What to Do With Conflicting Medical Advice?

This week one of our readers wrote in that she recently moved and is now using a multi-doctor practice in her new town. She said her prior vet’s humorous yet brief advice regarding diet was, “Don’t feed donuts” to her diabetic dog. At her new hospital they were strongly advising her to change to a prescription food for her diabetic dog. She felt her dog had been doing well on the organic food she had been feeding for several years.

So, what do you do when you receive different medical advice from different doctors? Veterinarians go through 8 years of college to get their veterinary degree. Specialists such as internists and surgeons and radiologists get to endure an extra four years. I always say, “If you ask five different vets the same question you will probably get five different answers”! Who do you believe?

I thought today I might address some common disparities in opinion regarding diabetes treatment of diabetic pets. I’ve heard these comments from our ADW clients about their vets, or I have personally encountered these opinions by other vets I’ve met over the years regarding diabetes.

1. Home monitoring. This used to be a bit of a hot button for some vets, but in the last few years it has become commonplace. I’ve been practicing since 1993 and even early on in my career, before we had species-calibrated glucose meters for pets, I had clients checking blood glucose levels on their pets at home. It has always seemed logical to me to have a meter at home, but some vets were opposed to home testing. I think fewer and fewer veterinarians are opposed to home monitoring these days. When I have heard vets say they prefer curves at the clinic instead of at home, it seems they were worried that they would lose client communication and lose control of the pet’s diabetic management. I find just the opposite is true. My clients email or text me their curves. Easy. I’ve also heard vets say their clients get frustrated getting blood samples, but with current glucose meters we can get a glucose reading with as little as 0.3 microliter of blood. That’s a pretty tiny droplet of blood.
2. What to feed. This is a different story for diabetic dogs versus diabetic cats. Some clients receive minimal dietary recommendations about what to feed. Some clients get pushed hard to go with one or another of the veterinary prescription diets. In general, I believe there are many good options of quality pet food for diabetic dogs and diabetic cats. I’m not adamant about any particular diet, as I hope for a diet the pet truly enjoys. We all have different tastes after all. If I can make any strong general recommendations for successful feeding, diabetic dogs should ingest complex carbohydrates (no donuts), and felines should receive low carbohydrate diets (less than 10 percent, the lower the better – pretty much canned food). Additionally, since many diabetic pets are chubby and many have had episodes of pancreatitis, low fat diets are often recommended for diabetic pets.
3. When to feed. I think most vets agree that meal feeding of dogs and cats is best and should be done at the time of insulin dosing. Now what do you do between insulin injections? Do we feed snacks? Do we only feed at the time of insulin injections? Since vets have in the past chosen overwhelmingly longer acting insulin (Glargine, PZI) for cats and intermediate acting insulin for dogs (vetsulin, NPH), we have been less strict about avoiding mid-meal snacks for cats and more adamant about not feeding diabetic dogs between meals. Again, some veterinarians don’t make recommendations about timing of food, but I do. I think feeding the majority of calories fed at the time of insulin makes for a better controlled diabetic.
4. Human glucose meter vs. pet glucose meter. I strongly recommend using a glucose meter calibrated for the species. In general, using a human glucose meter on a dog or cat tends to underestimate the glucose value. Why tolerate inaccuracies, when our goal is to have the best glucose regulation possible? If we strive for the best quality of life and use a glucose meter to adjust insulin dosing, it’s worth the small increase in cost to get a pet glucose meter over a human meter. And yet, there are veterinarians who recommend using various human glucose meters.
5. When and how often to check blood glucose. Home glucose monitoring used to be uncommon. Now it is now not only common to run glucose curves at home, some owners check blood glucose levels before each dose of insulin! What is right for your situation? Home glucose curves should be run every couple months – even if a diabetic pet is thought to be well regulated. Certainly if the insulin dose is changed, a curve should be checked a week or so later. Now, do you need to check a glucose before each insulin dose on a daily basis? For the average pet this isn’t probably necessary. However, diabetic cat owners aiming for tight diabetic control and remission will likely check glucose levels before each insulin injection.

We call it medical “practice” because there is rarely ONE right way of doing anything. When you receive medical advice, take the time to understand why you are doing what you are doing. I love when my clients ask questions! It means they are not only listening to, but also comprehending my treatment recommendations. Most vets want to interact with clients in this way. Don’t be afraid to ask questions and ask for educational handouts or website links to further your understanding of your pet’s condition. The right path may be different for different families.

NOTE: Consult your veterinarian to confirm that my recommendations are applicable for the health needs of your pet.