Guide for VNs advising clients on insulin treatment at home
• Introduce yourself to the client and explain the reason for the consultation . Explain DM and respond to the client ' s questions before focusing on the insulin treatment .
• Demonstrate how to prepare and administer insulin , ideally using a soft toy or an orange as a model while explaining the process to the client . The client should then demonstrate the process to you , so their confidence and understanding of the entire process can be gauged .
• Remove the insulin vial from the refrigerator and roll ( rather than shake ) the bottle before use . Draw up the correct dose of insulin ( measured in international units ( IU )). Explain the importance of drawing up the correct dose . If the insulin vial contains any clumps , advise the client that it may need to be replaced . Once the insulin is drawn up , show the client how to make a skin tent at the back of their pet ' s neck ( between the scapulae ), where the needle is to be inserted at a slight angle ( 20 – 30 degrees ). Demonstrate that they should draw back the plunger of the syringe slightly to check that no blood is present before injecting the insulin slowly . ( Explain that if blood is present in the syringe , this indicates that a blood vessel has been hit , and the whole insulin syringe should be disposed of and a fresh dose drawn up in a clean syringe .) Demonstrate how to remove the needle and syringe , rub the injection site gently , and dispose of the needle and syringe in a sharps bin .
• If needed for confidence , the client should ask someone in their household to assist them . If the patient is food orientated , it can be fed ( and thereby distracted ) while the insulin is given .
• Insulin is usually given twice daily , with doses spaced evenly apart ( every 12 hours ), but this is case dependent . In the case of a missed dose , as stated on the Caninsulin website , advise the client to wait until the next insulin dose is due and continue as normal [ 14 ] . A brief period of hyperglycaemia due to too low an insulin dose is not as dangerous as the possibility of causing hypoglycaemia by giving too much insulin [ 14 ] .
• The client should be given a sharps bin to take home for their used needles and syringes . Once it is full , they can bring it back to the practice to be disposed of and replaced with a new one .
• Insulin broach date is 60 days from opening . Vials should always be kept in a fridge .
If purchasing insulin from the practice is too expensive for the client , a written prescription could be offered , at the discretion of the VS .
Clients should be made aware that they will need to bring their pet to the practice regularly for checks , blood glucose curves and blood tests . Allow at least an hour for the initial VN consultation to thoroughly explain everything to the client and to respond to any questions they may have . Follow-up clinics are likely to take between 30 and 60 minutes .
Explain the signs of hypoglycaemia and advise the client to contact the veterinary practice immediately if their pet displays any of the signs . It is also advisable to recommend that the client keeps a small bottle of honey at home as a first aid measure . Ensure that they have the practice ' s out-of-hours emergency number .
Some clients may not wish to feed their pet a prescription diet but it is important to discuss the patient ' s current diet to check if it is suitable , and explain the benefits of feeding a DM-specific diet .
Checks and blood glucose curves will need to be carried out regularly until the patient is stabilised . Explain to the client what a blood glucose curve is , and how it is carried out . Their pet will usually be admitted as a day patient and , in the morning , a blood glucose reading will be taken . Depending on the owner ' s routine and the recommendation of the VS , the patient may be fed at home and insulin administered , or this may be done in the practice on admission after the first glucose reading . Several blood samples for glucose readings will be taken throughout the course of the day ( usually every 2 hours ). Samples will be taken from the ear , the jugular or the cephalic vein .
Clients may expect an immediate reduction in their pet ' s clinical signs when it is stabilised , but it is important to explain that it can take time to stabilise their pet .
If possible , ensure that one VN is assigned to the patient to ensure continuity of care .
Follow-up communication
Clients should be contacted by phone or email a day after their VN consultation to see how they are getting on , to check that they have been able to give their pet the insulin and to offer assistance if necessary . It may be helpful to invite the client to bring their pet into the practice for the first couple of insulin doses , to increase the client ' s confidence and their trust in the practice .
Confirm with the client that they are able to give the insulin at the same time every day , with the same duration between doses , especially while the patient is being stabilised . Keeping a stable routine for insulin and feeding times is essential . Water should always be available , especially for diabetic cats that are polydipsic .
56 Veterinary Nursing Journal