scott@vtx-cpd.com

Replying to Laura Jones 19/11/2023 - 15:36

Thanks for this.

Really helpful. I will keep them in mind for future cases.

Scott 🙂

Hello Amanda.

I hope you are safe and well. I am so sorry to hear about your poor Dad, sending my best wishes. This is a super interesting question and one that I think is really relevant in veterinary medicine.

Overall, we are often too aggressive in our renal patients when it comes to fluid therapy and often we end up fluid overloading them. A more conservative fluid approach is much more appropriate in most cases. There is literature to support this… let me look for that and I will share.

I have also forwarded this to Liz (cardiology) and Kerry (ECC) who are much smarter than me and will have some gems to share I am sure.

Scott 🙂

This is a really interesting drug Laura, thank you for sharing.

I have no direct experience of using it, but is certainly an interesting addition to our tool kit in the right patients. There is more information regarding this medication on the drug company website:

https://bi-animalhealth.com/pets/feline/products/therapeutics/senvelgo

I always like to take a balanced approach. Overall, the published data on the drug is more limited:

https://pubmed.ncbi.nlm.nih.gov/29139146/

A lot of the ‘data’ that has been discussed is unpublished data from the drug company. I attended a round table discussion regarding this drug at ECVIM Congress recently. The opinion was mixed. Some people have some positive experience of using the drug. Others feel very strongly that there is not a place for it and the side effects are rather undesirable. I suppose the other side of the discussion is the owners perception of treatment and the euthanasia of some DM patients:

https://pubmed.ncbi.nlm.nih.gov/29139146/

The argument being that some patients would not be euthanised if there were alternatives to insulin injection. I am in no way suggesting that this is an alternative to insulin treatment, but may be another option in the tool kit for some patients.

As with most things endocrinology based, there is very rarely a right or wrong answer, just a lot of different (often very strong) opinions!

Would be interested to hear what others think. I think in the right cases it has a place!

Have a great weekend.

Scott 🙂

Thank you for sharing this Laura.

As you say, this is a great review for those who are wanting to learn more about these monitors and start using them in practice.

Laura and I were discussing preferred site of placement at the live Q&A and in seems that the thorax comes out on top generally. This is an interesting excerpt from the discussion:

“The application of the FreeStyle Libre sensor was easy and painless in most cats, and only a few cats showed a slight reaction. The sensors were all placed by the same person (MK) and were easier to place on the dorsolateral thoracic wall than the dorsal aspect of the neck. This subjective observation is underlined by the fact that in nearly half of the cats where the sensor was placed on the neck, extra glue was necessary to fix the sensor to the skin. Moreover, the correlation between BG and IG was higher if the sensors were placed on the thorax than on the neck. In a study by Hafner et al, a Guardian Real-Time sensor placed in the dorsal neck region had a higher proportion of successful first calibrations and appeared to be clinically more accurate and reliable than those that were placed in the lateral chest wall or knee fold. However, the Guardian Real-Time is a different type of sensor and the numbers in that study were small. In contrast, a study by Shoelson et al showed a higher complication rate (early detachment, mild or major dermatological changes or a dysfunctional sensor) in cats where the FGMS was applied on the dorsal neck (n = 2/3) than cats in which the FGMS was applied on the dorsolateral aspect of the thorax (n = 8/30).”

Would love to know if anyone has a preferred placement site in cats or any top tips about placement generally!

Scott 🙂