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I was fortunate to get to attend a presentation last night on managing canine and feline diabetes by Dr. Dave Bruyette, an internal medicine specialist in LA who does a lot of work with endocrine disorders. The audience was mainly veterinarians and technicians, who received CE credit, and Abbott was there selling the AlphaTrak meter to them.
So there was a strong emphasis on home blood glucose testing in the presentation, which was very encouraging.
Among the interesting topics to me was a detailed description of precisely how canine and feline diabetes differ. They may have the same name but that's about as far as the similarities go.
Dr. Bruyette described a protocol used by Dr. Rand in Australia with cats that involves a four or six week period of very intensive testing (8 times a day 6 days a week) combined with Lantus insulin, which works very well in cats, and the high-protein low-carb diet to drive their blood sugars quickly down below the renal threshold, which in cats is higher, somewhere around 270, and maintain to there with as little fluctuation as possible. Dr. Rand, according to Dr. Bruyette, is achieving remission in better than 90% of the cats treated with this protocol if the diabetes is caught earlier rather than later. Eventually, they go off insulin and stay on the high protein, low carb diet and theoretically can be diabetes free indefinitely. This is because cats' islets cells do not die unless they go untreated for long periods of time. And the studies are showing that a basal type insulin like Lantus does a far better job of inducing remission than insulins that provide more ups and downs in the blood sugar.
He made a clear distinction between that type of diabetes in cats and diabetes in dogs, which is an autoimmune disorder in which the islet cells are destroyed, making dogs permanently insulin-dependent diabetics. This is also why oral medications can be used in cats but not in dogs. But his general feeling is that the oral meds are not the first best approach as you can very likely get a cat fully into remission with the insulin and diet change and then mainly just need to keep them at a healthy weight.
I was sad to see, when Dr. Bruyette asked how many start with Vetsulin in dogs and how many with NPH, not one person said they start with NPH. At the end of the talk, someone asked about a starting dose for Lantus for a 70 pound dog going through three vials of Vetsulin a day. At which point I asked if they had ever tried NPH. They hadn't. The speaker was of the commonly held opinion that NPH would disappear by fall and I challenged that assumption, saying that they have to give six months notice before discontinuing it and I've been hearing about its demise for four years now. So I hope I planted a seed to take the claims often made by marketers of Vetsulin that there's no point in using NPH since, they say, it will be gone any day now.
Not that I think NPH will stay forever. But it's a great insulin, especially in larger dogs, and even if we have it only six more months, that's six months of inexpensive, easy diabetes treatment for that 70 pound dog. One concern was expense and Lantus certainly wasn't going to help there, although at least it would be a smaller volume of insulin.
I heard much discussion among people during the break that they just didn't think they could get owners to test and they didn't even know how to tell them to do it at home. Dr. Bruyette emphasized after the break that it's a thoroughly manageable task for most pets and to check k9diabetes.com and Abbott's website for assistance! (I talked to him briefly during the break and told him about the videos on home testing at the site) He puts all cats on home testing if they will tolerate it and the owners are willing.
An Abbott rep claimed that UCD's vet school endocrinologists have come around to supporting home blood glucose testing in the past year. Will do a little research later this week and see if I can substantiate that. I told them that Nelson's presentation at WSAVA 2007 discouraged it. Also told them I didn't routinely use the AlphaTrak because it is too expensive for frequent use. They included a survey in the packet on what would make participants more inclined to use AlphaTrak and I again stated that the cost of the meter and especially of the strips was prohibitive for frequent testing.
So it was a very interesting night... discouraging on some fronts in that so few are using NPH and how many vets and techs felt home testing was difficult. But they were there and they were hearing that it's not only possible but much easier than they think and far more useful than they may realize.
Also, Dr. Bruyette asked that vets never make a dosage adjustment based solely on a fructosamine test. That a higher result on the fruc test tells you something is causing a loss of blood sugar regulation but not WHAT is causing it. So if the fruc test shows regulation is fading or failing, you need to do a curve to see what's actually happening with the blood sugar and investigate things like UTIs, etc. before choosing how to tackle the problem. Very good advice in my mind.
Natalie
So there was a strong emphasis on home blood glucose testing in the presentation, which was very encouraging.
Among the interesting topics to me was a detailed description of precisely how canine and feline diabetes differ. They may have the same name but that's about as far as the similarities go.
Dr. Bruyette described a protocol used by Dr. Rand in Australia with cats that involves a four or six week period of very intensive testing (8 times a day 6 days a week) combined with Lantus insulin, which works very well in cats, and the high-protein low-carb diet to drive their blood sugars quickly down below the renal threshold, which in cats is higher, somewhere around 270, and maintain to there with as little fluctuation as possible. Dr. Rand, according to Dr. Bruyette, is achieving remission in better than 90% of the cats treated with this protocol if the diabetes is caught earlier rather than later. Eventually, they go off insulin and stay on the high protein, low carb diet and theoretically can be diabetes free indefinitely. This is because cats' islets cells do not die unless they go untreated for long periods of time. And the studies are showing that a basal type insulin like Lantus does a far better job of inducing remission than insulins that provide more ups and downs in the blood sugar.
He made a clear distinction between that type of diabetes in cats and diabetes in dogs, which is an autoimmune disorder in which the islet cells are destroyed, making dogs permanently insulin-dependent diabetics. This is also why oral medications can be used in cats but not in dogs. But his general feeling is that the oral meds are not the first best approach as you can very likely get a cat fully into remission with the insulin and diet change and then mainly just need to keep them at a healthy weight.
I was sad to see, when Dr. Bruyette asked how many start with Vetsulin in dogs and how many with NPH, not one person said they start with NPH. At the end of the talk, someone asked about a starting dose for Lantus for a 70 pound dog going through three vials of Vetsulin a day. At which point I asked if they had ever tried NPH. They hadn't. The speaker was of the commonly held opinion that NPH would disappear by fall and I challenged that assumption, saying that they have to give six months notice before discontinuing it and I've been hearing about its demise for four years now. So I hope I planted a seed to take the claims often made by marketers of Vetsulin that there's no point in using NPH since, they say, it will be gone any day now.
Not that I think NPH will stay forever. But it's a great insulin, especially in larger dogs, and even if we have it only six more months, that's six months of inexpensive, easy diabetes treatment for that 70 pound dog. One concern was expense and Lantus certainly wasn't going to help there, although at least it would be a smaller volume of insulin.
I heard much discussion among people during the break that they just didn't think they could get owners to test and they didn't even know how to tell them to do it at home. Dr. Bruyette emphasized after the break that it's a thoroughly manageable task for most pets and to check k9diabetes.com and Abbott's website for assistance! (I talked to him briefly during the break and told him about the videos on home testing at the site) He puts all cats on home testing if they will tolerate it and the owners are willing.
An Abbott rep claimed that UCD's vet school endocrinologists have come around to supporting home blood glucose testing in the past year. Will do a little research later this week and see if I can substantiate that. I told them that Nelson's presentation at WSAVA 2007 discouraged it. Also told them I didn't routinely use the AlphaTrak because it is too expensive for frequent use. They included a survey in the packet on what would make participants more inclined to use AlphaTrak and I again stated that the cost of the meter and especially of the strips was prohibitive for frequent testing.
So it was a very interesting night... discouraging on some fronts in that so few are using NPH and how many vets and techs felt home testing was difficult. But they were there and they were hearing that it's not only possible but much easier than they think and far more useful than they may realize.
Also, Dr. Bruyette asked that vets never make a dosage adjustment based solely on a fructosamine test. That a higher result on the fruc test tells you something is causing a loss of blood sugar regulation but not WHAT is causing it. So if the fruc test shows regulation is fading or failing, you need to do a curve to see what's actually happening with the blood sugar and investigate things like UTIs, etc. before choosing how to tackle the problem. Very good advice in my mind.
Natalie
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