Effective monitoring is essential for the management of dogs and cats with diabetes mellitus. However, methods for evaluating glycemic control must be tailored to meet both the needs of the patient and the expectations of the owner. This article discusses the philosophies that drive blood glucose monitoring in veterinary diabetics and review common practices. The advantages and limitations of anger cancer connection various options are presented.
Diabetes mellitus is a common endocrinopathy in dogs and cats. Although the underlying etiologies differ for the two species, both are treated with exogenous insulin and require regular monitoring to ensure appropriate therapy.
The latter is particularly important for veterinary diabetics, as these patients cannot assist themselves if blood glucose BG concentrations drop precipitously. The frequency of monitoring for diabetic dogs and cats is variable, although some form of evaluation is generally recommended every 4—12 weeks. A substantial percentage of feline patients undergo remission within the first few months of insulin therapy, and therefore require careful monitoring so that hypoglycemia does not occur.
If the owner notices a change in thirst, appetite, weight, or activity levels or observes any changes in behavior that may suggest hypoglycemia, prompt evaluation is indicated. From the veterinary perspective, owner medroxyprogesterone for animal regarding quality of abbot animal health report on diabetes and abbot animal health report on diabetes severity of clinical signs, along with patient body weight, are key parts of the assessment process; laboratory data of any kind are essentially supplemental and used to guide treatment changes when owner satisfaction is poor.
Some owners are willing and able to monitor their pets regularly and are highly compliant with clinical recommendations. Others may approach their responsibilities as pet owner with a different philosophy and may be reluctant to follow suggested protocols if substantial cost or time is required.
School and community relations plan methods can be broadly classified as indirect or direct, abbot animal health report on diabetes. Most veterinarians encourage periodic direct measurements of BG, as the indirect methods may fail to identify periods of hypoglycemia.
However, direct methods can have logistical limitations, in which case indirect assessments may be used. Direct measurements of BG can be particularly challenging in feline patients due to a phenomenon called stress hyperglycemia. These values may be maintained for several hours following the trigger event and can markedly confuse interpretation of direct BG measurements. For many feline patients, a simple trip to the veterinary hospital can trigger stress hyperglycemia.
When BG concentration exceeds the reabsorptive capacity of the proximal convoluted tubules, glucose will persist in the renal filtrate and cause an osmotic diuresis. Animals consume water when driven by the sensation of thirst, not for vegitarianism and allergies or social reasons, so fluid intake crudely reflects BG status.
A decrease in water intake is often used initially in feline diabetics to document a response to insulin administration. Conversely, a substantial increase in water intake suggests sustained hyperglycemia. Periods of hypoglycemia may not uranium mining and cancer recognized, however, abbot animal health report on diabetes, so increasing insulin abbot animal health report on diabetes solely on the basis of persistent polydipsia can be problematic and result in insulin overdose.
It is also important to recognize that factors other than BG concentrations can impact water intake. These include concurrent renal disease, thyroidal disease, ambient temperature, and the moisture content of the food. Owners of canine patients can simply hold a glucose reagent strip in the urine stream while the pet voids.
Unfortunately, abbot animal health report on diabetes, very few dogs will urinate on command and may not completely empty their bladder when voiding occurs. Urine glucose test results therefore reflect the events of many hours, and transient hypoglycemia may essentially be masked by periods of hyperglycemia. Both dogs and cats can experience the Somogyi effect, i.
It is therefore inappropriate to increase an insulin dose simply abbot animal health report on diabetes the basis of persistent glycosuria. A well-controlled canine diabetic may experience several hours of euglycemia during the course of a day but will generally be glycosuric for substantial periods.
A prolonged interval without glycosuria is therefore suggestive of insulin overdose and should prompt investigation. Louis, MO can be mixed with the litter and checked within a 12 h period for abbot animal health report on diabetes color change. This product is particularly helpful for detection of onset of diabetic remission, and BG should be measured if prolonged periods without glycosuria are noted.
Similarly, this product can be used once weekly to monitor for diabetic relapse if insulin is abbot animal health report on diabetes. If owners opt to check for glycosuria using a reagent strip, it is prudent to purchase a product that also identifies ketonuria e. It is not unusual for newly diagnosed diabetes patients to have mild ketonuria in the first week or so, but this should not be a persistent finding.
Serum fructosamine concentrations provide a quantitative indirect assessment of diabetic regulation in both dogs and cats. An elevated fructosamine concentration indicates persistent hyper-glycemia over the previous 2 weeks.
There are published target levels for canine and feline diabetics, although alterations in serum protein levels or increased protein antibiotics animal people can impact the accuracy of this test, abbot animal health report on diabetes.
A low concentration suggests insulin overdose, probably due to the onset of diabetic remission. Elevated levels in either species indicate poor diabetic regulation but do not indicate the cause. In fact, some patients receiving too much insulin have high fructosamine levels due to the Somogyi effect. Glycosylated hemoglobin concentrations can also be measured in dogs and cats and provide relevant information regarding glycemic control for the previous 6 weeks. Undoubtedly, direct measurements of BG have numerous advantages over the indirect methods and provide the information needed for safe and effective dose adjust-ment, namely, duration of action of insulin, BG nadir, and an estimation of average BG.
The targets for veterinary patients are very different from their human counterparts, as modest hyperglycemia is better tolerated than hypoglycemia. Due to innately low aldose reductase activity in the feline lens, cataracts are very uncommon in diabetic cats. A traditional BG curve requires the collection of a blood sample every 2 h, starting ideally just prior to insulin administration and continuing to the time of the next dose.
Patients should eat their standard diet at the usual time during this process. For cats on ultra-long-acting products such as insulin glargine, adequate information can often be obtained with a sample every 4 h, as BG fluctuations are often modest. In the past, patients were admitted to the veterinary hospital for a BG curve, as venipuncture was required for sample collection. In-clinic curves have some substantial limitations, including anorexia or hyporexia due to anxiety, disruption of normal exercise routines, and the effect of stress on feline BG values.
Clients are also impacted by the inconvenience and expense of these visits and may postpone a recheck to avoid these issues. However, the newer handheld glucometers require much smaller blood samples, and pet owners are now able to collect an adequate volume of capillary blood using a lancet or a small gauge needle.
In addition, improved test strip design means that the blood is essentially wicked from the puncture site, with the glucometer held at any angle. Studies have confirmed that BG concentrations obtained in this way are comparable to the standard venous values. Most owners quickly become comfortable with sample collection, and the majority of pets tolerate the process with little or no apparent discomfort. Optimal sampling sites can vary from patient to patient, and it is often helpful to identify a good location before demonstrating the technique to the owner.
In addition, online resources such as videos can be used to encourage client confidence and compliance. At-home monitoring of feline diabetics has particular advantages, including the prompt identification of remission and avoidance of stress hyperglycemia. In addition, abbot animal health report on diabetes BG monitoring and careful adjustment of insulin dosage appears to facilitate the onset of diabetic remission, most likely due to reversal of glucose toxicity.
In one study, intensive BG monitoring of newly diagnosed diabetic cats i. Selection of an appropriate glucometer is important because devices designed for the human market are variably discrepant when used on canine and feline patients. However, canine and feline erythrocytes contain substantially less glucose and, therefore, contribute much less to the total amount measured.
This can have a critical impact on identification of the BG nadir and may result in inappropriate insulin dose reduction. Handheld glucometers targeted for veterinary use have appeared on the market, abbot animal health report on diabetes. A species-specific code is used to adjust the algorithm for the patient in question, thereby improving reliability and accuracy.
Pet owners should be encouraged to use a device that is validated and approved for the species in question. Peer-reviewed studies have supported the use of these monitors in veterinary patients.
Variations in patient hematocrit can also impact the accuracy of the oxidase-based testing systems, even if a validated veterinary device is used. Several studies have highlighted the poor repeatability of BG curves in both dogs and cats. This may be due to subtle variations in insulin absorption or reflect alterations in the secretion of counter-regulatory hormones such as cortisol. For this reason, data collected on a BG curve should never be considered in isolation from other clinical information, such as thirst, urination, and body weight.
Continuous glucose monitoring systems CGMSs are not widely used in veterinary medicine, although several studies have demonstrated their clinical utility.
In addition, a traditional BG curve provides enough information to allow appropriate dose adjustment in most instances. A CGMS is a useful alternative if a patient requires close monitoring of BG concentrations, but frequent sampling would be technically challenging or cause substantial distress. Examples would include fractious animals or patients with diabetic ketoacidosis. Many referral institutions use a CGMS in these circumstances, although technical issues can be problematic, abbot animal health report on diabetes.
Although most dogs and cats do not resent insertion of the subcutaneous sensor, many patients will attempt to remove it by scratching, biting, or rolling. For this reason, abbot animal health report on diabetes, sensors are usually placed on the dorsal cervical area, out of reach of the mouth. Instead, a light adhesive dressing may be used to prevent dislodgement.
Devices that remotely transmit data to a distant receiver are generally preferred, as this eliminates the need to attach the display device to the patient. In the home setting, it may be possible to attach the display device to a collar or harness, thereby permitting the patient to abbot animal health report on diabetes freely around the house and yard and perform its usual activities. The data collected can be downloaded later for analysis. Using a CGMS does not eliminate the need for blood collection, however, as two or three BG measurements are needed for initial calibration when the device is first activated.
As many poorly regulated or ketoacidotic veterinary patients have values substantially above this ceiling, these devices may not be used until the BG enters the required range.
Acceptable correlation has been reported between BG values and interstitial glucose concentrations measured by CGMSs in several species, including the cat and dog.
Although treating dogs and cats with diabetes mellitus can be challenging, many patients do well, and owner satisfaction is usually high, abbot animal health report on diabetes. Effective communication between the veterinary team and the client is essential, as owner perceptions regarding the quality of life of the pet will ultimately determine outcome.
Audrey Cook has provided consultation services to Abbott Animal Health. National Center for Biotechnology InformationU.
J Diabetes Sci Technol. Published online May 1. This article has been cited by other articles in PMC. Abstract Effective monitoring is essential strength and muscle building lifting plans the management of dogs and cats with diabetes mellitus.
J Am Anim Hosp Assoc. Use of glargine and lente insulins in cats with diabetes mellitus. J Vet Intern Med.