How to place a FreeStyle Libre in veterinary patients

Diabetes mellitus (DM) is a common endocrinopathy in canine and feline medicine, and its treatment requires commitment from both the client and veterinary team (Behrend, et al, 2018). In human medicine, the disease is characterised by primary pancreatic beta cell deficiency and insufficient insulin production (typically termed type I), or initial insulin resistance which can result in beta cell damage and eventually beta cell loss (type II). Canine patients often present with a ‘type I like’ diabetes and feline patients most commonly present with a ‘type II like’ disease (Fults, 2016; Cornell University, 2017). Clinical signs include polyuria, polydipsia and weight loss. If treatment is delayed or unsuccessful, patients may develop diabetic ketoacidosis (DKA). At this stage, the patient is likely to present dehydrated (severe dehydration will result in hypovolaemic shock), with a metabolic acidosis. DKA can be confirmed based on presenting clinical signs, such as those mentioned above, in addition to the presence of excessive urine or serum ketones and a metabolic acidosis (Scudder et al, 2016). Patients in DKA can often present in critical conditions requiring intensive nursing and medical care (Hamlin, 2010). This highlights the importance of recognising those clinical signs related to diabetes to allow prompt veterinary treatment for improved patient outcome.