Richard Goldstein, DVM, DACVIM: Spider has been sitting here so patiently listening to us talk about cats.
Ruth MacPete, DVM: You have to hear us talk about cats, huh?
Richard Goldstein, DVM, DACVIM: I know. Azi, tell us about Spider. How did you get Spider? When you got Spider, what happened?
Azi Chegini: For the record, Spider likes cats. Not for dinner, but as friends.
Richard Goldstein, DVM, DACVIM: Good. Diabetic cats or just any cats?
Azi Chegini: Actually, Spider came to me about a couple of years ago, a few years back. He was found walking the streets of Winchester, Virginia, and he was picked up by Animal Control and taken to a shelter. Because he’s so young and cute, somebody from the shelter called Mutt Love, which is the rescue group in the northern Virginia area, and they came in and got him.
Richard Goldstein, DVM, DACVIM: I know he was young and cute, but do you know how old they thought he was?
Azi Chegini: About 2 years old.
Richard Goldstein, DVM, DACVIM: So, young.
Azi Chegini: That’s what the veterinarian thinks that he was. He was picked up, put in a foster home, and right away they noticed some of the things you were mentioning. He was urinating a lot. He was drinking a lot. He was tired. He’s tired because he had a good day today. But he didn’t look quite well, and he was diagnosed with diabetes.
Richard Goldstein, DVM, DACVIM: At his time in the shelter?
Azi Chegini: No, at the foster home.
Richard Goldstein, DVM, DACVIM: At the foster home, OK.
Azi Chegini: Mutt Love, again, is the rescue organization that helped him, took care of him, took him to vets, and put him on insulin. He even had cataract surgery due to one of the complications of diabetes, and they paid for his eye surgery because he was young and he had a lot of life in front of him.
Richard Goldstein, DVM, DACVIM: Azi, you adopted a diabetic dog from a foster family.
Ruth MacPete, DVM: She’s amazing.
Richard Goldstein, DVM, DACVIM: I know. What made you do that?
Azi Chegini: Look at her. How could you not?
Richard Goldstein, DVM, DACVIM: Did you know much about diabetes?
Azi Chegini: I did. I had a chihuahua just like Spider named Charlie. Charlie got diabetes much later on in his life. And unfortunately, I didn’t know about diabetes and all the complications, but I learned through a very hard process.
Richard Goldstein, DVM, DACVIM: If you remember, if you could go back, what was your initial thought process? What were you thinking about?
Azi Chegini: I panicked. Right away, I thought this was the end. I just remember emotionally being bankrupt. I didn’t know what to do. I don’t think that I could even hear everything that my veterinarian was telling me. It took me 24 hours until she came back to me; she gave me some time to grieve with the whole idea. And then I learned there are tools, there are medicines, and there are things that I can do to take control of it. That’s how I learned about it.
Richard Goldstein, DVM, DACVIM: Dr. MacPete and Britany our technician, who is going to join us in a little bit, we’ve all had that conversation so many times with owners. People’s initial reaction is, “I can’t do it, it’s too much. What am I going to do?” But then you realize that you actually can do it.
Azi Chegini: Yes. I realized how easy it was and that it wasn’t a death sentence at all. As a matter of fact, you become smarter and you become better at taking care of your pets. But it’s also a disease that we share with this animal. It makes you smart about your own diet, your own life, and then you realize that you’re able to help animals just like Spider to have a second chance.
Ruth MacPete, DVM: And there’s the bond you feel. You are so close and so in tune with your pet, it really just strengthens the animal bond.
Azi Chegini: True.
Richard Goldstein, DVM, DACVIM: If you were a veterinarian—Azi, when you brought Charlie in first, that’s when you really learned about diabetes—what questions would you have had for Dr. MacPete back then?
Azi Chegini: I think the first question was, why? Why did this happen to him?
Ruth MacPete, DVM: As Azi said, it’s so shocking for people to hear that initially. I think a lot of people are unaware that it even occurs in animals like it does in humans. But also, why? Why me? Why my pet? I loved what you said about taking 24 hours, because I find that’s really what I’ve seen with my clients. It takes people a while to really let it sink in. I try to answer all their questions, but I also send people home with literature and resources that are good solid resources so they can go to on the Web and see videos, so that they can learn more about diabetes. It really takes a while for it to sink in, what it means. It’s a big commitment for pet parents to have a diabetic animal. It’s a big commitment of time and a financial commitment as well, and they really have to be on board and understand it and be comfortable with it.
Richard Goldstein, DVM, DACVIM: But at the same time, not get overwhelmed, right?
Ruth MacPete, DVM: Yes, not get overwhelmed.
Richard Goldstein, DVM, DACVIM: But you can do it. You don’t have to change your life. If you like playing golf on Sundays, you can still play golf on Sundays, but you can also incorporate the diabetic monitoring and care into your current life. I feel like that’s our role. Our role as veterinarians is to enable people to keep their pets with diabetes and almost fit the diabetes into their lifestyle versus trying to change their world, because people just can’t do that.
Ruth MacPete, DVM: Absolutely. It’s great that you mentioned that because I think so many people do think, “Oh my god, I’m never going to be able to go out. I’m never going to be able to take a trip.”
Richard Goldstein, DVM, DACVIM: And that it’s 7 and 7 for the insulin.
Ruth MacPete, DVM: That’s not the case. It is manageable, not just the disease but in your life. It’s a manageable condition. And Azi, you’re such a great example of that, how easy it is to fit into your life and adjust.
Richard Goldstein, DVM, DACVIM: Probably long term, the most important thing is to have their diabetes under control, right?
Ruth MacPete, DVM: Yes.
Richard Goldstein, DVM, DACVIM: We want them to be happy and healthy and under control. Is that hard? Do you find that hard to achieve with most pets, like Spider?
Ruth MacPete, DVM: Yes. I think the beginning is the hardest part, as you know, because the beginning is where we’re really starting an animal on insulin and diet modification and teaching the pet parents how to do home monitoring, which is really key. Home monitoring is one of the things that helps people get their pet regulated quicker and helps cut down on the number of veterinary visits, and it helps the pet parent comanage the disease with their veterinarian.
Richard Goldstein, DVM, DACVIM: It’s a more accurate picture of what’s actually happening, right?
Ruth MacPete, DVM: Absolutely.
Richard Goldstein, DVM, DACVIM: Because Spider, as much as he seems to love where he is right now on Azi’s lap, might be a different dog in the clinic with a barking shepherd next to him and a really cute cat on the floor.
Ruth MacPete, DVM: Especially cats. Cats are very, very sensitive to stress and change in environment. We find that when we’re checking a cat’s blood glucose in a hospital, it may not be an accurate read. We may get stress or hyperglycemia, and so home monitoring is definitely better. But I think to your point, it’s just in the beginning that it may be more challenging while we’re regulating the animal.
Once we get the animal regulated, which may be 3 to 6 months down the line, it becomes much more routine. I know you’re in that phase, where you’re in the groove. It’s a lot easier. You know what to look for, and you’re really in tune with your pet. When Spider may be off, you know how to do these little spot glucose checks at home. You also know that your veterinarian is there for you as a resource, that you could always contact and talk to them. But it becomes much easier as it gets going.
That’s what I try to explain to my patients, that the beginning is challenging. The beginning is definitely tough as you’re getting your pet regulated. It’s manageable, but you’re going to come in and we’re going to see each other a lot more. And then, once we get it under control, it really becomes pretty easy for people. It becomes routine for people to do.
Richard Goldstein, DVM, DACVIM: In a case like this, when Spider first presented, the diagnosis was pretty easy, right? There are simple lab tests, a simple physical exam. I know we said this, but what would be the typical lab test that you would find and do?
Ruth MacPete, DVM: We’re going to run bloodwork, so bloodwork and urine. Usually with that bloodwork, it’s a CBC and a chemistry panel. It’s going to show an elevated blood sugar level or blood glucose. Also looking at urine, we would see glucose in the urine, which shouldn’t be there unless you have a diabetic animal. Sometimes in cats, we’ll also run a test called fructosamine, which is a better test of blood sugar levels over the course of time, more chronically. It’s looking over the course of a couple of weeks, what has the blood sugar level been?
Richard Goldstein, DVM, DACVIM: Cats are so stressed, and people think that a stressed cat is a cat that’s screaming. Just huddling in the back of their cage can be a sign of a lot of stress, and because they’re so stressed, their blood sugar can actually be high. They can even have sugar in their urine just from stress. So, that fructosamine test helps us really define if it is a diabetic cat or just a really stressed cat. He doesn’t look too stressed. I think he’s fine.
Ruth MacPete, DVM: He’s good. Like you said, fructosamine is also a good monitoring tool you have to look at regulation. Like you said, it’s pretty easy for us with these blood and urine tests to be able to diagnose a diabetic animal. But then, we need to start talking about treatment.
Richard Goldstein, DVM, DACVIM: Then comes the challenge, right? Regulation, treatment, easing the owners into it, and teaching them how to do it. We’re going to be talking a little about that in just a moment.