Diabetes compliance issues.

Re: Diabetes compliance issues.

Hannah Wynne Richards — Sat, 17 May 2014 10:23:16 GMT

PS to above - if they don't come in,don't get insulin, and the dog has a keto-acidotic crisis; don't feel guilty - it's the owner's fault not yours. Your legal and moral duty is to treat the animal. The owners legal and moral duty is to obey veterinary orders, and to pay for the treatment. Two seperate and clearly defined duties.

Wynne

Re: Diabetes compliance issues.

Hannah Wynne Richards — Sat, 17 May 2014 10:19:58 GMT

Insist on seeing. Absolute worst case scenario - the dog has died, and the owner uses the insulin to bumpoff mother-in-law. Where will that leave you legally if you haven't seen it for over a year.

I know they could bump off mother - in law the day after you saw the dog, but at least you'd be seen to be behaving responsibly

Wynne

Re: Diabetes compliance issues.

ChrisBVSc — Sat, 17 May 2014 09:22:43 GMT

As with lots of the above we also have a 6 month rule (as with all meds), and fructosamine/glucose curves are done as necessary based on clinical signs and willingness of the owner. I'm also quite happy not to do any tests if it's a long term stable case, I'll usually offer at least a fructosamine as "good practice" and note this down, but I certainly won't push it if the owner declines & the dog is fine.

Re: Diabetes compliance issues.

Braden Collins — Sat, 17 May 2014 00:34:21 GMT

We have a 6 month revisit rule. If they can't make it at 6 months we will occasionally do 1 more bottle for them, but that is it. We always tell people right at the start what level of commitment is needed and send them home to think about it for 24 hours if they are at all uncertain. It seems to hammer things home that it is really important to do the follow-ups and we find we have excellent compliance.

One of our vets is diabetic, so he's a great reference point for this condition and is great with diabetic pets.

Re: Diabetes compliance issues.

Martin Atkinson — Thu, 15 May 2014 18:26:14 GMT

We have a client like this with 2 diabetic min schnauzers. She is diabetic herself and grossly obese so there is little hope really! I feel it is half on cost grounds and half lack of commitment. I do manage to get her to do a home glucose curve about every 12 months. My rule is normally 3 months or you don't get any more meds but at she is at least touching base when she comes for supplies and I feel it is better they are getting insulin rather than not. The cynic in me says it will cost her a lot more if they have to be hospitalised because they go DKA or overswing.

Re: Diabetes compliance issues.

Andrew Kent — Thu, 15 May 2014 17:11:52 GMT

My experience with cases like this is that they usually feel that if they bring the dog they will get a big bill. As others have said I am quite happy not to do extra testing if the clinical signs are well controlled as in dogs that is sufficient. So if you let them know its just a quick check over and they don't have to do lots of testing then I would be happy with that. But, if they don't present the dog at least every 6 months then I would refuse to supply any more insulin - as long as they have been warned in advance then that is on them.

Andy

Re: Diabetes compliance issues.

Emma Middleton — Thu, 15 May 2014 16:34:01 GMT

Unless you have specific concerns that a case is very poorly controlled, then a physical examination and chat with the owner will probably tell you all you need to know. Spot glucose, urine samples etc will not give you any idea of overall control and are of little value if used in this way. Even fructosamine has limitations and I remember being taught to always treat the patient, not the numbers!

[quote user="GrooveJet"]I now haven't seen the patient in nearly 5 months and have no idea what the real state of affairs is.[/quote]

If it's impossible to get them in, then a chat on the phone would be good - appetite, thirst, urination, weight etc. Any alarm bells then this would give you cause to tell them you need to check the dog over and possibly do a curve/alter the dose/check diet and exercise regime etc. If they realise it's just the cost and time of a consultation then maybe they will comply? But then again...

Re: Diabetes compliance issues.

Sammy82 — Thu, 15 May 2014 16:08:56 GMT

Maybe you could get them to at least bring in a urine sample. And try to find out why they don't want to bring the dog. Cost? Stress for the dog? Lack of transport? Maybe they are happy to do some more monitoring at home like measuring water intake, urine dip sticks or even blood glucose monitoring from ear/paw prick.

Re: Diabetes compliance issues.

Michael Woodhouse — Thu, 15 May 2014 14:10:46 GMT

We would not allow them the insulin after 6 months. I'm not one for doing bloods too often if everything stable - so long as animal well, steady weight and no changes in drinking/urination I'm happy with a check over.

There are some dogs that need regular bloods, curves done at the surgery etc. A month may be too long.

We don't have a 'fructosamine every 3 months rule' or anything so draconian. Our minimum is laying on of hands every 6 months and then tailored to the individual dog.

Re: Diabetes compliance issues.

Bob Russell — Thu, 15 May 2014 13:54:17 GMT

We have had several owners like this. The dogs have been seen far too rarely, nowhere near as well controlled as I would like and one was so fat it was considered high risk to spay so the owner did not go for that either.

I saw the dogs as often as I could to keep me on the right side of the rules and made lots of notes confirming my efforts to encourage better monitoring.

Some people are just satisfied with controlling thirst and puddles on the floor and are not worried about the dog being blind! I assess welfare as best I can and let them get on with it!

No supplies if not seen for six months IMO but are no longer active clients if not seen for a year!