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Diabetes in People, Cats, and Dogs: Biomedicine and Manifold OntologiesMelanie Rocka; Patricia Babinecb

a Department of Community Health Sciences, University of Calgary in Alberta, Canada b University ofCalgary,

To cite this Article Rock, Melanie and Babinec, Patricia(2008) 'Diabetes in People, Cats, and Dogs: Biomedicine andManifold Ontologies', Medical Anthropology, 27: 4, 324 — 352To link to this Article: DOI: 10.1080/01459740802427091URL: http://dx.doi.org/10.1080/01459740802427091

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ARTICLES

Diabetes in People, Cats, and Dogs:Biomedicine and Manifold Ontologies

Melanie Rock and Patricia Babinec

If people express salient beliefs and values in caring for pets then it is worthconsidering that dogs and housecats are routinely treated using the biomedicalarmamentarium. To investigate animal-human connections in the treatment ofdogs and housecats for diabetes, we conducted ethnographic interviews inCanada with 12 pet owners and six health professionals in conjunction witha review of documentation on diabetes in cats, dogs, and people. Treating dogsand housecats for diabetes, we conclude, pivots on recognition of these ani-mals as sentient selves. At the same time, treating diabetes in dogs and house-cats helps to produce a named disease as a physical thing. In treating ahousecat or a dog for diabetes, pet owners breach one of the foundational dis-tinctions of Western science: human and nonhuman bodies exhibit continuityin terms of physicality, but a fundamental discontinuity exists when it comes tointeriority.

MELANIE ROCK holds the position of Assistant Professor in the Department of Community

Health Sciences at the University of Calgary in Alberta, Canada. Additional affiliations include

the University of Montreal’s interdisciplinary health research group and the University of

Calgary’s Department of Anthropology, Faculty of Social Work, Centre for Health and Policy

Studies, and Population Health Intervention Research Centre. Her current research focuses on

animal-human connections in health care and in health promotion. She may be reached at:

[email protected]

PATRICIA BABINEC originally trained as a pharmacist at the University of Alberta and

remains active in the profession. More recently, she completed a BA followed by an MA in

communication studies at the University of Calgary. In September 2008, she entered the PhD

program in the Graduate Division of Educational Research at the University of Calgary.

Ms. Babinec has also taught as a sessional instructor in the Faculty of Communication and

Culture at the University of Calgary and is a member of the Southern Alberta Primary

Care Research Network team (SAPCReN). She may be reached at [email protected]

MEDICAL ANTHROPOLOGY, 27(4):324–352

Copyright # 2008 Taylor & Francis Group, LLC

ISSN: 0145-9740 print/1545-5882 online

DOI: 10.1080/01459740802427091

324

Downloaded By: [Texas A&M University] At: 20:51 15 February 2011

Key Words: anthrozoology; biomedicine; Canada; cognitive anthropology; companion animals;

diabetes mellitus; explanatory models; medical anthropology; pets; science and technology studies;

valuation; veterinary medicine

INTRODUCTION

Anthropologists have long attended to people’s use of animals as foodsources, tools, and symbolic resources (Clutton-Brock 1989; Ingold 1988;Mullin 1999; Shanklin 1985). In addition to and in parallel with utilitarianrelationships with animals, anthropologists have concluded that manypeople relate to certain species or to specific animals as sentient selves(Adelson 2000; Anderson 2003; Descola 2005, 2006; Harris 1989; Kohn2007; Nadasdy 2007; Povinelli 1992, 1993; Sabloff 2001; Saj et al. 2006;Scott 1996). Similar to medical historians and medical sociologists, however,medical anthropologists have not tended to delve deeply into the rolesplayed by animals in biomedicine or in other medical systems (McCorkleet al. 1996; McCorkle and Mathias-Mundy 1992; Nyamanga et al. 2006;Rock et al. 2007). In fact, anthropologists have paid less attention to veter-inary biomedicine than have historians or sociologists (Gardiner 2006a,b;Hardy 2002; Jones 1997, 2003, 2004; Sanders 1994a,b, 1995, 1999b; Swabe1999, 2000, 2005).

By attending to the deployment of biomedical expertise and technologiesto treat diabetes in cats and dogs, this article draws attention to intricateinterconnections between animals and people. We suggest that biomedicaltreatment of diabetes in dogs and housecats as well as in people appearsto pivot on the recognition of these animals as sentient selves. At the sametime, pet1 care helps to produce diabetes as something that is named andknown.

BACKGROUND

Diabetes, in biomedicine, has never been purely human. First, animals wereimplicitly present in the notions of nature and of disease connected with therise of biomedicine, generally, and biomedical research on diabetes, morespecifically (Keating 2001). Consequently, biomedical research on diabeteshas consistently relied on nonhuman animals. From the 19th century tothe present, a variety of nonhuman animals have served as laboratory mod-els for diabetes in people. Dogs served as diabetes models in the researchthat culminated in the commercialization of insulin (Bliss 2000 [1982];Schlich 1993); mice, rats, and even fruit flies have also served as stand-ins

DIABETES IN PEOPLE, CATS, AND DOGS 325


for diabetes in people (Rock 2005c); and domestic cats are currently beingtouted as useful for modeling type 2 diabetes in people (Henson and O’Brien2006; Hoenig 2006).

With the advent of insulin therapy in the 1920s, biomedical treatment ofdiabetes in people became dependent on nonhuman animals in a new way:as a source for therapeutics. Slaughtered pigs were the most common sourceof commercial insulin from the 1920s until the 1980s, but many people withdiabetes also injected themselves with insulin that was extracted fromslaughtered cattle (Bliss 2000 [1982]; Feudtner 2003). All people withtype 1 diabetes who had lost the capacity to produce insulin and thereforerequired regular insulin injections for survival thus became dependent onindustrial slaughter facilities. Many people with type 2 diabetes have alsoused bovine or porcine insulin.

The first synthetic human insulin that was created using recombinantDNA technology came onto the market in the early 1980s (King 2003).Since then, the market has become dominated by human insulin analoguesthat vary in the average amount of time that they remain active followinginjection (King 2003). In fact, large pharmaceutical companies such asEli-Lilly and Novo Nordisk no longer manufacture porcine and bovineinsulin products for human use to the chagrin of some people who have longrelied on these products. A less-prominent company, Wockhardt UK Ltd,continues to produce a porcine insulin for human use and has gainedapproval for this product in some jurisdictions (e.g., Government of Canada2006a). Bovine and porcine byproducts are still used, however, in the manu-facture of some human insulin analogues (e.g., Government of Canada2006b).

Veterinarians, meanwhile, had diagnosed diabetes in dogs at least 40years prior to the discovery of insulin (Gardiner 2006a).2 By the 1940s, insu-lin had become incorporated into the veterinary treatment of diabetic dogs,as patients (Gardiner 2006b); and by the 1960s, insulin began to be usedregularly to treat housecats for diabetes, too (Gardiner 2006b). Until the1950s and 1960s, cats did not regularly reside in people’s houses (Jones2003), which helps account for the time lag between regular treatment ofdiabetes in dogs compared with diabetes in housecats. Research on felinedisease only began in the late 1960s, and was prompted by owners’ demon-strated willingness to seek veterinary treatment for housecats (see Jones1997, for further discussion). Available figures suggest that in affluentcountries, diabetes currently develops in about 1 in 500 dogs and 1 in 250housecats (Catchpole et al. 2005; McCann et al. 2007; Rand et al. 2004).

The recent suggestion that domestic cats could model type 2 diabetes inpeople stems from consensus that in terms of etiology, type 2 diabetes inpeople resembles most cases of feline diabetes (Henson and O’Brien 2006;

326 M. ROCK AND P. BABINEC


Hoenig 2006; Rijnberk et al. 2003). Like people with type 2 diabetes, dom-estic cats with diabetes tend to retain the capacity to produce insulin butthey cannot produce enough, or their insulin is not effective in transferringglucose from the bloodstream to the body’s cell, or both. Onset of diabetesin domestic cats and type 2 diabetes in people tends to occur at mid-life orolder. Furthermore, researchers have concluded that excess body weight dueto overeating, physical inactivity, or both often contributes to diabetes indomestic cats and in people. Yet there exist only three case reports ofchronic hyperglycemia in exotic cats (Kollias et al. 1984; Prowten 1975;Sanchez et al. 2005), perhaps due to what zoo cats are fed combined withthe routine use of food to stimulate physical activity in zoo environments.

Canine diabetes, like diabetes in domestic cats and type 2 diabetes inpeople, tends to set in at mid-life or older. In terms of etiology, however,canine diabetes resembles type 1 diabetes in people because most cases ofcanine diabetes and type 1 diabetes in people are thought to stem from anautoimmune reaction that results in the destruction of the insulin-producingcells found in the pancreas. Common environmental factors may accountfor a similar seasonal pattern in the onset of diabetes in dogs and of type1 diabetes in people (Catchpole et al. 2005). While there are no publisheddata showing that obesity increases risk of developing canine diabetes (Randet al. 2004), regular exercise is recommended for all dogs and their owners(Cutt et al. 2007). The impact of physical activity on glycemic control inpeople with type 1 diabetes remains unclear, but as in the general popu-lation, the potential benefits could include improved cardiovascular health(Kavookjian et al. 2007). Physical activity has been shown meanwhile todelay or avert the onset of type 2 diabetes in people (Tuomilehto 2007)and to increase glycemic control in people with type 2 diabetes (Sigal et al.2007).

In summary, complicated lines of interdependencies that cross-multiplespecies lines have emerged in relation to diabetes. Not only have animalscontributed to biomedical treatment of diabetes in people as laboratorymodels and as insulin sources but select animals have benefited from biome-dical treatments that were originally intended for people. Yet at least someof these animals appear to develop chronic hyperglycemia because they livewith people. Insulin often serves as a therapy of last resort when treatingpeople with type 2 diabetes, even though insulin therapy may be used effec-tively earlier on (Gerstein et al. 2006; United Kingdom Prospective DiabetesStudy Group 1998a). But insulin is always required to treat diabetic dogsand to treat people with type 1 diabetes. In addition, insulin is routinely pre-scribed to treat diabetes in cats. Porcine insulin, bovine insulin, porcine-bov-ine insulin combinations, and human insulin products are all currentlyprescribed to treat dogs and cats with diabetes (Behrend 2006; IDEXX



Laboratories 2008; Intervet 2007). Indeed, the discontinuation of twohuman insulin products that were commonly used to treat cats and dogswith diabetes has caused consternation among many veterinarians and petowners (Business Wire 2005; Medical News Today 2005).

SETTING AND METHODS

This article relies mainly on interviews conducted between March 2006 andMarch 2008 with pet owners living in Calgary, Alberta, Canada. Calgarywas the focal point for this study because both authors reside in Calgary,a city whose human population slightly exceeds one million (City of Calgary2008). In addition to human inhabitants, more than 100,000 dogs and100,000 cats are registered with the City of Calgary (2006a). According toofficial statistics the ratio of dogs and cats to people is approximately oneto five. These statistics likely underestimate the number of cats, in parti-cular, since the City of Calgary did not require registration of housecatsuntil 2006 (City of Calgary 2007). Registration of dogs and other regulationsthat govern dog owners, by contrast, have been a part of Calgary’s historysince 1885 (City of Calgary 2006b).

Slightly more than half of all households in Canada include at least onepet (Ipsos-Reid 2001; Statistics Canada 2007); approximately one thirdinclude dogs, one third include cats, and one in ten includes both cats anddogs (Ipsos-Reid 2001). Spending patterns suggest that many Canadiansvalue and feel committed to their pets’ health. For example, Canadiansspent about CAD$4 billion per year on their pets in 2005, includingCAD$2 billion on veterinary care (Statistics Canada 2007). Canadian petowners spent, on average, CAD$377 on their pets in 2005, whereas pet own-ers residing in Alberta spent, on average, CAD$461 (Statistics Canada2007). The higher pet-spending figures for Alberta may reflect an economicboom fuelled by the oil and gas sector, which continues today. By compari-son, about six in ten Canadian households reported out-of-pocket spendingon prescription drugs in 2002, with an average expenditure of CAD$378, fora total of CAD$3 billion (Luffman 2005).

With one exception we recruited the 12 pet owners interviewed for thisstudy via a letter distributed through e-mail. It was signed by Melanie Rock,included her contact information, was formatted on University of Calgaryletterhead, and read:

Does your dog or cat have diabetes? If so, I hope that you will agree to beinterviewed. This study aims to bring about a better understanding of whatit is like to look after a diabetic dog or cat, and how this experience relates



to thinking or feelings about human health and health care. Please contact meif you would like more information, or to volunteer to be interviewed.

On 9 March 2006, Rock sent this letter as an e-mail attachment to a friendwho is a dog owner, who works in the oil and gas sector, and who volun-teered to forward it on to a colleague known to be an ‘‘animal lover.’’ Fromthere, judging from the response, the letter circulated far and wide. Of thepet owners whose interviews form the basis for this article, six did not per-sonally receive the letter by e-mail. Instead, five heard about the study froma friend, relative, or neighbor, and one interviewee learned about the studybecause the letter had been posted at her dog’s daycare. Babinec recruitedone additional pet owner whom she knew was treating his cat for diabetesfrom her personal network.

Using e-mail to assist with recruitment was an adaptation of chain refer-ral selection also known as snowball sampling in which ‘‘each study partici-pant suggests to the researcher the next person or set of people to becontacted, based on a set of criteria the researcher has established inadvance’’ (Schensul et al. 1999: 241). Rather than giving us the names ofpeople to contact, we used e-mail communication channels to tap into manydifferent social networks. Not only did this recruitment method prove to beinexpensive and effective, we were also able to circumvent the ethical issueof asking for personal information without consent.

We interviewed a total of five men and seven women with experience incaring for diabetic pets. All had treated a dog or a cat for diabetes for morethan one year at the time of recruitment. The pet owners who volunteered toparticipate in this study live in neighborhoods that are geographically dis-perse (see Figure 1)3 and that differ on demographic and socioeconomiccharacteristics (see Table 1).4 Nine live within Calgary city limits; one livesin a Langdon (a village of about 1,700 people located approximately 40 kmsfrom Calgary); one lives in Red Deer (a city of about 68,000 people locatedapproximately 140 kms from Calgary); and one lives in Vancouver (a metro-politan area of over 2 million people located approximately 1,000 kms fromCalgary).

The authors personally conducted all the interviews in an ethnographicstyle (Spradley 1979). All interviewees signed a consent form, or, in the caseof telephone interviews, received a consent form by e-mail or by post.5

Opening questions for pet owners included: ‘‘How did [pet’s name] cometo live with you?,’’ ‘‘How did [name of pet] come to be diagnosed with dia-betes?,’’ and ‘‘What is involved in taking care of a diabetic pet?’’ In conjunc-tion with follow-up prompts such as ‘‘Tell me more about . . . ,’’ ‘‘I didn’tknow that . . . ,’’ and ‘‘How is that different from diabetes in people?,’’responses lasted 40 minutes or more. A review of the audio recordings



and transcripts from the first two interviews suggested that the narrativesaddressed many of the questions that have been used to elicit explanatorymodels of diabetes (e.g., Arcury et al. 2004; Ferzacca 2000, 2004), amongmany other sicknesses. Thereafter, we used the explanatory model questionsin checklist form as a source of prompts—we tried to ensure that each inter-view covered the following points, but not necessarily in the following order:what they call this sickness; what they say caused this sickness; why they saythis sickness started when it did; what they say this sickness does and howthey think the sickness works; how severe they say this sickness is andhow long they predict the sickness will last; what treatment is appropriate,in their opinion, and the expected results of treatment; what problems havebeen caused by this sickness; and what they fear most about this sickness(Kleinman 1980: 106; Kleinman et al. 1978).

In addition to pet owners, we interviewed four veterinarians based inCalgary whose patients are mainly cats and dogs (a general practitioner,an internal medicine specialist who continues to work part-time in generalpractice, an internal medicine resident with extensive experience treatingfeline diabetes and canine diabetes in general practice, and a clinical pathol-ogist). We invited these veterinarians at the outset to describe their practiceand as the interviews continued on, to talk about veterinary care for

FIGURE 1. Place of residence for owners of diabetic pets.



diabetes in cats and dogs. We also interviewed a zoo veterinarian and a Cal-gary-based pharmacist who regularly compounds ‘‘bespoke’’ medicines fordogs and cats. The ‘‘grand tour’’ opening question for these interviewswas: ‘‘How did you come to be in this [kind of practice]?’’ Through theseinterviews with health care professionals we learned more about what isinvolved in treating feline diabetes and canine diabetes, in particular, as wellas veterinary practice with cats and dogs more generally. One or both of us

TABLE 1

Pet Owner Sample Characteristics

Pseudonym

Age

group Gender

Neighborhood

median

household

income

Neighborhood

dominant

educational

attainment

Type of

participation

Pets with

diabetes

1. Brenda Over 65 Female $50–74 K Non-university

credential

2 Telephone

interviews

1 Dog

2. Brice 51–65 Male $75–99 K University 2 Face-to-face

interviews

4 Cats

3. Catherine 20–35 Female $50–74 K Grades 9–12 3 Face-to-face

interviews,

1 Telephone

interview

1 Cat

4. Francine 51–65 Female $75–99 K University 2 Face-to-face

interviews

4 Cats

5. Gloria 51–65 Female $75–99 K Grades 9–12 1 Telephone

interview

1 Cat

6. Joe Over 65 Male $25–49 K Grades 9–12 1 Telephone

interview,

1 Face-to-face

interview

1 Dog

7. Lisa 51–65 Female $50–74 K Non-university

credential

1 Face-to-face

interview,

1 Telephone

interview

1 Dog

8. Natasha 36–50 Female $25–49 K University 1 Telephone

interview,

1 E-mail update

1 Cat

9. Peter 36–50 Male $25–49 K University 2 Face-to-face

interviews

1 Dog

10. Reginald 51–65 Male More than

$100 K

University 1 Face-to-face

interview

1 Cat

11. Shane 36–50 Male $50–74 K Non-university

credential

1 Telephone

interview

1 Cat

12. Wanda Over 65 Female $25–49 K Grades 9–12 1 Face-to-face

interview

1 Dog



also visited a particular veterinary hospital on six separate occasions, and onthe most recent occasion, presented a version of this article for commentsand discussion as part of their regular teaching rounds. In parallel withthe field-based research, we also examined original research articles, pro-fessional handbooks, pamphlets, and Web sites that deal with veterinarymedicine, diabetes in cats, diabetes in dogs, and diabetes in people.

Our iterative approach to analysis has involved processes of immersionand efforts to draw comparisons between treatments for diabetes incats, dogs, and people (Borkan 1999; Emerson et al. 1995; Lecompte andSchensul 1999). Our sources of knowledge about the treatment of diabetesin people came mainly from Babinec’s years of experience in clinical practiceas a pharmacist, previous research by Rock (Rock 2003a,b, 2004, 2005a–d),and other sources on biomedicine and diabetes (Broom and Whittaker 2004;Cohn 1997; Ferzacca 2000, 2004; Loewe et al. 1998; Loewe and Freeman2000; Lutfey 2005; Lutfey and Freese 2005; Marks 1997; McCarthy andMartin-McDonald 2007; Meyers 2007; Mol and Law 2004; Sinding 1999;Smith-Morris 2005). Using the software FreeMind, we worked together toconstruct a mind-map of continuities and discontinuities in treating people,cats, and dogs for diabetes. Later, Rock used the software NVivo to drawconnections between (i.e., code and annotate) our various fieldnotes andinterview transcripts. We also exchanged hundreds of e-mails and met twiceor more per month, from July 2006 onward. As Rock wrote successivedrafts and partial drafts, Babinec responded to them with memos and ques-tions. Our analysis also benefited from comments on previous drafts pro-vided by Steve Ferzacca, Eric Mykhalovskiy, Thomas Schlich, and threeanonymous reviewers.

RESULTS

Treating a housecat or a dog for diabetes seems to result from attachment tothat animal as a sentient being endowed with capacities to feel not only painor discomfort but also to enjoy being alive and to feel loved. Treating a cator dog for diabetes is in other words an extension of caring about that ani-mal as a subject with a distinct personality or even a soul. Through recourseto veterinary expertise and through the use of technologies originallyinvented to treat people for diabetes, pet owners draw on Western scienceto affirm that their dogs and housecats with diabetes truly qualify as selves.Treating dogs and housecats for diabetes helps to sustain the conviction thatthese animals are more than physical bodies, to cement people’s ownsense of who they are, and to make diabetes real to them in very practicalways.



Recognizing Sickness and Diagnosing Diabetes

When our informants narrated how their cats and dogs came to be diag-nosed with diabetes, being there for significant others appeared to be impor-tant. Consider, for example, this account:

Catherine: Yes . . . so, it was actually, it was kind of a weird situation. I hadgone to the hospital to see my dad [who was being treated for cancer], Ihad come home [from sister’s wedding] to go to the funeral [of a friend whohad just died in a house fire, trying to save the cats trapped inside], whichwas actually just at this funeral home down the street. And I was sitting homewhen I got home after the funeral, and I was a wreck because of everythingthat was going on—I was an emotional basket case. And I’m looking atVincent, and I could just tell: something was off. He was drinking a lot.

M.R.: Is that right?Catherine: And that’s one of the biggest symptoms you look for. And then I

know I checked the litter boxes, and I didn’t know how recently the girl [petsitter] had scooped them, but they were really bad. They drink a lot, theypee a lot. And so, I remember I called the pet sitter to say, you know, ‘‘Hassomething been out of the ordinary, or anything that you had seen?’’ Didn’tget a hold of her right away, I remember calling my husband, and I againwasn’t emotionally very stable at this point. And I was, I’m like, you know,something’s wrong with Vincent. I don’t know what it is, but something’s justnot quite right. So I called my vet and I was able to get in right away. Um, itwas about five o’clock at night at that point, so I’d been home less than 24hours. We got him to the vet, and I said to my vet, I’m worried that he’s dia-betic and these are the reasons: because he’s drinking a lot, I think he’s peeinga lot, and he was kind of yowling, walking around complaining more thannormal. So, we did the blood tests, and if I remember correctly of course every-thing was all muddy back then, um, we got the blood tests back immediately, ifnot the next day. And yes, he was diabetic, no question, went on insulin rightaway. So you know, I was always squirmish about needles and my husband iseven worse, so for us because we were not doing good emotionally for otherreasons, it was really a hard transition for us.6

Veterinarians have told us that a key reason for using insulin to treatdiabetic housecats rather than using one of the oral agents approved to treattype 2 diabetes in people is that most cats are loathe to swallow pills (seealso Jones 1997). But when owners have been unwilling to treat a case offeline diabetes with insulin for financial reasons or because they will berequired to give injections, at least one veterinarian interviewed for thisstudy has prescribed pills approved for treating type 2 diabetes in people,saying, ‘‘I haven’t had a whole lot of success but I have had a couple caseswhere we’ve managed them with orals.’’



Other cat as well as dog owners told us that they first became aware thatsomething was wrong when their pet exhibited one or more of the classicsymptoms of diabetes, such as drinking and urinating frequently. LikeCatherine with her cat Vincent, another owner noticed that his pet was sickafter being away from home, in this case, for more than a month:

Joe: He seemed like he was excited to see me, but soon I realized—I realizedthere’s something wrong with this dog. He’s not like he was, he would havejust knocked me over, he would have been all over me, you know? And Ithought, ‘‘there’s something wrong with him.’’ He was happy, and everything,and then he was like that, and I was watching him then, didn’t I dear? [to hiswife, who also participated in this interview]

I watched him, and he was real sluggish, and he was going out to pee a lot, anddrinking a lot of water. And, see, ‘cause I got diabetes, I know that’s what you do.

So I said, there’s something wrong with him, I—and in my mind, I alwaysthought it was diabetes, diabetes. So in about three days I took him over tothe doctor, and the doctor said, yeah, he has diabetes.

Thus, Joe concluded that his dog might have diabetes because he recognizedthe symptoms from his own experience as a person with type 2 diabetes andbecause he recognized that the dog just did not seem to be his usual self.

Another owner, whose diabetic dog, Mickey, had died shortly beforebeing recruited for this study, gave the following account of how Mickeyended up being diagnosed.

Peter: We’re not sure how long he was [diabetic] because he was going pee alot, which is obviously a sign, but he was also always famished and then wefound out he was losing a lot of weight. But you know, it’s kind of hard some-times, to notice, immediately. . . . But he was losing weight—[laughs] it’s goingto be an interesting recording, we’re close to trains and we’re close to planes[pauses until airplane noise fades away]. . . . He was constantly ravenous; hestarted counter-surfing, stealing food off the counter, which he’d neverdone before. Eating everything that he possibly could get his hands on. Andhe was still losing weight, so did the tests.

P.B.: But where did the name diabetes come from, how did that diagnosiscome about?

Peter: Because of him needing insulin, because of the sugar, and the inabilityto regulate the sugar.

Since frequent urination, constant hunger, and weight loss constitute symp-toms of diabetes in people, it is not apparent from the first few lines of thequoted transcript excerpt whether the diabetic in question is a dog or insteada human child. The first clue that this exchange is about a diabetic pet comeswhen Peter refers to ‘‘counter-surfing, stealing food off the counter.’’



In veterinary practice with dogs and cats, diabetes is diagnosed in relationto reported symptoms along with measures of glucose in the blood or detec-tion of glucose in the urine (Greco 2001). Veterinarians, just like physicianswho treat human patients, regard the presence of glucose in the urine as astrong indication of diabetes. And while physicians use the hemoglobinA1C test to monitor blood glucose levels in people with diabetes, veterinar-ians use fructosamine test results as an indicator of average blood glucoselevels in the recent past. Veterinarians may order a fructosamine test toassist with the diagnosis of feline diabetes because the experience of comingto a veterinary clinic may be stressful enough to elevate glucose levels in acat without chronic hyperglycemia. None of the pet owners interviewedfor this study seemed to entertain any doubts that their cat or dog had agenuine case of diabetes. They readily accepted, in other words, that thesame biomedical category could apply to cats, dogs, and people.

Recognizing Selves and Deciding to Treat (or Not)

The veterinarians whom we interviewed told us that most, but not all, petowners are willing to try insulin treatments for dogs and housecats that havebeen diagnosed with diabetes. Not all pet owners whom we interviewed,however, thought that diabetes treatment would be appropriate in all cases.Some cats, in particular, were cited as poor candidates for diabetes treat-ment because of their personalities.

Catherine: If it was our other cat, it would be a death sentence [euthanasiawould be required]. I’ll tell you that much right now, we know we couldn’tdo it.

M.R.: Just the different relationship?Catherine: Yeah, she’s just—and a different personality. She’s just a miser-

able cat, at the best of times.M.R.: [referring to a parody of a ‘‘beware of dog’’ sign, posted in the front

window of Catherine’s home, indicating that a cat is guarding the place.] Isthat the, is that where the . . .

Catherine: Yeah, that’s what that is—yeah, that’s not Vincent. So, yeah,she’s—We couldn’t treat her, we know we couldn’t treat her. We couldn’tdo the—we can barely cut her toenails.

Deciding to treat a dog or housecat for diabetes thus seems to be part ofrecognizing that animal as a self so much so that recognition of a particularanimal’s selfhood may factor into not treating diabetes.

Whether in a human, feline, or canine body, each treated case of dia-betes constitutes a fresh instantiation of a chronic disease. And with



chronic disease comes a concern with monitoring as the foundation forcontinual intervention. Daily action must be taken to counter the threatof hyperglycemia. Yet treatment—especially treatment with insulin—mayresult in dangerously little glucose in the bloodstream: hypoglycemia. Fol-lowing diabetes thus involves watching out for both hyperglycemia andhypoglycemia and being prepared to counteract each. Treating a dog ora cat for diabetes differs from the ideal of self-management that is currentin human diabetes care because self-management is impossible for a dog orcat. Pet owners, however, observe their pets and regularly intervene infeline and canine diabetes. Through the recognition of both sickness andself in pets, a pet owner’s own sense of self-awareness may encompassheightened concern for what a dog or a cat is doing, feeling, needing,and communicating.

For example, Peter would occasionally test his dog’s blood glucose levelsif the current insulin dosage no longer seemed sufficient or if he was worriedabout hypoglycemia. In other words, his dog could not seem to sense thedifference between being hyperglycemic and hypoglycemic or when insulinwould help and when insulin could cause harm.

Peter: I had him crash on me a couple of times where his blood sugar went solow that he became very disoriented and couldn’t walk. One time I had tocarry him about seven, eight blocks home, and after that I started carryingsomething with glucose in it in case that ever happened again, I wasn’t carryinghim home.

P.B.: Oh, okay. Okay, so there were times when that happened. And thesymptoms were, you said . . . ?

Peter: It happened a couple times, um. Dizziness, very lethargic, disoriented,um, and then he would start wandering and stop being able to really walk.

P.B.: Do you think the dog, did he know when he needed the insulininjection, and how do you think he felt?

Peter: I don’t think he knew when he needed the injection . . . because rightup to the time when I did have him crash on me, he was walking along . . . .It’s not something that I noticed happened gradually or anything, it just allof a sudden happened. Times I had fun with him is when he first got it [dia-betes] he was still intact. And, when the girls came into season, he would stopeating. Just because dogs, male dogs do, when the girls are in season. ‘‘I don’twant to eat; I’ve got other things on my mind right now.’’ And it becamedifficult to regulate his blood sugar because he wasn’t eating.

P.B.: Oh okay, that’s new to me. Right.Peter: Then I’d have to start doing testing of his blood sugar; most of the

time I didn’t bother testing his blood sugar. Just watching, only testing if hestarted showing other symptoms, like excessive drinking would be the firstone that we’d usually start seeing.



Peter would obtain a blood sample for glucose testing from a vein in thefront leg, with the same type of needle he was using to inject insulin, explain-ing that ‘‘He would just sit down when I had to do it, he would sit, give mehis paw. He was an excellent dog.’’ Then, he would use one of the handheldblood glucose meters marketed for use by people with diabetes to test theblood sample for its glucose concentration.

Similarly, Catherine uses a glucose meter to test her cat’s blood glucose, butshe does not extract blood samples in the same way. Using a flashlight to helplocate a capillary (a technique she learned via the Web site felinediabetes.com) she obtains the blood sample from one of Vincent’s ears. For example,she did some glucose testing after her cat had to switch to a different kind ofinsulin because the product that she had been using was taken off the humanmarket. The approach that she used is often called a blood glucose curve.She would test a blood sample every two hours or so to establish the durationof the insulin effect and the time required to reach the peak effect—the lowestblood glucose reading (see also Behrend 2006: 1093–1096; Casella et al. 2002).Many owners bring their pets to a veterinary clinic for blood glucose curves.Catherine, however, performs blood glucose curves in her home because ofVincent’s strongly negative response to the first and only time she had theprocedure done in a veterinary clinic.

I had decided, like basically, if we would have had to do that again, I probablywouldn’t have continued this treatment. . . . Having to leave him at the vet, wegot this wild animal by the time he’d done–he was so upset, and he was hissingand snorting, and like it took three of us to hold him down for his last bloodtest.

Veterinarians, in concert with pet owners, seem to focus on attenuatingsymptoms of diabetes and maintaining overall quality of life in cats anddogs that have been diagnosed with diabetes (see also Behrend 2006). Asone veterinarian put it, a diabetic complication that regularly arises in vet-erinary practice with pets is euthanasia. Standardized treatment protocolsare more difficult to achieve in veterinary medicine than in human medicine,according to this same veterinarian, for at least three reasons. First, thereexists considerable variability among the animals themselves; second, therealso exists variability in relationships with owners; and third, as one veter-inarian explained, ‘‘we don’t have the numbers,’’ i.e., large-scale epidemio-logical studies. Another veterinarian, while reading over the consent form,noted that while there exists considerable evidence for treating people withdiabetes, there is very little either for feline diabetes or for canine diabetes.When Rock, who conducted this interview, commented that this lack of evi-dence might pose difficulties, the veterinarian said that in some ways, a lack



of quantitative evidence makes the practice very simple: ‘‘There are just afew things that can be tried.’’

Recognizing Selves and Routinizing Treatment

All the pet owners whom we interviewed described an insulin injection rou-tine with which their animals cooperate knowingly and fully. For example:

Reginald: Like giving him the insulin isn’t a problem. Like he knows, he’sconditioned now.

P.B.: Tell me about that.Reginald: We come down in the morning, he always wants to eat. I pull the

insulin out of the fridge, I get the needle, and he sits down and he turns hisback to me. He knows, he doesn’t run away.

Catherine, in fact, wonders whether her cat Vincent is sufficiently self-awareto know when he needs insulin and when he does not.

Catherine: He seems to understand why he needs his needle, you know not whyhe needs his needle, but he gets it. I don’t know if I’m just anthropomorphizingor what, but one thing I’ve noticed is every once in awhile he’s really goodabout getting his needles 99.9 percent of the time and then, once in awhile, he’llrun away from me when I go to do his needle and I have learned now if he actslike that, I do a blood test. And the last time he ran away from me and I did ablood test, he was too high. He, oh no he was too low–he didn’t need a needle.

Feline diabetes is often more challenging to treat than canine diabetes,partly because dog owners must usually make fewer changes to their ownlifestyle than cat owners. After Peter told Babinec, ‘‘twice a day, after everymeal, we would give Mickey insulin,’’ she asked how that affected his dailyroutine. ‘‘What do you mean?’’ he replied. ‘‘It just made us feed him a littlebit more regularly. But not real regularly. It’s something that you don’tworry [about] quite as much, you don’t worry about keeping the bloodsugar quite as steady as you do in a human.’’ Dogs generally require dailyattention, including twice-daily feedings, to which may be added twice-dailyinsulin injections.

Many housecat owners, by contrast, simply put out food, water, andfresh litter and then leave town for a few days at a time. Treating a catfor diabetes commits owners to a schedule, and scheduling concerns mayhave led to these owners to choose a housecat over a dog. Furthermore,while a dog might accompany the owners on a picnic or on a daylong hike,such outings are harder to arrange with housecats. To resolve this very issue,Catherine and her husband recently purchased a motor home so that they



will be less ‘‘tied down’’ by feline diabetes. They may now bring Vincentalong on spur-of-the-moment and extended trips, and simply keep his insu-lin in the fridge. That is precisely what Peter used to do with the fridge in hismotor home while Mickey was still alive.

DISCUSSION

Partly because human bodies have been conceptualized as physically similarto animal bodies, biomedical treatment of diabetes in people has never beenentirely separate from animals. Attentiveness to physical similarities hasenabled insulin to move between animal and human bodies, has enabledhuman insulin products to be used to treat animal patients, and has enabledinsulin to move between animal bodies representing different species. Withmodifications to the usual instructions, attentiveness to bodily similaritieshas also allowed blood glucose meters to be used with both feline and caninepatients.

The treatment of diabetes in cats and in dogs variously resonates withand differs from the treatment of diabetes in humans; within and across spe-cies boundaries, new connections and distinctions can always be made. Petscan bring people into the experiential realm of chronic disease, and manyattendant dilemmas and issues carry over from human health care (Jones1997, 2003). Regarding diabetes, these dilemmas and issues can includereconciling the demands of treatment with other priorities, acting on partialinformation, figuring out how intensively to treat, trusting new technolo-gies, and wondering about quality of life. The feasibility of using biomedicalexpertise and technologies to treat animals for diabetes combined with theattribution of similar kinds of thoughts and feelings to people and pets helpsto produce diseases and bodies as manifold ontologies.

Lived experience and practical realities, in other words, have been shownin this article to depart from monolithic conceptualizations of Westernscience, medicine, or culture. While we do think that this article breaks somenew ground, we are also cognizant of many limitations, including small sam-ples of both pet owners and health care professionals and a heavy relianceon interviews. Furthermore, we do not presume that our interview data fullyconvey how these people have thought or felt about diabetes (as per Young1982). In addition, for practical reasons or at the request of some pet own-ers, we conducted some interviews by telephone. While telephone communi-cation is certainly part of these people’s daily lives and is a legitimatefieldwork strategy (Sunderland 1999), face-to-face interviews carry theadvantage of observational opportunities that may inform the interviewitself and that may be documented in field notes (Emerson et al. 1995;



Spradley 1979). For this project, relevant observations included how petowners spoke to and behaved toward their pets and how these animalsbehaved and situated themselves during the interviews. In light of these lim-itations, we have only directly quoted pet owners with whom the interviewerhad a long-standing relationship or whom we interviewed at least twice andin person at least once. This article, therefore, illustrates what can beinvolved in caring for diabetic cats and dogs.

The most significant difference in treating people for diabetes versustreating dogs and housecats for diabetes appears, nevertheless, to be inthe overall orientation. In treating people for diabetes, health guidelinesrecommend tight control over blood glucose (e.g., Canadian DiabetesAssociation Clinical Practice Guidelines Expert Committee 2003) todiminish the long-term likelihood of several serious health problems(as per Diabetes Control and Complications Trial Research Group1993, 1995; United Kingdom Prospective Diabetes Study Group1998b). In treating dogs and cats for diabetes, a different standard seemsto be typical. Rather than aiming to reduce or avert the onset ofadditional health problems, pet owners and veterinarians emphasize con-trolling symptoms.

Yet by postponing death, often via euthanasia, control over the symp-toms of diabetes in dogs and cats may contribute to animal welfare andtranslate directly into longevity. Moreover, due to the reliance on insulintherapy and in the absence of the capacity to self-manage food intake andinsulin dosages, hypoglycemia is a genuine concern when treating dogsand cats for diabetes. The very real possibility of killing these patients withinsulin, with kindness, steers veterinarians away from recommending tightblood glucose control. But in human biomedicine, in the quest to normalizeblood glucose levels, researchers and health professionals construe hypogly-caemia as a manageable risk (Mol and Law 2004).

We have gravitated toward the adjective ‘‘manifold’’ to describe howvariability and similitude entwine when treating diabetes in people, cats,and dogs. Such bodies come to exist somewhat differently, in different set-tings, through the use of various techniques and technologies (Mol 2002).These bodies, techniques, and technologies also fold in on each other andby enfolding, make diabetes appear as a cogent thing.7 Yet in treating dia-betes in a given body over time, some of that cogency may dissipate orunfold. Mol (2006) has called for more attention to be paid to how diseasesare actually lived and to what could be done to improve these experiences.In that light, we think that nonhuman beings deserve consideration becauseso many people invest so much time and money on medical treatments forselect animals and because the overall quality of medical treatments forselect animals greatly exceeds that received by many people.



We must not take for granted that diabetes treatment exists at all fordogs and cats. Just because the disease state can be diagnosed in dogsand cats does not mean that such cases will be noticed at all, never mindtackled with the biomedical armamentarium. In detecting sickness, seekingbiomedical expertise, and treating their dogs and cats for diabetes, the petowners interviewed for this study gave accounts of responding to and reso-nating with the inner life of their pets. They see evidence for the existence ofa self in a pet’s sickness and in how a pet responds to treatment physiolo-gically, but also socially. Concern about their pet’s health and willingnessto seek and to apply veterinary advice is consistent with the notion that petsare family members. A telephone survey with a randomly drawn sample of1,500 pet owners in urban areas across Canada found that eight in ten con-sidered their pet to be a family member; seven in ten allowed their pets tosleep on their beds; six in ten carried pictures in their wallets or includedpets in displays of family photos; and one in two claimed that they wouldgo into debt to treat a pet suffering from a chronic disease (Ipsos-Reid2001: 4–5).

The most important commonality, therefore, in biomedical treatments ofdiabetes in people, cats, and dogs appears to be that patients representing allthree of these species are regarded as selves whose lives have intrinsic value.Without an embodied sense that the life of a dog or cat is worth prolonging,treatment does not make sense. Yet a pet owner’s decision to euthanize a cator dog with diabetes does not necessarily stem from perceiving the animal tobe more like an interchangeable thing than as a unique self (Appadurai1986; Graeber 2001; Kopytoff 1986). Based on their interpretation of an ani-mal’s personality and quality of life, pet owners may never begin treatingdiabetes in a particular cat or dog. Alternatively, months or years afterbeginning to treat a cat or dog for diabetes they may decide not to continuewith treatment.8

In gravitating toward the nomenclature of manifold ontologies todescribe diabetes treatments, in different species and in specific bodies, wehave also gravitated toward the notion that treatment of diabetes alwayshinges on processes of recognition. By recognition, we do not mean the dis-covery of an immutable reality that was always there but was simply unac-knowledged and unnamed. Rather, we mean recognition in the sense ofrethinking, remembering, or reflecting (i.e., re-cognizing). While the prac-tices and technologies involved in treating diabetes in cats and dogs wouldappear to correspond with what Mol (2002: 32–33) has termed enactment,we are resolutely human-centered in saying that pet owners who seek andapply veterinary expertise do so because they already interact with theirpet as a self. Mol’s (2002) concept of enactment, by contrast, is nothuman-centered.9 We do not deny that nonhuman beings may engage in



processes of recognition and thus contribute directly to people’s sense thatthey truly are selves, but this article focuses on interpreting what pet ownershave told us about treating diabetes in cats and dogs. And because it ishuman-centered, it is not an example of synthesizing ethology with eth-nography (Lestel 2006). By being diagnosed and treated in dogs and cats,the thing known as diabetes appears to become that much more actual orreal to people: through pet care, diabetes acquires new meaning. Not onlytechniques, but also different kinds of bodies (cf. Mol 2002) lend coherenceto diabetes as a thing that may involve insulin and glucose, drinking andurinating, weight loss and weight gain.

In our reading, people’s recognition (or lack thereof) of diabetes in catsand dogs is consistent with ‘‘becoming with’’ through reciprocal induction(Haraway 2008). In other words, organisms are structured through thecontingent co-shaping of cell life and cell death, including contact withorganisms from other species (Haraway 2008, 219): ‘‘The ordinary is a mul-tipartner mud dance issuing from and in entangled species. It is turtles allthe way down. The partners do not pre-exist their constitutive intra-actionat every folded layer of time and space’’ (Haraway 2008, 32). As feralcreatures that are actively aided by people, and certainly as pets, animalstend to live longer than they would otherwise (Haraway 2008, 275–281for further discussion). Thus, even without being treated as diabetes, chroni-cally elevated blood glucose in dogs and cats tends to emerge throughinteractions with people. For chronically elevated blood glucose in dogsor housecats to be treated as diabetes typically depends on a pet-ownerrelationship as well as on a pet-owner-veterinarian relationship. The collec-tive effects of these relationships reach the cellular level in the pets, at thevery least, and help shape the lives of all concerned.

When treating a cat or a dog for diabetes, pet owners use scientific expert-ise and technologies to breach one of the foundational distinctions ofWestern science: that human and nonhuman bodies exhibit continuity in termsof physicality, but that a fundamental discontinuity exists when it comes tointeriority. Descola (2005: 322) briefly touched on this possibility in explainingthat collectivities tend to be organized around a prevailing or dominant way ofrelating to each other and to nonhuman beings, whereas people everywheremay deploy various modes of identification. He highlighted that due to theirformal and informal education, most Europeans tend to think and act in natu-ralistic terms (i.e., humans resemble nonhuman entities in physical terms, butdiffer so much from nonhuman beings when it comes to subjectivity that onlypeople qualify as selves). Then he observed that this tendency does not preventsome Europeans from treating their cat as though it had a soul. Finally, hemaintained that non-naturalistic suppositions, such as cats having souls, donot take on the force of a robust ontology in Western collectivities because



of the staying power of automatisms acquired over time and because of theenduring influence of surrounding institutions that emphasize prevailing dis-tinctions between people, inert objects, and animals.

Nevertheless, within households, if not across entire Western nations,many people do appear to recognize their pets as selves. Writing in the sym-bolic interactionist tradition, the sociologist Clinton Sanders (1993, 1999a)has suggested that the attribution of mindedness is a common practiceamong people who care for pets, and others have reached similar conclu-sions (Alger and Alger 1999; Anderson 2003; Fox 2006; Irvine 2004).Previous research has noted that veterinarians also attribute what mightbe thought of as a personality, self, or soul to their nonhuman patients(Sanders 1994b) and may actually empathize less with their paying custo-mers than with their nonhuman patients (Shaw et al. 2006; Swabe 2005).We have shown, meanwhile, that the attribution to pets of need, of thecapacity to benefit, of participation in routines, and of personality all enterinto the treatment of diabetes in dogs and cats. Extending biomedical treat-ments to pets has, we suggest, stabilized a distinct framework through whichthe attribution of human-like interiority is not only legitimate but is anurgent moral preoccupation. Indeed, common complaints logged by payingcustomers suggest that some veterinarians lag behind this shift in how theypractice (Adams and Frankel 2007). If, as Descola (2006: 155) argued, astrict separation of nature from cultures embodied by speaking creatureshas already outlived its moral and epistemological efficiency, makingway for ‘‘a new exciting period of intellectual and political turmoil,’’ thendevelopments in veterinary medicine deserve our rapt attention.

ACKNOWLEDGMENTS

The authors would like to thank the pet owners and the health care profes-sionals who were interviewed for this study as well as those who helped withrecruitment. They also thank Melissa Jakobfi, Bonnie Phoung, and ShannaSunley for assisting with the research; Lisa Kozleski for her help with copy-editing and with shepherding this article through the publication process;and Steve Ferzacca, Eric Mykhalovskiy, Thomas Schlich, and threeanonymous reviewers for their incisive comments. Funding for this researchcame from a Population Health Investigator award from the AlbertaHeritage Foundation for Medical Research to Melanie Rock (AHFMR-200600378); the 2006 Petro-Canada Young Innovator in CommunityHealth research prize to Rock; a New Investigator in Societal and CulturalDimensions of Health Award from the Canadian Institutes of HealthResearch to Rock (CIHR-200609MSH-83745); and a Standard Research



Grant from the Social Sciences and Humanities Research Council ofCanada to Rock as principal investigator and to Eric Mykhalovskiy andThomas Schlich as co-investigators (SSHRC-410-204-2152).

NOTES

1. In this article, we use the more conventional terms of ‘‘pet’’ and ‘‘pet owner’’ and not terms

such as ‘‘companion animal’’ or ‘‘human companion.’’ We are certainly aware, however, that

many people value these animals for their companionship. For further discussion of com-

panion and companionship in cross-species relationships, see Haraway’s (2003, 2008) recent

work.

2. The dogs used in the research that culminated in insulin therapy were not diabetic, however,

until the surgical removal of their pancreas (Bliss 2000 [1982]).

3. The Calgary map shows six, rather than nine, dots because four of the pet owners residing in

Calgary volunteered to be interviewed as couples, and because two additional pet owners live

in separate households but share the same postal code.

4. ‘‘Neighborhood’’ is defined in this table as the ‘‘dissemination area’’ for census data collected

for the Government of Canada in 2000. These dissemination areas were linked to pet owners’

postal codes using the Statistics Canada’s postal code conversion file, September 2006

update. Two of the postal codes linked to more than one dissemination area. To choose

the most appropriate location for these two postal codes, the single link indicator function

from the conversion file was used. The table shows neighborhood median household income

and dominant educational attainment for the neighborhood at the time of recruitment. Two

pet owners have moved, however, since being recruited in 2006.

5. This research project has been approved by the University of Calgary’s Conjoint Health

Research Ethics Board (tracking number, 18060).

6. All transcript excerpts have been lightly edited to make them easier to read.

7. Mol titled her book The Body Multiple, but in a crucial passage, refers to ‘‘manyfoldedness’’

in reality: ‘‘This, then, is what I would like the term multiple to convey: there is manyfolded-

ness, but not pluralism. In the hospital the body (singular) is multiple (many). The drawing

together of a diversity of objects that go by a single name involves various modes of coordi-

nation.’’ (Mol 2002, 84)

8. In using a word like ‘‘decide,’’ we do not mean to imply that diabetes treatment or euthanasia

are matters of unfettered or free choice (Mol 2006; Mykhalovskiy 2008).

9. Disease enactments, according to Mol, take place in and as a result of extensive networks

made up of practices, techniques, and so on. People form part of these networks but they

are not the subjects.

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