Boarding diabetic animals

Boarding your diabetic animal requires a few extra provisions. Though you always want to board your animals with trustworthy people in trustworthy facilities, it is of special importance when you have an animal that needs daily medical monitoring. The insulin needs of diabetics can change based on exercise habits, stress, diet, food amounts or times fed, and so forth, and all of these things can change while boarding.

We have developed this guide for diabetic pet owners to help them assess their options when they must leave their pets. These options are presented in order of preference. 24-hour monitoring--either with a homesitter, or in a 24-hour veterinary hospital--is the best choice for all diabetic pets. However, as we discuss further below, home visits by a knowledgeable veterinary technician or skilled sitter are a third option for well-regulated, controlled pets on stable regimens.

We do not recommend boarding any diabetic pet at a non-24 hour veterinary facility--even if you consider your animal to be well-controlled. It is our strong belief--based on professional knowledge and personal experience--that this is not a safe option. Boarding subjects the animal to stress-related changes. When these changes occur in a 24-hour facility, the pet can be monitored to ensure that hypoglycemia or other diabetic crises, such as diabetic ketoacidosis (DKA), do not result. However, when the animal is boarding at facility that does not provide 24-hour coverage, staff are not always present to monitor the effects of those changes. Given the risk of hypoglycemia and other diabetic complications, this is very dangerous. Remember that recovery in cases of severe hypoglycemia is determined primarily by how soon the hypoglycemia is treated--and in a non-24 hour hospital, there is a very real chance that it will remain untreated, leading to permanent damage. In addition, it will be difficult if not impossible for the owner to effectively "check up" and monitor care when staff are not present 24 hours a day.

The "Rules" for Caregivers

Regardless of which of the following three options you arrange, the following rules apply for care given in your absence:

1. A blood glucose reading must be taken before every shot. There are no exceptions to this rule, ever. (See also item 7 for a description of how the care provider should use this reading to determine insulin dosing.) A urinary ketone reading should be taken whenever possible.
2. Provide a chart, set up to be filled in with AM and PM pre-shot values, the amount of insulin given afterward, and the results of urine testing for ketones.
3. Provide insulin, insulin syringes, your glucometer and test strips, and urine testing stix.
4. Unpack one insulin syringe and mark it clearly at the “fill” line. This is extra insurance that the person administering insulin will use your syringes and (hopefully) not over-fill. You may want to break the needle off of the syringe so no one goes ahead and uses it, as this should be the "reference" syringe. Tape it to the box of syringes or the insulin bottle.
5. Provide a list of “DOs” and “DON’Ts”: do not leave dry food out, do not give treats, and so forth as pertains to your animal. Include in the “DOs” that you must be called if there are changes in behavior, litterbox use, appetite, digestion (such as vomiting or diarrhea).
6. Provide clear instructions on feeding, insulin dosages, and your contact information in case of questions or emergencies.
7. We recommend that you give a blood glucose range (based on your animal’s averages) and have the caregiver call you (or, if you’re unreachable, your veterinarian, spouse, or so forth) if the blood glucose is out of range. For example:

• Fluffers can be given 1.5 units of glargine insulin if her pre-shot blood glucose levels are between 250-350. If you get a higher or lower reading, do NOT give insulin and contact us immediately.

If your animal has any quirks such as AM readings being much lower than PM readings and so forth be sure to mention this and provide instructions for these special cases.

Because an emergency can occur any hour of the day or night, it is best if you have a cell phone with you, leave it on at all times, and give this number to your caregiver. If you do not have a cell phone, try to provide a schedule of where you will be throughout your absence with numbers at each location.

All of the above listed rules apply whether the care you arrange is in-home 24-hour care, in-hospital 24-hour care, or in-home visit care. The sections below provide additional instructions for each of these options.

Skilled Live-In Home Care: The Best Option

The best situation for animals with diabetes is to stay in your home with someone who is comfortable and knowledgeable with both taking blood glucose readings (with your home meter) and giving insulin shots. If at all possible, you should begin trying to arrange this well in advance. This person could be a family member who has taken part in helping you care for your diabetic pet, or a trusted and trustworthy friend who is willing to work with you over a period of weeks to learn to develop the required knowledge and skills. One benefit of having someone in the home 24-hours a day is that in the event of a diabetic crisis--such as hypoglycemia or DKA--someone will be there to recognize the symptoms and take action. Also, by leaving your pet in his or her own environment, you avoid the many stress-related changes and other factors, such as restricted movement/lack of exercise, that can complicate diabetes care in a boarding situation.

If you can secure this kind of live-in, 24-hour petsitting, the petsitter (whether a family member or professional) should comply with all of the procedures listed below under petsitter visits. In addition, of course, he or she should monitor the pet for any symptoms of hypoglycemia, vomiting, polyuria, polydipsia, ketones, or other danger signs, and should know what to do when these are observed. He or she should know to contact you in the event of any questions or concerns, and should be comfortable doing so.

"Medical Boarding" at a 24-Hour Referral Hospital

Animals that have recently been diagnosed, that have had a recent insulin dosage/type change, or that have had an incident of hypoglycemia or DKA within the past 6 months must either have a live-in sitter or boarded at a 24-hr veterinary facility. This means that the hospital is open 24 hrs or they have 24-hr nursing care (a veterinary technician stays all night with the animals).

Before boarding your pet at a 24-hour facility:

1. Ask for the names of the veterinarians who will be in charge of medical boards during your animal's stay. Confirm that the technicians who will be on duty that weekend have substantial experience in caring for diabetic animals. Confirm the hospital's procedures for handling hypoglycemia and DKA. If possible, speak with the veterinarians who will be in charge during your pet's stay to make sure they are aware that your pet is diabetic and will be boarding. Discuss with the hospital staff any of your pet's quirks or issues that affect his or her regulation.
2. If this isn’t your animal’s regular veterinary hospital, send them his or her records ahead of time. If you’re boarding over a holiday, find out which doctor(s) will be on duty and specifically address the records to their attention. If your animal has an extensive medical history, just include relevant information; they don’t need to know that nine years ago Fluffers broke a toenail. Absolutely include all recent lab work, diagnostic radiology reports, and a photocopy of your home blood glucose journal or log. Include a note for a doctor to call you when the records are received. If you are mailing them instead of dropping them off, put a call in a few days later and leave a reminder message for the vet to call you. (Note: If your animal has not had lab work done recently, they may ask permission to run regular blood and urine tests when your animal arrives. This is not a money-making scheme but rather the sign of a practice that wants to be prepared to treat your animal medically should the need arise.)
3. If this isn’t your animal’s regular hospital, stop by and ask to see where the animals are boarded. If you have a dog, ask about their dog-walking schedule.
4. Call for a daily status update. A hospital with 24-hour nursing care (as opposed to an emergency/critical care hospital that is open 24 hrs—these places usually do not board animals) will probably have one or two technicians working overnight. While they usually don’t answer the phone, you can leave a message the night before to have someone call you in the morning. When you speak to staff, ask for the preshot blood glucose readings taken from your pet, so that you can discuss with staff any observed blood glucose changes. If your pets blood glucose readings while boarding deviate substantially from home readings, you may wish to confer with the vet on duty to determine if changes in insulin dosing or feeding need to be made to ensure that your pet's blood glucose values remain in safe range while boarding.
5. Finally, be aware that accidents--including insulin overdoses--can and do happen at veterinary hospitals regardless of the assurances provided to you by the hospital staff. This is why it is very important that you confirm, to the best of your ability, the knowledge and skill of the practitioners who will care for your pet, rather than take it on "faith."

Skilled Care by a Visiting Petsitter

Note: For all diabetic animals 24-hour supervision is the best option. However, while the option of a visiting sitter may be considered by owners with well-regulated animals, it is not recommended for animals that have recently been diagnosed, that have had a recent insulin dosage/type change, or that have had an incident of hypoglycemia or DKA within the past 6 months. These animals must either have a live-in sitter or be boarded at a 24-hr veterinary facility.

If you cannot secure 24-hour care and your animal is a) well-regulated and b) has been on the same dosage of insulin and getting predictable responses (that is, the same range of pre-shot blood glucose readings and comparable peaks) you may consider leaving your pet at home and having a pet sitter come twice daily to test the blood glucose levels, feed, and administer insulin. In this case the pet sitter must:

1. Have solid knowledge of diabetes care, including: insulin dose measurement and administration; symptoms of hypoglycemia; and symptoms of diabetic ketoacidosis. This individual should be able to answer questions about what to do in the event of suspected or confirmed hypoglycemia or ketoacidosis.
2. Be comfortable taking blood glucose reading on your home meter. To confirm this comfort level, during your "interview" or prep session, have the vet technician or sitter demonstrate for you by taking a blood glucose reading from your pet using your home meter.
3. Be comfortable administering insulin. You should confirm the sitter's knowledge and understanding of your pet's proper dose by asking the petsitter to demonstrate withdrawal of the proper dose into a syringe. If possible, and if you can arrange for the pet sitter to meet with you at shot time, you should observe the pet sitter prepare and administer an insulin dose. You may need to pay for this time, but it is well worth the price in peace of mind! (An alternative is to have the petsitter show you their administration of a shot using a sterile saline solution.)
4. When the petsitter visits in your absence, he or she must stay to see that your pet is eating his/her meal before giving insulin. (You don’t want someone to come, test the blood glucose, shoot insulin, and then walk out the door. What if your pet doesn’t eat? Also, pets who tend to regurgitate food usually do so within a short time after eating, so the petsitter should stay for a time after the dose is administered.)
5. Remember--this person may be called upon to care for your cat in a worst-case scenario. The petsitter should be someone you can trust. Before making a commitment to engage the services of a petsitting candidate, ask yourself: Have I confirmed that this individual possesses the knowledge, skills, and moral character to care for my pet and to keep his or her commitments to me? Is this someone who knows what to do if she or he finds my pet in shock or seizing (administer sugar or syrup and rush my cat to the vet)--and equally important, can he or she be trusted to do it?

Get references -- preferably from people you know and trust. A good place to start in your search for veterinary technicians who provide medical petsitting services is your veterinarian, who may be able to give you the names of veterinary technicians (nurses) who do this. You might also check with friends, family, and neighbors with special needs pets who might have used these services in the past. Your local 24-hour referral clinic may also be able to provide references.