[00:00:02] Introduction: Welcome to All Cats Considered, a podcast from the Feline Veterinary Medical Association.
Here we interview professionals from across the veterinary world and take deep dives into the latest evidence based research developments, studies and guidelines that improve feline health and well being.
We are the home for veterinary professionals seeking to enhance the care of cats through high standards of practice, continuing education and evidence based medicine. In each episode you'll hear interviews with a variety of experts in our field, covering a wide range of topics and the latest developments in feline health. We'll share the key points you need to know to improve your patients care.
Let's dive in and listen to this week's experts.
[00:00:44] Gómez‑Mejías: Thank you so much for joining us today. I don't know what to say because you're always so helpful. I've run out of words, to thank you for all you do for us and for icatcare.
So based on the feedback we receive in icatcare and the number of views on the SAGE website, we know that practitioners highly value the icatcare veterinary guidelines. And ensuring these publications are comprehensive enough and address all the practical aspects must be really challenging. So how do you start? How do you guide the writing process?
[00:01:14] Dr. Taylor: Well, thank you. It's a very good question and thank you for having me. As you know, I am very proud of the guidelines. I absolutely don't take credit. It's the clever authors that we put together, not me.
But I appreciate your comments and I really value that practitioners use them and like them.
The aim of our guidelines, if people don't know, the aim of our guidelines is exactly that, with the practitioner at the front of our mind. This is not, and I'm really, really clear, this is not a literature review, that's no use to anyone. You can go and read that yourself in your own. What you want to know is what, what should I be doing in the clinic? What's the latest information? What does this group of experts advise me to do in this situation? And that's what we try to do. So the sort of process is first of all coming up with that plan. What do we aim to do? What do we want to tell people?
And then we think about who do we want to be involved in this.
And as you know, we're quite careful. We select our authors who are obviously absolute experts in their field, but also just have an understanding of what practitioners need, what they need to know. And hopefully they love cats as well, the people that we invite. So we try and invite people who obviously they are experts but also they, they really share our vision of trying to provide practical information to practitioners in a readable format and also thinking about caregivers as well. So producing a sort of companion. We always produce a kind of companion guide to go with the guidelines. And actually for this one, our authors have been really involved in that because several of our, well, all of our authors, but several in very passionate about how we communicate with caregivers about diabetes. So that was great pleasure to include that information.
So the process starts with an idea, expands to finding our fabulous authors, and then we start to refine what do we want to include? That's always too much and ends up being kind of over ambitious. But we then discuss who would like to write each section. So we try and obviously people have their own preferences or their own research areas, and then we bring those individual sort of submissions together into what ends up being a very long document and slowly we chip away at it and whittle it down into something that we hope is readable and usable.
So it's very much an interactive process. And I have no doubt that by the end the authors are absolutely sick of seeing emails from me because there's lots of toing and froing to make sure that everyone agrees, everyone's happy with the advice.
Cause there are areas that have no strict answer. You know, there are areas where people do different things and I think it's really important that we confront that. So sometimes we will say in the guidelines, you know, not all authors do this, some authors do this and these are the reasons why. So we hope then practitioners can read that and make their own decision.
So it's a bit of a process with lots of review and help from JFMS team as well, to make it, you know, they turn a big scruffy word document into this super smart, kind of readable. I don't know how, how they do it. And they put up with us changing things at the last minute and adding references and there's lots of molding to get to that end point. But I really enjoy that and I get to work with these super clever people. So that's a pleasure for me as well.
Gómez‑Mejías: Oh, there's a lot of collaboration involved.
Dr. Taylor: Yes, definitely. But I think that's really important because I don't think people want to read what I think or necessarily what, you know, what one author think, what they want to see, that. I hope that it has been really well discussed and thought about amongst a group and we often just try and add people from all around the world. So this should not be a UK or a US Guideline, we try and have an author from different areas because there's hugely different perspectives. That can be a challenge. What's done in Australia might not be what you and me do in the UK, so we try and choose authors from different parts of the world to really bring.
[00:05:19] Gómez‑Mejías: The availability of drugs is different as well.
[00:05:22] Dr. Taylor: and just different approaches sometimes, which we can really all learn from. So, yeah, we try and make it very, very international as well.
[00:05:29] Gómez‑Mejías: Well, thank you for everything you do. The last consensus of Management of Feline Diabetes was published in 2015. Which new aspects of feline diabetes do these new guidelines cover?
[00:05:41] Dr. Taylor: Yeah, and actually if you look at the sort of downloads for that, previous diabetes guidelines, lots of people have read them, which is fantastic. But. But over 10 years. Diabetes is an area of feline medicine that has had a lot of research, a lot of publications. We often talk about research for cats lagging behind dogs, but actually in diabetes, there's been so many developments in specifically about cats, which is really cool. So the main one is the use or the availability of the SGLT2 inhibitors, which is, if any listener's not familiar read our guidelines, but this is the oral treatment for feline diabetes and that was a big development that obviously hadn't been covered in the previous guidelines. And the other thing is the use of continuous glucose monitoring. So the freestyle libras, brilliant development, but of course weren't really around at the time, 10 years ago when that guideline was written. So I think we tried to bring in all of those new aspects and we have included a section on DKA which wasn't in the previous guidelines. And that was something I thought quite carefully about because I know it makes them longer guidelines, but I know that I struggle with DKA in practice. I get anxious when one's coming down. I know they're difficult cases, so I wanted to add that in too. And I think we tried to focus on - now we've got choices, which is super cool, we've got insulin and we've got oral treatment. Brilliant. But then we've got to decide which one to use. So we wanted to be helpful to people in how they made those decisions.
[00:07:12] Gómez‑Mejías: So, yeah, the more therapies available, the more difficult is the clinical decision making and more complex it all becomes. Yeah. So Talking about these SGLT2 inhibitors varying on diabetic ketoacidosis as well, which you also mentioned, bearing in mind the possibility of diabetic ketoacidosis in a small percentage of cats treated with this drug, what should we monitor during the initial treatment period?
[00:07:40] Dr. Taylor: I think it was a really good question. It's actually something that in writing the guidelines, I really learned from some of the authors on was the real emphasis on the patient in front of you and the clinical signs.
So as many people know, this is a serious adverse effect potentially of these drugs. And so each, depending where you are in the world, there will be manufacturer guidelines of monitoring ketones, in particular, in that first two weeks. And we can monitor them in the blood or in the urine.
But what really came from our communication and writing these guidelines was how important it was to look at the cat clinically.
And I found that really interesting. Cause I think myself I'd been obsessed with sort of measuring the ketones, which is appropriate, don't get me wrong. But what we really learned and talked about was how important it was to look at whether these cats are eating, whether they're bright, how they are in themselves, because that's such an important reflection of what's going on, you know, internally. So that combination of them having clinical signs, i.e. refusing food, you know, seeming lethargic is so important to put with that ketone result.
So I think I really learned that from. From writing these and from my co-authors who just emphasized how important it is to look at the. Look at the cat again, how important it is to communicate that to the caregiver as well.
You know, that we want to know how this cat is. We want to know how their appetite is, their demeanor, and that's the gold bit of information that we want.
Of course, we're going to be doing our ketone monitoring process, but it's how that cat is. Is key.
So I think that. Yeah, that's really important.
[00:09:19] Gómez‑Mejías: Yeah. This month in November, another episode of this podcast will be released about the importance of comprehensive care and I will talk about the importance of assessing certain parameters related to behavior really quickly in every consultation. But it's so important to that integral aspect of health. And yeah, also in this case, as I say, and since 2015, we have also learned new things about comorbidities. So the guidelines recommend that screening for hypersomatotropism should now be discussed with caregivers of all diabetic cats, rather than reserving it for those showing a poor response to insulin. What is the rationale behind this shift in recommendation, especially when SGLT2 inhibitors are an option?
[00:10:12] Dr. Taylor: Yeah, I think that's a really great question as well. We know that cats with - I can't say either very well. Yeah, hypersomatotropism are perhaps more prevalent than we previously thought. And as you say, historically, you'd only test for that if you're escalating doses of insulin, not getting a response.
But we know that it is there in the background and it could be affecting quite a few of our diabetic cats.
And so it sort of makes sense to know that early on in your process of treatment.
And then the other problem, of course, with using SGLT2 inhibitors is that you use a set dose, we don't adjust the dose. And so we wouldn't know in the same way as we would know with using insulin. And what that might mean is that we've got a cat with that condition undiagnosed and that condition is sort of progressing in the background. And we know that that condition can, in the long term, of course, cause organ failure and all sorts of things, as well as the diabetes. So I think the thinking is actually, hold on. If this is affecting a good proportion of our diabetics, does it make sense to be a bit more proactive in looking for it? That doesn't mean that practitioners have to do it in every case. Of course, it's going to depend on the individual and finances and all sorts of other questions. Absolutely. But it's to put in our minds a little it that we're going to miss this potentially. And if we do have a client who, for example, might want to go for further treatment of that condition, then we might want to detect that a little bit earlier. So it's not sort of prescriptively saying, you know, every diabetic cat, we should be doing that. Although, you know, some people might think that's a good idea. I think we've got to base it on the individual cat and their owner, of course. So it's bringing it forward, basically. Bringing it a little bit into our minds a bit earlier, perhaps, than we would have done previously, because we do see people going for further treatment of that condition.
[00:12:09] Gómez‑Mejías: Yeah, definitely. And we have to give the option. I agree that it's convenient to give the option in those cases where people are keen. Thank you for clarifying that. I think that would be very useful. And another popular topic is diabetic remission. Have the main recommendations about remission changed since the last guidelines were published?
[00:12:34] Dr. Taylor: Yeah, I think probably not massively changed. What I suppose I'd like to emphasize is the importance of things like early diagnosis. We certainly know that if we diagnose diabetic cats earlier, they're more likely to go into remission. That's definitely something that's been shown in those studies. So to me it really lends itself to screening or communication again of, you know, if you have a middle-aged cat, then it is drinking more, then we want to see that cat. So getting that diagnosis earlier is of great benefit. We talk about things like withdrawing drugs that could be contributing to the diabetes. So I think that if we, I'm an internal medicine person, I use a lot of steroids, you know, totally do we prescribe a lot of steroids. But I try and be a bit mindful that we know that use of high, particularly high dose steroids for a long period could contribute to the development of diabetes. So I've become, I think myself as well a bit more mindful of, of perhaps recommending in an at risk cat, say it's a middle-aged cat that's a bit chubby or it's Burmese, you know, you're going to be using high dose steroids. Well, should we be checking the urine for glucose? You know, just being a little bit more mindful of the potential effects in that way because we know that if we can withdraw them, we can encourage remission greatly. Those cats are more likely to go into remission.
And then I think mentioned in the previous guidelines, but would emphasize again is things like a diet that's low in carbohydrate which can really help diabetic cats in regards remission as well as general diabetic control.
But again, that's very individual and I would hate owners to feel pressured to buy a very expensive diabetic diet. And in the guidelines we talk about, we can reduce carbs in other ways as well by particularly feeding a wet diet. It doesn't have to be a diabetic diet if that's not within the owner's reach or the cat doesn't eat it. Importantly, it's important that the cat eats it so you can achieve remission in cats that eat high carbohydrate diets. You know, there are lots of factors involved but diet can be important in helping, helping us achieve that.
[00:14:45] Gómez‑Mejías: Okay, so early diagnosis bearing in mind diabetogenic drugs and breed predisposition and then finally the diet, if possible.
[00:15:01] Dr. Taylor: Yeah, I just think sometimes we, we can be very prescriptive with diet and you know, we might know what's ideal, but that doesn't mean the cat knows that.
And I had a very memorable case once where these lovely, lovely owners, so, so dedicated owners and they, they fed the diabetic diet. The cat hated it, the cat got thinner, wasn't Doing very well, you know, and they were so committed to the diet.
So I think it's just really important that we flex to that situation rather than just what's perfect and tell owners that they're. I want to know if the cat's not eating it. That's really important that we know that.
[00:15:36] Gómez‑Mejías: Definitely. And some of these cats come. Yeah, some of these cats arrive being really thin as well, with this low body condition score. So, yeah, yeah.
[00:15:45] Dr. Taylor: So they, if they leave thinking, oh, this cat must absolutely only eat this diet and the cat doesn't eat that diet, that's going down disaster road, isn't it?
[00:15:54] Gómez‑Mejías: Yeah.
[00:15:54] Dr. Taylor: So, yeah, I think we learned that from the guidelines. I have to say, I really learned that from my co authors, was about that flexibility and individualness. That's not the right word. Individualization of the care in that there's something that might work for some client, it won't work for the other client.
And I really think diabetes is a perfect example of that because there are some people who can give injections twice a day, do home glucose curves, you know, fabulous. But what about that person that works nights and unpredictable shifts or, you know, is cost constrained? Things like you can't say one size fits all for these. And it's so important, I think, to be. To listen to what their concerns are and then be flexible.
[00:16:38] Gómez‑Mejías: Definitely, definitely. And another thing that has become much more popular, or so I perceive it in my environment, is the freestyle labor sensor. But they keep falling off the cat. So are there any tips you would like to share to increase their lifespan, especially when trying to achieve stabilization or remission?
[00:16:59] Dr. Taylor: Yeah, I mean, they're not perfect. They're designed for humans, they're not designed for cats. I still hope and hear in the background that someone might design one sort of made for cats, but they're made for humans. And so that's why they're not perfect. They often fall off because of hair regrowth, actually, you know. Obviously, we shave the cat and then the hair regrows and that dislodges them. So we can't do much about that, can we? And they certainly fall off for me sometimes too. So I think one thing is to say to people, if they fall off, you're not probably doing anything wrong. Like they're not perfect. You know, in some situations they do fall off. And I'll never forget the second one I ever put on.
I put it on and I let go sort of straight away. And the cat shook, did a massive shake and it flew into the air, this libra device and hit the ground. And I've never forgotten that. So it does happen. But there are a few tips that I would, would give people. One of them is clipping. You know, obviously clipping. We're going to do that cleaning and drying really well because I think if the coat is greasy, you know, the skin is greasy at all, then they don't stick very well. If it's still wet, they don't stick very well. It needs to be really, really dry. Sometimes we're impatient, but actually we've got to wait for it to properly dry or that glue won't stick. I then do put a little dot around the edge of tissue glue.
So I do a few little dots at the edges because if you'll notice when they fall off, it's often because they're peeling up at the edge. And so don't go mad, though, if you put a lot of glue on, they can be really sore or they don't fall off for ages. And owners don't particularly like that either. I've got one cat and it ended up with two on because one of them just wouldn't come off. It was the opposite. It wouldn't fall off.
[00:18:42] Gómez‑Mejías: Oh, my God.
[00:18:43] Dr. Taylor: I know. So then it looked ridiculous that these two Libras are so a little bit of glue, I will dot just in little dots almost around the edge.
And then when you put it on, don't do what I did and pull straight away. You know, make sure that you do sort of hold it on for a second.
And then you might need to almost tease it out of the applicator because if you pull the applicator straight off and the sticky hasn't set, you'll pull it off straight away. So I usually have a pair of forceps or tweezers or something that I can just almost peel it out. Just make sure it's going to come out of the applicator properly. And then I will use those forceps just to stick it, stick it down so it's really nicely stuck down at the edges. But a tip I learned from a colleague recently, which I confess I've only tried on one cat, you can buy these little skin wipes that are designed for humans with stoma devices that are essentially, they look like wet wipes, but they're sticky.
So you've shaved it, you've cleaned it, you've dried it. You then use one of these wipes to just sort of outline where you're going to put the device and it quickly becomes slightly tacky and you then put the, put the device there. And I've no evidence that that helps, but I hear from colleagues that that's helpful. And they're very cheap. They're a cheap sort of way of adding a bit of extra stick, basically, to keep them in position.
Yeah, it's a bit of a process. And some of them will still fall off. And don't feel bad, that just happens. Cats, they're not always, you know, tolerant of these things.
[00:20:18] Gómez‑Mejías: Thank you. But those are really, really useful tips. Thank you for that. Thank you. And talking about getting back to the, to the treatments. Another, another thing that we've been talking about for a while is Glargine. So in what clinical scenario would the advantages of Glargine U300 clearly outweigh to the use of standards intermediate acting insulins?
[00:20:41] Dr Taylor: Yeah, I think it's really interesting, isn't it? So the Glargine U300, if people are not aware of, is essentially a much more. We're not talking about ordinary glargine, we're talking about glargine that's much more concentrated. And what that means is that each, each drop has a sort of bigger surface, a smaller, sorry, smaller surface area. So it's essentially absorbed much more slowly. And I couldn't get my head around that. What do you mean? It's more concentrated, but it's absorbed more slowly. But it's to do with it being a sort of smaller depot drop with a smaller surface area, so it's essentially slowly released. Which sounds awesome, doesn't it? Because that's what we're trying to mimic is that background kind of insulin.
And they talk about it being a curveless insulin in that it doesn't go up and down like we might see with some of our intermediate acting, it will actually give a very smooth curve. This is the idea. So minimizing clinical signs. And in the UK we're quite early, I think, using this, and I haven't used it myself in cats, but in Australia they have a lot of experience and I think in the US and other parts of the world, and actually one of our fabulous authors, Linda Fleeman, who's a real genius of diabetes, she is using it very, very frequently in cases and finds it to be extremely useful. So I confess to not having my own clinical experience, but I think everyone look out for this, there'll be more publications because it meets some of the criteria that we want, which is this long-acting kind of background insulin. And so I'm encouraged to try it, depending on the case.
Keep an eye out for more publications and more information. And we talk about it in the guidelines being this, you know, potentially one of the few that would have that length of action in our feline patients.
[00:22:32] Gómez‑Mejías: And hopefully if next year we delve a little bit deeper into diabetes and maybe we can interview Linda Fleeman.
[00:22:39] Dr Taylor: Oh, I'm absolutely sure she would love to talk about it. Yeah. And it's difficult, isn't it? Sometimes I think when you have a new drug, there's a level of com. You sort of have to be brave, don't you, to try to try it? You know, it's.
[00:22:54] Gómez‑Mejías: Yeah. And sometimes I guess if I can extrapolate, like refer to experiences in other aspects of the veterinary medicine, sometimes it's safer to stick to something, you know. Well, rather than experimenting with in and experiencing a lot of uncertainty and making the owner feel a lot of uncertainty around. Around it. So you've got you've got to choose the case to experiment with the new treatment.
[00:23:23] Dr. Taylor: Absolutely. But I think we'll see more experience with that particular drug all around the world and then we learn more and become more confident, don't we, to try these things. Yeah.
[00:23:33] Gómez‑Mejías: And you've mentioned communication a couple of times. Effectively, the guidelines include a lot of tools which are found very, very interesting as well and helpful. And communication is always important in any case. Diabetic or whether regardless of diabetes or the presence of diabetes or any other thing. But as a general rule in diabetes, are there any specific moments in the disease process where we need to be more proactive in the aspect. In this aspect?
[00:24:05] Dr. Taylor: Yeah, I think it's, it's. It's a really interesting area people have. It's a bit like when you talk about cancers and things, you know, owners often come with a lot of preconceptions and a lot of ideas about it. And when you start talking about injections, different people are going to have a really different reaction to that as well. So I think that initial discussion is quite important because I think owners need to understand that these cats can live a really good life.
And actually the prognosis is pretty good for these patients. But we know that a reasonable portion of them are euthanized at diagnosis or relatively soon after diagnosis. And some of that might be to do with owners not understanding what can be done. And again, coming back to that flexibility, because I think, well, I can't do injections twice a day, so that's the end of it. You know, we've got to talk about flexibility. Are they suitable for SGLT2s? Are they even suitable for once a day treatments? Not ideal. But again we talk about this flexibility of approach and so I think understanding what some of those preconceptions are and what people's limits are, they're going to be people who want to have brilliant control and they're going to check the cat's ear blood glucose several times a day and they're really interested in the libra and then they're going to be other people that doesn't suit and that's fine.
Both of those cats in those situations can have a good quality of life, can't they? But if we try and press one of those protocols on the wrong person, it's not quite going to work. So I think that at diagnosis, I guess is what I'm trying to say in a long-winded fashion. Yeah, it's a big news, isn't it? Your cat's got diabetes.
And for some people that's going to be a really devastating and super worrying news. They're worried about finances, they're worried about how do I ever go on holiday anymore, you know, with this cat if I'm injecting it twice a day. What if, what if there's a, a school trip and everyone's away or you know, these kind of questions they're all going to, they're going to come up with. And so I think communication there is, is really important. I think communication in that initial treatment A bit coming back to what we said about the SGLT2s, talking about what people, when they should worry and when they don't need to worry and being clear about that, you know, I want to know if your cat doesn't eat its breakfast, I want to know about that in that initial treatment period. So being quite clear in what they're looking for sort of early on and checking in I guess as well, I can't imagine. I don't know about you, but we travel a bit and we do different things, don't we?
Thinking I had to inject my cat at 8am and 8pm every day. I just couldn't do it. I don't know how I would do it if my cat was diabetic. And so I think checking in, how people are doing is really important. I had a lovely client recently, their cat was a recent diabetic and absolutely lovely people and we showed them how to do the injections. But I know that when we spoke to them a couple of days later, they'd had various sort of hiccups and challenges and they were worried about a bubble in the syringe, you know, lots of different things. And so checking in with people, how they're getting on, I think is quite important as well. And then I think, you know, as you go along the treatment process and you move further on, being really clear about monitoring when you want to see them again, just making sure that's quite sort of set, you know, set so they know what to expect. And I suppose the other thing is cost, isn't it?
You can't get away from the fact that actually treating a diabetic cat can be really expensive. But there are ways that we can again flex that so people can cope with that. But we've got to be clear with it, haven't we, as to what their costs might be, looking, you know, looking ahead and then work with what they can do. So, yeah, I suppose those are a few kind of areas that I think are important. I don't know if you agree.
[00:27:58] Gómez‑Mejías: Yeah, I definitely agree. And then I think of the late stages where, especially when there are comorbidities to discuss, yeah, you have to discuss quality of life and it may not just be diabetes. And then things start getting complicated. So it is one of those things that needs monitoring and needs like a close follow up during the whole process. And that clarity in between the initial stage and the end stage where you feel that it's more obvious, the need of communication is more obvious.
And that clarity you mentioned, I think is super important because sometimes we lose track of when was the next time we had to monitor or, you know, is it really clear that we have to sample, to do blood samples or to do, you know, whatever you've discussed with the client. So that clarity and that, that schedule of the next appointment, the next review, and the other thing I thought of while you were talking is the feeling of guilt.
Because some people, the initial reaction, when the emotional reaction, the initial caregiver's emotional response is guilt, they feel guilt about whatever they may have done for the cat to be ill for some reason, even though they haven't done anything wrong.
But they ask you, what could I have done? Could I have prevented it? And then I find important to make them feel, not reassure them and make sure that they don't feel that they are responsible for the cat's disease as well.
[00:29:32] Dr. Taylor: And there's a lot of emotion behind a diagnosis of diabetes. I think it's quite sort of surprising. Different people have different worries. I've got one lovely client, but absolutely. I know suffers a lot of anxiety thinking about hypo episodes that causes her a huge amount of anxiety. And so for her, we try and avoid that as much as possible. So maybe we're not going to do quite such fine control that could risk that because that would make her super anxious. And then I've got another client who said to me, it might surprise you. She please don't put another libra on.
And I said, oh, why did the cat not like it? It made me so anxious checking it constantly checking it. She was getting up in the night checking it.
Gómez‑Mejías: Absolutely.
Dr. Taylor: Well, yeah. So it was interesting because my thought of me doing a good thing like helping, putting on the libra actually caused them lots of anxiety. And in the end we compromised on looking at the cat, the weight and the water intake and how the cat was eating and actually a weight lifted off them. I think of not having to be obsessed with looking at what their blood sugar was.
So it's. Yeah, people are really different in there.
[00:30:40] Gómez‑Mejías: Very different. And cats are different as well. Yeah. I saw a client not long ago and I was working in a new practice and the owner looked at me with an expression of horror on the face. And it was just brought the cat for monitoring. I can't remember what. And she said, please just don't take bloods. I don't want a blood test on. And I was like, okay, okay, fine, fine. I want. I won't take bloods. But what happened? The cat, like, apparently the cat was super traumatized for three days afterwards and she. The cat was even aggressive towards the owner when it had never showed aggression before.
So the owner understood that it was a consequence of having. Taking the cat to practice and having had the blood sample taken. And then in that moment I felt, well, I can't take bloods now. I may discuss it at a later stage, but definitely not now because she's really anxious about it. And I believe from the way she told the story, like the cat was really traumatized. So, yeah, it had never happened to me, like listening to such a story in many years of practice. But apparently that cat in particular took it really wrong. So, yeah, it's super important to listen, isn't it?
So just to wrap up the interview, which has been very enjoyable as usual, what were the major challenges that you had to face whilst preparing these guidelines?
[00:32:07] Dr. Taylor: I think first one was what we include, you know, what we included and not making it a book because there is a lot of research and there's a lot of stuff that we could have put in, you know, but it would just be too long and then not, not usable for people. You know, we wanted people to find the information in it. I don't expect people to leave, read it start to finish, but I'm hoping they can take bits out of it. So the first challenge was how do we make this readable? And the authors sort of, they'll often ask me for word counts and I find that really difficult to give people word counts because I don't quite know how much we're going to want to include in each section. So that was the first challenge, was keeping this short enough that it's readable.
So that was sort of number one. And then, yeah, some challenges with different parts of the world and different sort of approaches. Some people feel that remission is the sort of ultimate goal of treating diabetes, which is quite reasonable, I get that.
But for some clients, that's like my client that's terrified of the hypoglycemia, you know, that wouldn't be her goal. The goal would be perhaps controlling clinical signs or in very cost, limited clients that are not going to be able to do tons of bloods, remission might not be, not be your ultimate target.
So that was interesting. A little bit of, kind of difference of what, when you are faced with a diabetic cat, is your goal remission or is your goal control of clinical signs? So that was, I found, really an interesting discussion. And yeah, so internationally that attitude. But also, yeah, as we said in Australia, they use a lot of the Glargine. You know, you're starting to use that more than we are in the UK. So there's a little bit of different kind of experiences around the world. And then often when you do these guidelines, there'll be a clinical question that you want to answer so you can give advice, but actually there is no clear answer, there's no research. And some people do it this way and some people do it this way. And so our challenge is presenting that to practitioners. So it's helpful because it's not helpful. If they just read me writing, we don't know how you should manage pain, that's not very helpful. So it's trying to provide that information with as much evidence based as possible. But also acknowledging, you know, we don't quite know that we need a bit more research, but for now this might be helpful to you. And that can be difficult as well because, yeah, we don't have all the, don't have all the answers, do we?
[00:34:26] Gómez‑Mejías: Well, thank you so much for going through the trouble of organizing them. And thank you so much for joining us today and giving us so many such a thorough overview of the guidelines. Hopefully this will encourage people to read the whole thing. And also join us in the first few months of next year where we will be going a little bit deeper into diabetes.
[00:34:54] Dr. Taylor: Yeah. And I think hopefully hearing from some of our authors because they are just the absolute brains of diabetes. And I know we're going to invite them to do a bit more, aren't we? And that's going to be fabulous to listen to them.
[00:35:04] Conclusion: Thank you for listening to this episode of All Cats Considered. We hope you enjoyed this interview.
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