Align-ju STUDENT
Keeping a diabetes diary is useful for owners of pets with DM as it helps in the identification of abnormalities and trends . The RVC Pet Diabetes app ( https :// www . rvc . ac . uk / clinical-connections / pioneering-petdiabetes-app ) can be used by owners to record certain clinical parameters , such as changes in thirst , hunger and weight . It also has a tool to calculate the amount of food / calories the patient needs , a medication reminder function and helpful graphs to display trends .
Owners can use a home test kit to test their pet ' s urine to monitor the level of glucose . The VN should explain to the client the importance of wearing gloves when handling urine and advise on the different methods of collection , such as using clean gravel or Katkor / Medicat to obtain urine from their cat ' s litter tray , or using a clean container or a Uripet for collecting their dog ' s urine .
Advise clients against using human glucometers to check their pet ' s blood glucose at home , as they give readings that are 10 – 15 % lower than the true value . If a patient is stressed , a VS or VN can check the patient ' s blood glucose level at home to avoid the need to bring them into the practice .
Follow-up DM consultations
To prevent stress hyperglycaemia , try to reduce stress for the patient when it visits the practice . This may be difficult , however , as the patient may be stressed due to factors outside the practice , such as changes to its daily routine , exercise or environment .
Ask the client how their pet has been at home – have there been any changes in its water intake , urination and appetite ? Discuss the patient ' s diet . Assess the patient ' s dehydration levels ( create a skin tent , feel the mucous membranes ), then weigh the patient and carry out a body condition score . Perform a head-to-toe health check – including parameters such as temperature , pulse and respiratory rate – and carry out a pain score . Check the patient ' s blood glucose level , make notes on the file and flag up any abnormalities to the VS . Arrange a further follow-up appointment , if applicable .
Blood glucose monitoring
The FreeStyle Libre is an increasingly popular blood glucose monitoring system , which records interstitial glucose readings every minute for up to 2 weeks [ 15 ] . There are advantages and disadvantages to its use ( Table 3 ). A sensor is applied to the patient in a subcutaneous space and is left in situ for repeat measurements . The sensor can read glucose values between 2.2 and 27.8 mmol / l ; readings outside this range will read as LO or HI [ 15 ] . It is monitored through an app on a linked mobile phone . The readings can also be sent to the VS for assessment . It is recommended that the patient avoids swimming and bathing while the sensor is fitted [ 15 ] . After 2 weeks , the sensor should be changed or removed by a VS or VN .
Guide to preparing and placing a FreeStyle Libre sensor on a patient
• If possible , ask a colleague to hold the patient .
• Clip the area of the body where the sensor will be placed ( usually on the back where the patient cannot reach it ). A medical pet shirt or an Elizabethan collar may also be needed .
• Clean the area with surgical spirit . If the area is dirty , clean with chlorhexidine ( Hibiscrub ) first before cleaning with the surgical spirit .
• Hold the applicator device provided with the FreeStyle Libre and place the sensor .
• With the sensor positioned on the patient , press down on the applicator – you will hear a ‘ click ’, which signals that the sensor has been fitted .
• You may need to apply some tissue glue around the edges of the sensor to secure it properly .
• Install the app on the client ' s phone and connect the new sensor to the device .
Table 3 . Advantages and disadvantages of the FreeStyle Libre .
Advantages
Owners can use it at home to carry out blood glucose curves and the results can be sent to the VS
Glucose readings are made for up to 2 weeks before the sensor needs to be removed
It minimises the number of visits to the practice , which helps to reduce related stress in affected patients
Disadvantages
The sensor may cause skin irritation and it is possible for the patient to interfere with it or remove it
It is not as accurate as a glucometer , as it reads values only between 2.2 and 27.8 mmol / l ( and shows either LO or HI if the readings are outside this range ) so readings made using a glucometer in the practice may still be needed before treating the patient [ 15 ]
There is the potential for technological faults , such as the sensor not connecting to the app on the phone
Volume 38 ( 5 ) • October 2023
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