Few situations test a veterinary technician’s team like a diabetic boarding animal
A diabetic pet is constantly living a day or 2 away from crashing. When a patient is diagnosed with this condition, we stress the importance of regulation to their owners. We set up (sometimes several) glucose curves to balance their insulin doses. We recommend the owner bring the patient in often to have their BG (blood glucose) checked. It is a very intensive process and ownership experience. When that diabetic patient is boarding with us, its well-being is entirely in our hands. Boarding patients also have minimal interaction with our veterinarians. This means that regulation is entirely upon the veterinary technician team.
There are several aspects to the experience that must be managed. We’re going to divide the responsibilities into three categories: managing communication; managing the insulin; and managing the patient. If we do these things effectively and efficiently we will avoid any potential catastrophes. We all dread walking in to the cat room, occupied by an aggressive cat, and not hearing a welcome growl or hiss.
If you are good at one thing in a veterinary clinic, it should be communicating: verbalizing, writing things down, and using hand signals if necessary to get your point across. There should be a system in place to allow for written communication to span shifts. One person should be able to quickly look and see when a patient was last given insulin; not to mention if the patient has been eating, drinking, urinating, defecating, etc. A simple and readable “ICU Sheet” is a necessity for veterinary clinics. Using this sheet we can communicate what a patient is eating, how much, what its condition is, what type of insulin it uses, what its dose is and how often, what to watch out for, etc. Utilizing this written protocol is a must when a patient is boarding.
It’s also important to verbalize what medication you’re giving to your team. This way, if writing on the ICU sheet is somehow delayed, everyone is aware that the patient has been given its insulin. Also ensuring that everyone knows the status of the patient – if its inappetent, having diarrhea, hanging over the water bowl, perfectly fine, etc – helps to keep track of a patient’s status. It is uniquely your responsibility, as well as the entire team’s, to manage your patients.
Managing the insulin
The patient’s insulin should be refrigerated at all times. It may not be necessary with some insulin types, but when we start making exceptions to rules mishaps happen. As such the insulin should always be rolled in your hands prior to administration. The type of syringe needed, U-100 or U-40, should be highlighted and circled on the label/box. It is also a good idea to store the proper syringe with the insulin. The location of the syringe should be noted on the patient’s chart and “ICU Sheet”.
Managing the patient
You should know the diabetic, boarding animal’s history. When it arrives you should review the patient’s chart so that it is known if the patient is due for a blood glucose check, what the current dose of insulin is, if the patient has had any adverse events before and what caused them, etc. This knowledge feeds in to our communication. We must know what to communicate.
We should be observing the patient’s eating, drinking, urination, defecation, energy-level, weight, and demeanor. If a patient is not eating a doctor should be alerted and insulin should not be given. If a patient is acting differently, it should be assessed. When you interact with the patient you should make sure it is staying hydrated. Any weight loss should be noted and told to a doctor. It is important to remember that their lives are in our hands, as The Dude would say.
I’ve included a link to a Veterinary Partner article on Insulin Administration in Cats. It covers a lot of information about different types of insulin, how to store it, and what to watch for. It is great information for clients, as well as your veterinary technician team.
Insulin Administration in Cats