One area in which veterinary technicians excel is client education. In the case of a pet recently diagnosed with diabetes mellitus (DM), this becomes a critically important skill. Unlike many disease processes, management of a DM patient involves significant time, energy, and skill on the part of the client. DM is the second most common endocrine-related disorder seen in cats and dogs, with an incidence of one in 50 to one in 400, depending on the population studied.1 Once diagnosed, the veterinary team will set up a treatment plan that includes not only insulin or oral hypoglycemics, but also adjunctive treatments, such as diet and environmental enrichment, and addressing causes of insulin resistance, such as obesity, medications, hyperadrenocorticism, and diestrus in intact females.2 Once a diagnosis has been reached and a treatment plan developed, the veterinary technician can proceed to educate and train the client on how to perform and monitor treatment and institute dietary and lifestyle changes. Ensuring the client is comfortable with what veterinary teams are asking them to do involves considerable time and effort. Mitchell was diabetic and had a feeding tube placed for hepatic lipidosis. This level of discharge would typically take 45-60 minutes. Photo courtesy Ann Wortinger Goals and treatments Dietary goals and management We want to optimize body weight by using a diet that contains the appropriate levels of proteins, carbohydrates, fats, and calories. When calculating the kilocalorie requirement, it is recommended to use the estimated lean body mass if the animal is obese or overweight.2 Portion control is important, and using measured feeding and feeding puzzles can help slow down the rate of food intake and encourage satiety. For cats, the ideal diet for management of blood glucose levels is a higher protein diet, ideally > 40 percent metabolizable energy (ME), low carbohydrates, ideally < 12 percent ME, with moderate to low fat. The amount of fat restriction should be based on their diet history and the current fat content at the time of diagnosis. As pancreatitis can often be seen with DM, a fat content of <48 percent ME is recommended.1,3 For dogs, diets that contain a mixture of soluble and insoluble fibers can help with satiety. Additionally, feeding a restricted caloric intake may be recommended, along with regular and appropriate exercise.1 If the dog is underweight, the goal will be to normalize the body weight, stabilize metabolism, and level insulin requirements.1,3 Management can be started with a high-quality maintenance diet or diabetic diet that meets World Small Animal Veterinary Association (WSAVA) guidelines.4 Blood glucose and urine glucose monitoring The goal of blood and urine monitoring is to determine if the renal threshold for glucose is not exceeded for the majority of the day. This will help to decrease the clinical signs clients see in their pets. The renal threshold for glucose in dogs is < 200 mg/dl, and for cats, it is < 250-300 mg/dl.1 The individual monitoring modalities will be covered in depth below. Collecting blood for the glucometer can easily be done using the marginal ear vein in dogs and cats. Most glucometers utilize a wicking action for the blood, requiring smaller amounts than in the past. Photo courtesy Ann Wortinger Monitoring of clinical signs Owners should be encouraged to keep a daily log of their pet’s appetite, observable thirst/water intake, and urination habits. Medications being administered, as well as any changes in body weight, should be noted. Typically, if the body weight is stable, and minimal to no clinical signs are noted, the DM is seen as well-controlled. The long-term goal is to minimize the clinical signs that the owner observes.1 Client education Before embarking on their DM management journey, clients need to be provided with a realistic idea of the time and monetary commitment involved in their pet’s future care. This needs to be both written and discussed in person, including tackling common questions clients have, and what specific signs to watch for that may indicate either hyper- or hypoglycemia, how to respond to changes in their pet’s condition, typical troubleshooting hints, and how and when to access support staff for help. Detailed information needs to be provided on when and how to use insulin and oral hypoglycemics, how these work to lower the blood glucose, instructions on proper handling and disposal of insulin and needles, and instructions on what to do if their pet is not eating or is vomiting.1 The American Veterinary Medical Association (AVMA) client handout, Diabetes in Pets, provides a comprehensive list of common risk factors for clients, as well as signs of diabetes. This handout can provide a good introduction to DM and can be used to help augment your written instructions, as it contains information on how insulin and the oral hypoglycemic SGLT-2 inhibitors work, and signs of hypoglycemia and diabetic ketoacidosis (DKA).5 Blood and urine glucose monitoring While in-house blood glucose curves have been standard for monitoring DM, there are some significant problems associated with their use. Just being at the veterinary hospital can induce stress hyperglycemia in many animals. Additionally, their activities and eating schedules are seldom what is done at home, which can make the curve produced less accurate than desired. Spot glucose with a fructosamine can be effective in monitoring diabetic control and is typically done every three to six months. This works best for a well-controlled animal. Fructosamine has the advantage of not being affected by stress-hyperglycemia, unlike a spot glucose or an in-hospital glucose curve. As a fructosamine test monitors the average blood glucose over the previous two to three weeks, it can provide more information regarding control that a single curve can produce.6 At-home monitoring using glucometers. At-home monitoring can help identify diabetic remission in cats and is less subject to stress hyperglycemia, as the animals are in their own homes. Cats can suffer from glucose toxicity when they are hyperglycemic for extended periods of time and can go into remission when their blood glucose has been maintained within a normal range over a period of time. Not all glucometers are created equally. In humans, glucose is primarily bound to hemoglobin found in red blood cells, and this is what the glucometers are designed to detect. In dogs and cats, the glucose is primarily bound to albumin found in plasma. Human glucometers tend to underreport plasma/serum levels in dogs and cats, with the most significant changes seen with blood glucose readings below 200 mg/dl.7 The only glucometers calibrated specifically for dogs and cats are the Alpha Trac and Alpha Trak3, manufactured by Zoetis.8 Continuous glucose monitors (CGM). A continuous glucose monitor looks at the interstitial glucose levels, rather than the plasma levels, and may not produce the same numbers when compared to capillary samples used for glucometers or blood samples used with chemistry analyzers.7 CGMs can provide up to 14 days of readings, produced every 15 minutes, 24 hours a day, far exceeding what we can accomplish with blood glucose curves. The sensors are usually placed over the dorsal or lateral cervical to scapular region to help prevent premature removal by the animal. Tissue glue is often used to help secure the monitor. CGMs have a limited working range and cannot be calibrated when the blood glucose exceeds 400 mg/dl or is below 40 mg/dl.7 Urine glucose sticks. Semi-quantification of urine glucose is an indirect way to assess blood glucose levels. When negative, we know the blood glucose has not reached the renal threshold for that species, and when positive, we get a color change associated with how much glucose is spilling over into the urine. This is based on how frequently the animal is urinating. Even a well-controlled dog or cat may experience several hours of blood glucose in the normal range but can still be hyperglycemic over a substantial period. A prolonged period of no glycosuria could be suggestive of an insulin overdose. Collection of the urine can also be challenging, as few dogs will urinate on command, and fewer cats will cooperatively provide urine when needed.7 A cat with a working and non-working CGM in place over the scapular region, where the surface is flatter and the monitor will stay in place more easily. Photo courtesy Ann Wortinger The author’s diabetic cat, Ginger, is engaging in her favorite pastime, snuggling with her human. Photo courtesy Ann Wortinger Empowering our veterinary technicians to educate and train clients is a team-based approach to DM management. This allows our clients to feel capable and confident in managing the at-home care for their pet. Technicians can provide one-on-one training on sample collection, monitoring, and diet. Client communication helps everyone by providing the best care and support while engaging the veterinary technician in patient care.8 By setting realistic goals and timelines and using client-friendly tools, we can provide the best patient and client experience during their DM journey. Ann Wortinger, BIS, LVT, VTS (ECC)-R (SAIM) (Nutrition), Elite FFCP (Veterinary, Shelter), FVTE, has worked in general, emergency, specialty practice, education, and management. Wortinger is active in her state, national, and specialty organizations and has served on the Internal Medicine and Nutrition organizing committees. She is currently at the Appalachian State University’s Veterinary Technology Program as a content developer and faculty member and is an active speaker and writer. References Defarges A, Goldstein M. Section 5 Pancreas, Chap 2 Endocrinology in. Small Animal Internal Medicine for Veterinary Technicians and Nurses. Linda Merrill ed. Wiley-Blackwell, Ames, IA, 2012. pp 31-41 Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats. https://www.aaha.org/wp-content/uploads/globalassets/02-guidelines/diabetes/2018-aaha-diabetes-management-guidelines-2022-update.pdf accessed 8/31/25 Wortinger A, Burns KM. Endocrinology in. Nutrition and Disease Management for Veterinary Technicians and Nurses, 3rd ed. Wiley-Blackwell, Ames, IA 2024. pp 307-310 WSAVA Global Nutrition Guidelines. https://wsava.org/global-guidelines/global-nutrition-guidelines. Accessed 8/31/25 AVMA Diabetes in pets. https://www.avma.org/resources-tools/pet-owners/petcare/diabetes-pets. Accessed 8/31/25 Glycated Protein Levels. Merck Animal Health. https://www.merck-animal-health-usa.com/vetsulin/dogs/glycated-protein-levels-in-canines. Accessed 8/31/25. Cook AK. Monitoring Methods for Dogs and Cats with Diabetes Mellitus in. Journal of Diabetes Science and Technology, Vol 6, Issue 3, May 2012. https://pmc.ncbi.nlm.nih.gov/articles/PMC3440050 accessed 8/31/25 Diabetes Education Toolkit. AAFP https://catvets.com/wp-content/uploads/2024/01/AAFP-DiabetesToolkit-Full.pdf accessed 8/31/25
