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Hi.

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Thanks for joining us and
welcome to another episode

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of Chattering with iCatCare.

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I'm Yaiza Gomez, iCatCare
veterinary community coordinator

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and host of this podcast.

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This month we will start with Severine
Tasker talking about her new role as

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iCatCare Veterinary Strategic Lead.

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Then I will be interviewing Sam
Taylor, first author of the new

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iCatCare Diabetes Guidelines.

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Let's start with Severine, speaking
about her first impressions after only a

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couple of months within the organisation.

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What inspired you to move into the
iCatCare vet strategic lead position?

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I'm obviously a vet that went
to vet school loving cats.

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So that was a first love for me and
I eventually was very lucky to do a

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residency in feline medicine at the Dick
Vet School in Edinburgh and that was

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funded by Feline Advisory Bureau back
then, that is now International Cat Care.

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So I've had a very  long affiliation with
the charity, sometimes watching it from

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afar rather than being directly involved,
but always admiring what it does.

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Who would not want a job that
involves thinking, breathing

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cats all day and every day?

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So that was a big, a big call for
me being able to focus on cats.

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I've always tried to do that to
a certain extent, but I've never

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worked in the charity sector, so
it's gonna be interesting to do that.

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I've learned that you can try new
things even though you might not

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feel that qualified to do things.

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Have a go and if you feel that the purpose
is aligned with what you want to do, what

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makes you tick, what gets you up in the
morning, then that was another big reason

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for leaving to International Cat Care.

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The other bits, just the fact that it is
International Cat Care and more recently,

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I've been so privileged in my last job
to visit different parts of the world and

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visit clinics, speak to vets, speak to
vet techs and nurses, speak to  owners

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and caregivers and just understand
how much of an opportunity there is to

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sort of shape some of the cat friendly
care and the care cats get worldwide.

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I love to learn and thinking about
the mental wellbeing of cats is

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something I want to learn more
about, that holistic approach.

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The other bit that attracted
me was the population work.

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Again, unowned cats and balanced
populations is something I

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follow a little bit that I've
not been directly involved with.

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This is a post that is strategic to try
and inform what we do from a veterinary

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point of view and it's just incredible
to have all those different opportunities

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to hopefully have an impact and work with
amazing people in international cat care.

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Thank you for that.

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I agree that having this holistic
perspective of cats and everything

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we can do for cats is great.

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What are your main priorities
within the charity at  this point?

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I'm still obviously still quite new.

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I am blown away by how much this small
mighty team that is International

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Cat Care delivers and does.

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It's incredible.

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You know, I feel like I knew the charity
before, but until you are working within

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it and you realise there's a variety
of things that are done and how much

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care and effort is put into those.

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So I think I'd love to
learn about all of that.

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But also the hardest thing is gonna
be prioritising because I think

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there's so much that we do that
could have more impact worldwide.

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When there's so much going on, it can be
quite hard to stand back and just think

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so could we do this a bit differently?

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Or what's working brilliantly?

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What could we try and tweak?

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Let's think about what are those
things that people really need?

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So I'm also trying to get a little bit
of informal feedback as well from people

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and trying to create that space  for
them to be able to be honest with me.

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One of my priorities is learning
how to prioritise, which in itself

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is quite an interesting concept.

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That's where I am at the moment, learning.

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What do you see as the biggest
current challenges in feline

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healthcare, both in clinical practice
and in how we educate cat owners?

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You can think about this at a sort
of worldwide level, can't you, in an

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individual sort of practice level.

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But I think overall, there's a couple
of things that stand out for me.

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Getting cats to the vets.

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There's so many cats that are not
visiting vets at the moment, some

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of which definitely need to visit
a vet so that access to care.

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Be it because there aren't any vets
in the area, be it cost, be it concern

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about getting the cat to the vet. There's
so many different aspects to enabling

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cats to get to a vet and also thinking
about those preventative healthcare.

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So some of us, since some of the practices
that we work in, in the clinical work

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that we  do, that is not an issue in the
certain populations of cats it isn't.

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There's always gonna be elements that are
difficult but when we think of the bigger

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picture, being able to neuter cats, being
able to vaccinate cats, is not the norm or

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not available in some parts of the world.

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So I don't think we should ever
forget the foundations of what we

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could impact at a bigger scale.

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I'm certain iCatCare is working
in those areas brilliantly.

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I think helping vet professionals
to communicate with owners when

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there is little time, and sometimes
you need clients to be receptive

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to some of that information.

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Being able to spread the
cats friendly word around.

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In terms of healthcare the cats, what

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is the biggest challenge?

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It's, to a certain extent, it's getting
the healthcare to the cat in the right

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way that's right for where that cat is
and the environment it is, et cetera.

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So that might not be the
question you were  looking for.

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I don't know if you were thinking we
need to be able to do this amazing

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medical procedure or what have you, but
I think those sorts of things will be the

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things that we have the biggest impact.

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And vaccination rates, there's parvo
outbreaks at the moment in the north

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of England with a disease that we
can absolutely vaccinate against.

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So it's, it's those sorts of things
that are, to me, the biggest challenge.

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Now I will be interviewing Sam
Taylor about the new 2025 consensus

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guidelines on the diagnosis and
management of diabetes mellitus in cats.

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Remember that all articles published
in the Journal of Feline Medicine

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and Surgery are open access, and you
can find the link for the guidelines

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in this episode description.

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The last consensus of management of
feline diabetes was published in 2015.

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Which new aspects of feline diabetes
do these new guidelines cover?

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If you look at the downloads for that
previous diabetes guidelines, lots of

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people have read them, which is fantastic,
but over 10 years diabetes is  an area

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of feline medicine that has had a lot
of research, a lot of publications.

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We often talk about research in cats
lagging behind dogs, but actually

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in diabetes, there's been so many
developments in, specifically

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about cats, which is really cool.

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So the main one is the use or the
availability of the SGLT2 inhibitors,

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which is, if any listeners' not
familiar, read our guidelines.

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But this is the, the oral treatment
for feline diabetes and that was a big

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development that obviously hadn't been
covered in the previous guidelines.

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And the other thing is the use
of continuous glucose monitoring.

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So the Freestyle Libres.

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Brilliant development, but of course
weren't really around at the time, 10

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years ago when that guideline was written.

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So I think we've tried to bring
in the, all of those new aspects.

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And we have included a section on
DKA, which wasn't in the previous

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guidelines, and I thought quite
carefully about, because I know it

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makes them longer guidelines, but I know
that I struggle with DKA in practice.

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I get anxious  when one's coming down.

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I know they're difficult cases, and I
think we tried to focus on, now we've

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got choices, which is super cool.

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We've got insulin and
we've got oral treatment.

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Brilliant.

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But then we've got to
decide which one to use.

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So we wanted to be helpful to people
in how they made those decisions.

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The more therapies available, the more
difficult is the clinical decision making

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and the more complex it all becomes.

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Yeah.

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Talking about these SGLT2 inhibitors
and diabetic ketoacidosis as well,

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which you also mentioned, bearing
in mind the possibility of diabetic

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ketoacidosis in a small percentage
of cats treated with this drug.

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What should we monitor during
the initial treatment period?

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So as many people know, this is a serious
adverse effect potentially of these drugs

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and depending where you are in the world,
there will be manufacture guidelines

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of monitoring ketones in particular in
that first two weeks and we can monitor

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them in the blood or in the urine.

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But what really came from our
communication and writing these

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guidelines was how important it
was to look at the cat clinically.

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I'd been obsessed with
measuring the ketones, which is

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appropriate, don't get me wrong.

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But what we really learned and
talked about was how important it

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was to look at whether these cats
are eating, whether they're bright,

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how they are in themselves, because
that's such an important reflection

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of what's going on internally.

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So I think that that's really important.

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Since 2015, we have also learned
new things about comorbidities.

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So the guidelines recommend that screening
for hypersomatotropism should now be

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discussed with caregivers of all diabetic
cats rather than reserving it for those

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showing a poor response to insulin.

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What is the rationale behind this
shift in recommendation, especially

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when SGLT2 inhibitors are an option?

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We know that cats with
hypersomatotropism are perhaps more

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prevalent than we previously thought.

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Historically, you'd only test for
that if you are escalating doses of

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insulin and  not getting a response.

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But we know that it is there in the
background and it could be affecting

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quite a few of our diabetic cats and
so it makes sense to know that early

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on in your process of treatment.

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And then the other problem, of course,
with using SGLT2 inhibitors is that you

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use a set dose, we don't adjust the dose
and so we wouldn't know in the same way as

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we would know with using insulin and what
that might mean is that we've got a cat

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with that condition undiagnosed and that
condition is progressing in the background

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and we know that condition can, in the
long term cause organ failure and all

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sorts of things as well as the diabetes.

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So I think the thinking is actually, hold
on, if this is affecting a good proportion

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of our diabetics does it make sense to be
a bit more proactive in looking for it?

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That doesn't mean that practitioners
have to do it in every case.

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Of course it's gonna depend on the
individual and finances and all

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sorts of other questions, absolutely.

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But it's bringing it a  little bit
into our minds a bit earlier, perhaps,

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than we would've done previously,
because we do see people going for

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further treatment of that condition.

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Yeah, definitely.

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And we have to give the option.

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I agree.

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Another popular topic
is diabetic remission.

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Have the main recommendations
about remission changed since the

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last guidelines were published?

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Yeah, I think probably
not massively changed.

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What I'd like to emphasise is the
importance of things like early diagnosis.

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We certainly know that if we diagnose
diabetic cats earlier, they're

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more likely to go into remission.

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That's definitely something that's
been shown in those studies.

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Another thing that has become much
more popular or so I perceive it in

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my environment is the Freestyle Libre
sensor, but they keep falling off the cat.

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So are there any tips you would
like to share to increase their

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lifespan, especially when trying to
achieve stabilisation or remission?

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Yeah.

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They're not perfect.

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They're designed for humans.

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They're not designed for cats.

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I still hope, and hear in the
background that someone might

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design one made  for cats.

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They often fall off because of
hair regrowth, actually, because

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we shave the cat and then the hair
regrows and that dislodges them.

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So we can't do much about that, can we?

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And they certainly fall
off for me sometimes too.

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So I think one thing is to say
to people, if they fall off,

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you're not probably doing anything
wrong, like they're not perfect.

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In some situations they do
fall off, but there are a few

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tips that I would give people.

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One of them is clipping.

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Obviously clipping.

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We're gonna do that, cleaning and
drying really well 'cause I think if the

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coat is greasy, the skin is greasy at
all, then they don't stick very well.

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If it's still wet, they
don't stick very well.

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It needs to be really dry.

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So sometimes, I mean we're impatient
but actually we've got to wait for it to

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properly dry or that glue won't stick.

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I then do put a little dot
around the edge of tissue glue.

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So I do a few little dots at the
edges 'cause if you'll notice when

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they fall off, it's often 'cause
they're peeling up at the edge.

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Don't go mad though if you put a lot
of glue on they can be really sore or

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they don't fall off for ages and  owners
don't particularly like that either.

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I've got one cat and it ended
up with two on because one of

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them just wouldn't come off.

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It was the opposite.

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It wouldn't fall off.

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Oh my God.

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I know, so then it looked ridiculous.

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And then when you put it on, don't
do what I did and pull straight away.

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Make sure that you do hold it on for
a second, and then you might need to

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almost tease it out of the applicator
because if you pull the applicator

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straight off and the sticky hasn't
set, you'll pull it off straight away.

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So I usually have a pair of forceps or
tweezers or something that I can just

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almost peel it out, just make sure
it's gonna come out of the applicator

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properly, and then I will use those
forceps just to stick it down so it's

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really nicely stuck down at the edges.

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But a tip I learned from a colleague
recently, which I confess, I've only tried

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on one cat, you can buy these little skin
wipes that are designed for humans with

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stoma devices that are essentially, they
look like wet wipes, but they're sticky.

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So you've shaved it, you've
cleaned it, you've dried it.

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You then use one of these wipes to
just outline where you're gonna put the

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device, and it quickly becomes slightly
tacky and you then put the device there

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and I've no evidence that that helps.

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But I hear from colleagues that's
helpful and they're very cheap.

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But yeah, it's a bit of a process
and some of them will still

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fall off and don't feel bad.

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That just happens.

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Those are really useful tips.

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Thank you for that.

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Thank you so much for joining us.

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If you’re an iCatCare Veterinary Society
Member, don’t forget that you can access

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00:14:42,440 --> 00:14:46,400
all member benefits, including the full
version of this podcast episode and

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00:14:46,400 --> 00:14:49,450
other recordings at portal.icatcare.org.

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00:14:50,160 --> 00:14:54,009
If you’re looking for more free CPD
from International Cat Care, keep

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00:14:54,009 --> 00:14:58,209
an eye on the portal because on the
4th of December Dr Dana Connell will

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00:14:58,209 --> 00:15:03,280
discuss early diagnosis of common feline
neoplasia in a webinar sponsored by IDEXX.

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00:15:04,390 --> 00:15:07,930
We will be back again next month
with more interviews on cats and the

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00:15:07,930 --> 00:15:09,619
Journal of Feline Medicine and Surgery.