yeah, all this math involved. I remember issues and problems. That's what,
yes, that's right. issues and problems. Yeah. So. So yeah, so let's look at dogs first. Okay. So if you have a dog that the veterinarian comes in and says, Your dog is diabetic, okay, so they've done probably a urinalysis. They've done a CBC and a chemistry. And here we are, and maybe plus or minus something called a fructosamine. Who knows? And they say, now we're going to start your dog on insulin. What are the choices that the veterinarian is looking at?
Great question, I'd like to call out real quick that, you know, if your dog has a high blood sugar beyond a certain threshold, unlike in cats, where that can happen, just with stress from going to the vet, if the glucose is high in a dog, we tend to know they're diabetic when it gets above a certain threshold 300. That's very fair. That's very fair, right? So then at that point, we would say, Okay, it's time to start insulin. Most dogs when we think about the insulin that we're going to give them as an injection. By the way, it typically does not hurt very well, injections is a scary word, right? I'm
glad you brought that up.
I did, it can be scary. But it's actually I think it's easier to give an insulin injection than it is to give a pill. Personally, I'm just gonna throw that out there. But
I will tell you that I actually had to put my glasses on to see the needle for the injections, right? That's awesome. Yeah, well, they're really
small amount, it's a small amount. But we want to pick an insulin type that's really close to the structure of normal dog insulin. And it just so happens that dogs are pretty close to pigs, when it comes to their insulin structure. They're really, really close. So when we choose one, the most common when we choose as an intermediate acting insulin that's based on what we call porcine insulin, pig derived insulin. Okay, and so usually, we'll start them on something like that, and an intermediate acting, because there's three kinds that we usually think about, there's actually more but the three common ones are short acting insulin, intermediate acting insulin, and then long acting insulin analogs. Totally new structure, right, right. Dogs, we pick one of those intermediate acting ones. And most dogs will get an insulin injection twice a day. Yep, set a dose to do it twice a day.
And usually you're feeding them at the same time, because you don't want to have their blood sugar. If you give them insulin and there's no sugar in the blood, or there's low sugar, then they have zero. And that's when they fall over. And you know,
it's a good point. Typically, if this were to happen, and your pet, were diagnosed with diabetes, your dog and you would be given instructions. Here's the type of food I want you to feed, it's not going to cause massive surges in blood sugar, and then here's the insulin and you're going to give that twice a day to roughly 12 hours apart but at mealtime. We're going to do it consistently like that. They will also give you instructions for what if, what if your pup doesn't eat? Or what if they decide to skip dinner? What do you do that evening? You know how you handle administering insulin. So each your veterinarian would give you instructions on how to handle it.
Yeah, and I think that's so that's really critical too. If if you have a pet that's diabetic, and you don't trust your veterinarian, you should like today go get a different veterinarian you you I mean you have to have a trust and a relationship with your veterinarian because diabetes. A lot of times it's something where pets can become very well regulated. And this just becomes a normal part of your day. but it can be a little bit scary at first, and then you know, as your your pet loses weight, or they transition to that special diet, then, you know, they don't need as much insulin or now they're, they're doing quite well. And so you those are things that have to be kind of tweaked. And you need to really have a relationship where you're comfortable calling up the clinic, talking or texting with your veterinarian if they have that capability through their practice, and talking with them about what are we going to do now? And what do I do is this an emergency. And so if you'd like we always say here in the chat room, if you don't trust your veterinarian, it's time to find another veterinarian, right, because there's a lot of them find one that you trust,
you know, in that early part of trying to regulate a diabetic, which means just let's pick the right insulin dose and the right type of food that helps their blood sugar stay more or less closer to normal. I just want to call out that it's not going to be perfect. At the beginning, there's gonna be some refinement, in fact, I go into it, maybe a little bit more conservative with my insulin dose and work my way up and gradually adjust because I don't want to over swing because at the end of the day, high blood sugar is a problem. Chronically it's going to cause problems. Extremely low blood sugar,
bigger problems and immediate problem.
It can be an emergency, like, like, Jen was saying about the glucose dropping too low, and then you fall over because you don't have enough energy. It could actually cause big problems like seizures and so on. So we tend to start conservative and slowly work our way up, and we don't let perfect be the enemy of good. Oh,
that's one of my favorite sayings.
Right now. I like that one too. Yeah. And so that's, that is the other thing. So you know, I love how you said that. Where it's not like we're gonna have doggy insulin in a bottle. They pick one that's close to dog insulin and happens to be pig insulin. Right. And I think that's very appropriate, given that I have, you know, a Frenchie that we sometimes call the French pig. She really resembles a big Yeah. So so yeah. So talk to your veterinarian about that if you're if you're have questions about now, for cats, it might be a little bit different, though, right? I mean, we can still use the pig. product, right? The pig insulin. In fact, I think that's the one that's FDA approved for use in cats is one of poor sign origin. But cats just cats are strange, right? So if if, if you're concerned about the insulin in your cat, or your cat's not regulating, your vet may have to try something a little bit, you know, out of the norm, but first we try we try the one that of course is FDA approved. You know the porcelain? Of course I went okay. Jason, do you have another question about insulin? I don't
have another question. Just want to repeat you guys covered a lot of stuff there. Right. So you get diagnosed with diabetes, then we have to regulate it. And the very beginning part is going to probably be the most difficult slash scary for any kind of pet owner that doesn't has never dealt with it before. Correct. But once you get it regulated, you know, it's, it's not you know, most dogs can live a pretty good life once you get it regulated. Correct.
Very fair. All right. Quality of Life can be good. There's tools that you can I think download on your smartphone that help you assess quality of life as a score. But yes, as an owner, you know, your pet, you're going to kind of have an understanding when they get back to feeling like themselves.
Yeah, no active, there won't be any of those because most of them have gone to the vet because they have these these chronic signs of, you know, increased increased urination, increased eating appetite, all this stuff. So hopefully those will, will dissipate as well. Okay, so now we've got the pet regulated, ready to roll, right? Just yes. No changes. Right. I think Dr. Jenner is bringing up the love and the household situation.
Yes. Because this mood is love. And so that's the hardest thing that I find when I'm talking with pet owners who, whose pets are newly diagnosed. Is you know, they really they're like, I want them to lose weight. But what do I do? And I say, Well, you have to change and they go I don't want to change
what can I do if I continue to do the same thing?
Yes. What can I do while continuing to do exactly the same? Yeah. So for for me, I have to tell them to cut out treats and snacks. And so I don't think that's necessarily 100% required, right like so i This is always my question too. Because I always say Well, can I give them a carrot? Can I give them Can I give them for treat you know,
carry I'll give my dog and carry it can affect his blood sugar at all because he ain't gonna eat it.
Okay, you know what I mean? Like because it just becomes a habit. And I don't know if you guys are familiar with coset the foreign first Frenchie, but when she begs for treat, she gets the treat. Like I can't resist it. So Dr. Stone like, is there anything like at home? Should we just just bite the bullet gotta cut out all snack? Let
me let me rephrase Jen's question when coset develops diabetes. Treat feeding is terrible. Alright, sorry, sorry. Okay, is there an option here?
I'll tell you what, for me, this is another one of those areas where I'm balancing quality of life and perfection of the numbers, right? Okay. And we're not just treating a series of numbers, we're treating a patient, and we want quality of life to be good. And so I like to strike some sort of harmony, where what's important to me is consistency of when meals are fed the bulk of the meal being around the time that insulin is administered, right, twice a day. And then consistency of what sort of treat and when is given throughout the day. So if I say, Look, I know that we have to manage weight loss. And we have to choose a food that safe perspective, like how much fiber it has soluble and insoluble fiber, so blood sugar isn't rocket up too fast. So I'll choose my appropriate diet, I'll feed the bulk of it twice a day, I'll give my insulin twice a day at the time of those meals, we may hold back 10 25% of our total caloric intake if we need to, let's say we're eating a high fiber, dry food for a dog, for example. And I might offer that as treats throughout the day. Some dogs are really jazzed about dry dog food coming out of a cup in the refrigerator, because this is amazing. I just want to train ever write and small amounts of something like that, or a healthy vegetable, those sorts of things tend to not be massively loaded in carbohydrates, and they're not typically going to cause a massive surge in blood sugar. If we start getting significantly off cycle where we're giving large amounts of treats and things like that in between standard meals, in some sensitive patients, it may cause a problem. So if if we find that you're giving too much treats, and we also find that your your pet's blood sugar is off, it's staying too high, or we're having to ramp up our insulin dose too often, we may have to come back to the treat thing and say, Okay, maybe we're being too inconsistent or giving too much in the way of calories and sugar.
So I think that's interesting that you say that about like, we don't, we don't have to, like cut it all off. So it is, it is okay to give my diabetic pet a treat it you just have to pick the correct treat, and then do it consistently. And make sure it's now not negatively impacting your regular regulation of their diabetes, right? Go ahead,
I was just gonna say you talk to your veterinarian about something that you're looking for that would be relatively low calorie, relatively high in fiber, that tends to not cause a massive impact on blood sugar, that tends to be safe.
Alright, so I have two questions. One, how often should you recheck the blood glucose? Is this going to be once people do it all the time? Right? I mean, you see it all the time. And my second question is totally not Not really. Following. The first one is, don't they? Do they have like special treats for diabetic dogs? I know they have special diabetic stuff for humans, right. And I know we kind of follow that that sort of do do they have diabetic treats for dogs that are pre made that are low in in calories and low in carbohydrates and all this kind of stuff, and not just having to give them a carrot?
Yeah, let's jump into that first. And then we'll shift back to the question about how often we monitor, they do make prescription treats that are safe for dogs that have diabetes and all the major sort of pet food companies make make these that have a certain nutritional profile. And there's also certain things that you could give it home that would be somewhat similar meaning relatively low carbohydrate vegetables and things like that, and or just their prescription food to be used. But they do actually manufacture treats that are appropriate for dogs that have diabetes. I'll call out real quick that one of the other things you have to consider when they have diabetes is sometimes they have more than one condition. So there's
no wrong well, that doesn't happen in the real world. Get out here. We don't talk about those crazy get out of here.
Sometimes the 80s and they have a pancreas is quick to anger, right? They made pancreatitis. Well, Doctor. So in some cases, we try to go with low fat as well. So you might notice that some of those treats. And some of these prescription foods for dogs with diabetes are kind of modest in how much fat or
pancreas such a diva. Very important, but a diva. Yeah.
Now, back to your question about how often we monitor early on after diagnosis, I might start a patient on insulin and get them back in one to two weeks one week is pretty early, because you're just sort of getting used to that. Yeah. But I tend to be pretty aggressive personally early on to make sure one, we're not going too low in our blood sugar. I want to know that. And then we're doing really well. I might say okay, I'll get you back in two weeks or three weeks and then once they're very consistently manage, we'll spread it out from there. Some patients with diabetes, we might have them receiving insulin and their diet at home and as long as they're doing great. They might be able to go along doing well for two or three months. So before I get
that, I guess it would be everybody's goal, right? Get regulated work just becomes part of the routine and part of life. And that's just how it is. And you move on, you know, a lot like a lot like, you know, humans just be part of their part of their deal part of their deal. So,
yeah, and but I think it's a little bit it can be, I guess, my perception a little bit easier with pets, because we're, we can regulate their diet in a more controlled way,
they can open the fridge and get a Snickers. That's really what you're saying, right? And that's what's hard about humans, right? I gotta have a piece of cake
or screw. It's true. Yes, true. And we don't try to regulate them as tightly. You know, when people, we have all sorts of problems with kidney disease, vascular disease, where the little blood vessels out in the ends of our limbs, like, like your toes, yeah, can become damaged, and you get non healing wounds and things like that, as a result of the diabetes, we don't really see that in dogs, so we don't push them so aggressively down into the normal range with their blood sugar. So we have a little bit of a safety buffer there with respect to how we manage them. So we always encourage owners to watch for signs of diabetes coming back, which could be a combination of increased thirst, increased urination, volume, lethargy, changes in appetite, all those sorts of things. So come back in if you're seeing that, but if they're doing well, physically, they're maintaining their body weight, and we keep them in kind of an acceptable blood sugar range. We can go sometimes several months before we recheck them once they're stable, because we're not pushing your blood sugar down aggressively.
Now, I will tell you that one of the most common squarely to diagnosis with diabetes that I see in dogs and I was shocked when I found out this statistic. So my our folks, dog, Jason, Chrissy developed this. Like, I think, Now, you tell me if this seems incorrect, Dr. Stone, but I think it's something like 80% of dogs will develop cataracts, within six months of being diagnosed with diabetes. Oh, my
God, we're going along so good. We had all these good numbers, and you can fix it and you give us this horrible stat.
And that well, it's not horrible, because also cataracts. So correctable, but it has to do with the fact that he just mentioned that we don't aggressively maintain dogs in a very narrow range of blood glucose levels. And so you can have that deposition in the in the lens. You know, and so I just think that I feel like pet owners don't always get that information, that piece of information.
That's fair. And you know, we if we control them, well, we can actually delay the onset of cataracts. But you're right when your blood sugar is too high. sugar levels in the eye are too high. And then the lens does funny things with how it metabolizes that sugar and you're right, it ends up causing damage pulling water in and then that little lens in the eye gets really cloudy. forms that cataract Well, in reasonably well. Regulated dogs. Sometimes they can go a long time before they start developing any kind of cataract. But you're also correct that if we have trouble regulating them because they have other conditions, that high blood sugar over time, it seems inevitably will lead to a cataract formation.
Right? Right. Okay, so we talked a lot about dogs just with all of that. But in dogs, you put the food down the dog eats it, right? Like this is what happens you can give him the little shot with the itty bitty tiny needle that Dr. Jason can't even seewith his old man eyes. But what about cats, cats, you put the foot down and cat may not eat it for like till tomorrow. So it's a lot more challenging, right? It can
be but I'll tell you a couple of things that may change that dynamic a bit. So two things. One the diet cats they're pretty much obligate carnivores, right. They need a higher protein diet. They got to have meat. They got to have meat, right. There's
no such thing as a truly vegetarian cat. I don't care internet. It's not true.
It's not a thing. Yeah. Go go hang out with a cat in the wild they're not eating grass. And you know, when we when we look at the diet of a cat, most cats are on a dry kibble cat food. It's not necessarily bad. But if we're diabetic, innately a dry cat food often has more carbohydrate. Cats don't do well with carbohydrates, right? So often they end up getting put on a special either dry diabetes specific formulation, or more often a canned cat food and they make specialized diabetes related canned cat foods, but other canned cat foods as well are pretty high moisture pretty high in protein and lower in carbohydrate. So some cats that switched to that, that that type of diet encourages them to eat when the dish goes down. They're excited about it
sounds better to me
excited about it. I love it. They're excited about it.
I'm excited. You're excited. No, it's good, right. But there's one other thing. Yeah, most often cats end up doing best on a specific type of insulin analog that we call glargine, it's, there's a few things that have been changed in the structure of that insulin to make it longer acting. So it doesn't cause these massive swings of sugar up and down, it kind of gives you kind of a basal control throughout the day. And it's actually an insulin that in people is used as a basal insulin, and it helps you sort of maintain a more acceptable blood sugar throughout the day without the wide peaks and valleys. And so, in cats, when we use that type of insulin, you know, some cats do well on it once a day, most of my patients, it was twice a day, we would give it at this particular dose. And then if they graze throughout the day, that's okay. Because this tends to not cause a massive hypoglycemia or low blood sugar.
Well, and that, but the other thing that I find, that is like, all of a sudden overwhelms new diabetic pet owners, especially if they're cats is where there's one cat, there's three cats, right? Like if they have a multi cat household. And I have, so I've loved it when they say, Oh, wait, but we have like one of those mechanized feeders, where it corresponds with the cat's microchip. And so like, only that cat can open the door to eat that food. And so you can have your cat on a special food, even though you have two cats, or even though you have a dog, because I think it's called sure care, right? Because when the cat approaches, it says, Oh, you're the right kitty. And magically, the robot opens the door. And if there's food in there, the cat can eat.
Which I never heard of that. That's crazy. I think that's crazy. That's awesome. But still crazy. It's I'm sure. I'm sure it's like 20 years old. I'm so out of the loop. But whatever it is, that sounds really cool. I love it. I need I need that for me, right. So
the really, the really crazy thing is when a pet owner come in and say I know the cats either using the litter box, because there's also a litter box that will like Bluetooth to your phone and tell you if your cat urinates or whatever, based on the change in weight of the litter. You can see like how many times your cat actually goes to the litter box, you can see how many times your cat like uses the feeder thing. And there'll be like, Look, this is what's happening. And I think that's flippin incredible, right? You know, we can put a man on the moon, and you can know how many times your cat opens the feeder.
One thing worth calling out with respect to multi cat household, if we have to make a change in a diabetic cat's diet to optimize their control make it more likely that their blood sugar's where he wanted to be. I'll just call out that these diabetic diets that we feed, typically the can diets that are higher in protein in a healthy cat and otherwise healthy cat if the healthy cats eat that food, that's okay. It's probably closer to what they would eat in nature anyway. Right?
Yeah. Let's see if that happens. Yeah. Oh, that's very good to know, too. Yeah. Is that so it's okay for your healthy cat to eat the diabetic food. It's not okay for your diabetic cat necessarily to eat the healthy cat food. Right? There we go. Not. Right, not less than ideal. Boom. And you know what this is? This was my favorite phrase from Dr. Stone so far. Jason did. Did you hear? We're not just managing numbers we're managing.
I loved it. I was gonna I was gonna say something. But he just kept on going and always always got some stuff coming out. I think that was really good. Listen, who gets who gets diabetes more? Dogs or cats? You guys know? I mean, I might I absolutely Googled it. I had no idea. Googling? Yeah, no, not now. I was prepared. So I can't be unprepared and remind Richard flashbacks of school. So I think it said something like, up to 1% of all cats will eventually be diagnosed with diabetes 1%. Whereas dogs, it's more like one out of 300 which my math is like a third of the number of dogs are diagnosed or something like that. Yeah. So how about that for math? Right, one out of 100 versus one out 300? And then just overall general information. Yeah, but
you know what, I think? You know what good like so I would want to know if they controlled for?
No, there's no control and they just went NASS cat. I haven't What do you mean? Like no, because
we only we estimate that we actually only see 20 to 25% of of pet cats at the veterinarian anyway, throw
that in there, then it's about the same, right? So
yeah, so we're like we're not seeing cats. So listen, if you have a cat at home, you're probably taking in you have a dog. You're probably taking your dog to the vet once a year. You should take your cat once a year to write like, like just a shout out for that. Take your cat to the vet people. Especially if it's a big giant orange cat. Yeah, cuz
automatic I have diabetes, right? Oh, well,
you know, if you do that, which is a great thing to do, by the way, and let's say your cat, your big orange cat goes to the vet. And then when they get back the bloodwork, they call you, your veterinarian says, hey, the blood sugar was 190. And that's higher than the normal range, or 200. What are we doing that they may make a recommendation to you to do something that Dr. Jen, you mentioned earlier, which is run of fructose me? Oh, yes. Yes. Right. That helps us know, on average, in the last couple of weeks or so, was the blood sugar high? Or was it normal? Or was it low? You know, it helps us understand that a little bit. Because cats are tricky. Sometimes on that lab work. It's confusing. You know, why is your blood sugar high? Were you stressed? Are you kind of a diabetic? And that might be important information? Because we might recommend a diet change right then and there. If you find
as stone reminded us in the beginning, cats are not small dogs. They're very different.
That's correct. Well, and cats are tricky. But also I I love the fructose Amin piece because it's a very first time I heard about that and ran it. I felt like I got one over on the universe, right? Because cats cats show me That's right, because cats show up. And they're they're tricky. They don't want to be there necessarily. And cats just you know, they run the world. And so then when I'm like, well guess what? Dr. Jen, that's got a trick here. So you can do whatever you want with your blood sugar today, friend, but I'm getting to know what you've been doing lately. Right?
Like the hair. It's like the hair test or fingernail test for stuff. Right? So you
can't hide it. That's right. I know you've Dr. Jason's heard about this?
I don't know about that, man. Yeah.
Yeah, so. So I love that. Well, this has been kind of a rip roaring Convo all about about diabetes. And we didn't get to the most important thing. Here it is, at the end. The most common things most common presenting signs that your pet may be diabetic. Right, let's just let's just list those right click, right,
absolutely increased thirst, increased volume of urination. And frequency to right and frequency. Sometimes we will see weight loss even in the face of a voracious appetite, they want to eat but they can't maintain body weight, we will see that
I would consider that a plus. But anyway,
you know, well. And then lastly, sometimes I can't smell it. But some people can smell ketones. And if they get a really severe form of diabetes, they may develop a sort of ketotic breath, which means the metabolism has changed in their body because of the diabetes and they're becoming more ill.
Yeah. Yeah. And, and, and high blood sugar, not necessarily an emergency, but low blood sugar. Always emergency. That's right. Yeah, I then and that's something I think that um, I kind of helped I develop a like a little mantra with pet owners and like, if it's a little bit high, we're okay. If it's a little bit low, we're on the way, right? Because it just reminds him like, there is a way to err, if you're really afraid, you know, if you're afraid. And so yeah, so I think that's great. So if your pet has increased thirst, their drink and more, you have to fill that water bowl, if they're going out or begging to go out more and more and more and more and more if they're eating like hogs, but now you can see their ribs. Or if you just think they don't look quite lift themselves. Hey, go to the vet. And then one more step you have to do you have to say yes, when your veterinarian wants to run some diagnostics, say yes, because we if we could figure out exactly what was wrong with everything, just by looking at him, I'd be making a lot more money. And probably I might be somewhere in Vegas because I would know know the future.
And one other call out to say yes to is if they are diagnosis diabetic, consider treatment, because many patients with diabetes can do very well without injections and diet and all of this but you
can do it right now. That's what I was talking about sounds it sounds a little scary to those people who are listening and haven't had to deal with this. But it is right it's a it's a disease but but you can manage it and it's and it's many people have done it and many people will do it and it's I've got it down to a pretty good, pretty good science and how to take care of
it. So and there are incredible tools available for you. And if you are concerned we're going to in the show notes I'm going to put a couple of credible websites where you can find some stuff appropriate for for yourself as a pet owner, for a vet student who might be listening to get get an overview because diabetes is real friend, you're gonna see it. And then also for veterinarians who are just looking for maybe some pearls to play us up their diabetes knowledge. We'll put that stuff out there for you. But yeah, I mean, I had one lady just started sobbing when her cat, her cat came in and was paralyzed in the back end, couldn't couldn't use the back legs. And I was like, oh, goodness, this is look like a diabetic kidney. And she just started bawling. And she said, I guess I have to put her down. And I said, Wait, what? What now? So we had a conversation she was she loved her cat so much, and, and I said, No, no, you can do this. You can 100% You can do this. And so I kept the cat overnight in the hospital, because she just didn't know what to do with it at home. And the next day, we started insulin, and the cat was was walking. Normally, I think within just a couple of days, it was very quickly, and the lady that cat lived for years, you know, so you can do it. And do it well, and your pet can be very happy with a very high quality of life. There's a lot of tools at your disposal. There's insulin, there's diet management, all kinds of things.
The fact they have a lot of stuff is actually a really good sign. Yeah, I have a lot of choices, because they're they've really narrowed down to specific treatments for specific, you know, body types, lifestyle types, you know, species, all this kind of stuff they've done every day, man this day, companies fantastic. They got all kinds of stuff. But anyways, there are a lot of options. So that's really actually a good thing.
It's true. It's true, Dr. Stone, any last final comments that you would have for for folks on diabetes and pets.
We just say a lot of people are doing a lot of research in diabetes. And so there are new things that come out seems every year, dietary change new insulins available new technologies for how we monitor glucose. There's a lot of things on the horizon. But here and now, as you all said, we've got a ton at our disposal. So don't be discouraged. If your pets diagnosed with diabetes, go for the treatment. And more importantly, if you have a cat, and it's kind of one of those big kiddies that needs to lose a little bit of weight. Let's start working on that now. Because the sooner we get that under control, the less likely we are to be facing diabetes in the future.
That's right. And you don't even have to be the one to say no, you could just get that feeder that opens up and just say the robot said no, sorry. You've already eaten all of it. Anyway, well, this has been fantastic. Thank you so very much again, Dr. Richard stone with blue pearl for joining us and talking all about diabetes management in pets. I guess that's all that I have. I'm Dr. Jen
the vet. And I'm Dr. Jason. And we'll catch you on the next
episode. The PACCC CEU code for this episode is CC220008
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