When was the last time you made it your mission to discuss diabetes care with customers? If it was just yesterday, fantastic! But if it's been a while… consider making diabetes a top priority during your upcoming sales calls.
The biggest reason to talk about diabetes is, your customers may not be aware that they, and their clients, are missing out on the major benefits of today's veterinary-specific solutions.
When you ask your customers about their current diabetes protocols — you'll open the door to a rewarding shift for all (practices, patients, pet owners, and you!).
Recently we asked two veterinarians about this subject — Dr. Nyssa Reine-Salz from Merck, and Dr. Arne Zislin from Boehringer Ingelheim Vetmedica, Inc. (BIVI) — because both companies offer veterinary insulin products. Dr. Reine-Salz and Dr. Zislin are on the front lines every day, talking with veterinary practices about managing diabetes.
In the spirit of helping you improve animal health, we present their answers to our questions here. Their insights may surprise you regarding why many practices still follow outdated protocols and often prescribe human-medicine approaches, which are NOT advantageous to dogs and cats.
What is the main problem or struggle in trying to manage diabetes in veterinary patients today?
Dr. Reine-Salz: "This is a tough one to answer, as there are many. The first challenge we encounter is fear. Getting a diagnosis of diabetes can be very frightening. It requires a very big lifestyle change as well as interaction with medical devices that most people are not familiar or comfortable with. There is also the fear of your pet dying from this. And lastly, the fear of whether they will be able to afford the treatment.
Once we get treatment started, the challenge shifts to monitoring. What is the best protocol? How do we convince owners to do the monitoring protocol we have selected? How do we interpret the results we get? What do we do when things don’t go as planned?
Another big challenge that is realistically is a constant throughout, is cost. Treating and monitoring diabetes is a big financial burden. What do we do if they can’t afford it? How do we alter our protocols to fit the financial scenario?"
Dr. Zislin: "It can be challenging for owners to commit to the long-term management of this condition in their pets. It requires daily medication, periodic veterinary visits, maintenance of health logs at home and the cost of medication. This can be a hardship for owners for a variety of reasons including time, cost and the ability to give medication."
Why do so many veterinarians use human insulin for treating diabetes?
Dr. Reine-Salz: "Some vets may use them because they do not want to stock products in their facility. Some may do it so their owners can have easier access to the products. Others just do it because it is what they are used to and they work."
Dr. Zislin: "In earlier days, most pets were placed on animal-derived insulin intended for people. These products had very little, if any, safety or efficacy data in either dogs or cats. In addition, because they were intended for 180-lb. people, they were difficult to give to most dogs and cats. When recombinant insulin became available for people, they became very popular in human medicine due to the many advantages of recombinant technology, including consistency or actives and supply chains. For many of the same reasons, recombinant products became popular in veterinary medicine as well."
What is the overall opportunity for practices if they switch to veterinary-specific insulin and other products (can they save more lives, make it easier to comply, etc.)?
Dr. Reine-Salz: "First, it is always best to use products that are labeled for the species you are treating. Product support is also more likely available. It is advantageous to have complete control over access to the product, to assure that the owner is complying with instructions. Also, people tend to take much larger doses of insulin than pets, so subtle differences in dose may not impact them as much. Veterinary preparations are made with the doses that pets require. They are more dilute, so our ability to draw up smaller doses is improved. Veterinary approved insulin products are produced in a concentration that is easier to administer in small doses (40 IU/ml vs. 100 U/ml)."
(This note was added by Jill Lopez, DVM, Merck, a colleague of Dr. Reine-Salz's): "Also, by prescribing veterinary insulins, the veterinarian can help facilitate pet owner compliance for care by making sure the pet owner visits the vet hospital for prescription refills instead of picking up insulin at a pharmacy. For the best diabetic care, follow up examinations and also simple pet owner communication about the patient is key to an overall successful management."
Dr. Zislin: "Most human insulins are very expensive. One of the reasons owners may lose their enthusiasm and compliance with continuing care for their diabetic pet is the cost of treatment. Today’s veterinary insulins are effective and safe, and far less expensive than human insulins. Since cost of care can be an issue, a more affordable option may help some families keep their pet. Along with maintaining the health and well being of the pet, the veterinary hospital pharmacy can still be a source of revenue to support the financial health of the practice. When veterinarians script out prescriptions for human products, they lose the potential revenue that contributes to future investment in their own practices.
I own a diabetic cat. He was diagnosed with diabetes when he was 4 years old, and he is currently 18. Most pets are family members and no one wants to lose a family member. Treating a diabetic pet for many years is a large commitment. From the veterinarian’s standpoint, mentoring clients successfully in maintaining this family member can lead to happier pets and happier clients. Good communication between doctor and client is essential, and the bond that grows over time between the pet-owning family and the veterinarian is very fulfilling."
How would you suggest that distributor reps open the conversation with veterinarians — to get them to want a better solution such as yours?
Dr. Reine-Salz: "They can certainly refer to Vetsulin.com (www.vetsulin.com) as it has a great deal of information about diabetes within it including owner handouts, references, etc."
Dr. Zislin: "[At www.prozinc.com and www.bi-vetmedica.com/species/pet/products/prozinc.html], Boehringer Ingelheim Vetmedica, Inc. offers educational materials for practices and for pet cat owners that are available to all distributor representatives to use. Additionally, representatives can remind their clients that veterinary insulin products are backed by support for both veterinarians and owners during the entire time a pet cat is maintained on this product. If a pet cat is placed on a human product, this support does not exist. Representatives can find additional information at:"
About the experts:
Nyssa Reine-Salz, DVM
Nyssa Reine-Salz is a graduate of the University of Florida, College of Veterinary Medicine. She completed an internship in Small Animal Internal Medicine and Surgery and a residency in Small Animal Internal Medicine at the AMC in New York, New York. After achieving Board Certification in Internal Medicine, Dr. Reine-Salz was on staff at the Animal Medical Center with a focus on nephrology and endocrinology until 2009. She currently works as an Internal Medicine Consultant with an emphasis on diabetic patient support at Merck Animal Health.
Arne Zislin, VMD, MBA
Dr. Zislin earned his BA degree from Brandeis University and VMD degree from the University of Pennsylvania. Following graduation, he practiced in Washington, DC and in New Jersey. He holds a Master of Business Administration degree from Widener University. In 1995, Dr. Zislin joined Fort Dodge Animal Health and served in several Professional Services roles. In 2009, Dr. Zislin joined the Veterinary Medical Affairs group at BIVI as a technical manager where he continues to develop and manage the academic liaison program. Dr. Zislin has a special interest in feline medicine and was an AAFP board member from 2009-2014 and Chairperson for the annual meeting in Boston in September 2011.