TREATMENT AND MONITORING OF DIABETES IN DOGS AND CATS PATTY A. LATHAN, VMD, MS, DACVIM Associate Professor, Mississippi State University
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This section will focus on the clinical signs and glucose monitoring. CLINICAL SIGNS Since the primary goal of treating a diabetic patient is to control clinical signs, clinical signs should always be considered when assessing diabetic control. A stable diabetic patient should have normal water intake (<60 mL/kg/day) and urination, “normal” energy level, and a stable weight. Although weight loss is recommended in obese animals, it is preferably delayed until at least moderate diabetic control is achieved. Water intake directly correlates to BG concentrations, and having the owner measure (and log) daily water intake gives them a way to be active in the management of their pet. Additionally, owners can assess urination by recording how many urine clumps are in a cat’s litterbox, or how many times a dog asks to go out during the day (and the middle of the night!). Phone apps are now available to help owners log daily water intake, food consumption, signs of illness, and at home BGC measurements, including Merck’s PetDiabetes Tracker App and the RVC Pet Diabetes App. Both apps allow the owner to email information directly to the veterinarian. The patient’s weight should be recorded and assessed at each veterinary visit. Note that all other monitoring modalities should be interpreted in light of the patient’s clinical signs and weight. GLUCOSE MEASUREMENTS Blood Glucose Curves Traditionally, BGCs have been used to help identify clinically-undetectable
hypoglycemia, and can help determine an insulin’s duration of action. If the duration of activity is too short, that patient may benefit from a longer- acting insulin. BGCs are also helpful in determining whether it is safe to increase the patient’s insulin dose when clinical signs are present. They are particularly important when initially arriving at an insulin dose and when clinical signs return. Curves MUST be interpreted in light of clinical signs, such as PU/PD, polyphagia and weight loss. Disadvantages of BGCs include the inability to identify hypoglycemia during the hours or days in which a curve is not performed (ie, in the middle of the night, when more hypoglycemic events occur), inconsistent correlation with clinical signs, and the effects of stress hyperglycemia in cats. At-home Glucose Curves A much less stressful alternative to in-hospital BGCs is at-home glucose curves. These are ideal because they give us a more realistic idea of normal daily BGs in cats that experience SH, and are often less stressful for the pet and the owner (especially when the patient hates going to the clinic, resulting in owner guilt). Additionally, even if the owners don’t routinely perform full BGCs on their pets, knowing how to obtain BG readings at home can help them identify hypoglycemia when suspected. Sites for obtaining BG samples in cats include the marginal ear vein or inner pinna, and the edge of a non- weightbearing paw pad. In dogs, the inner pinna, gums, and elbow callus may be used.
Continuous Glucose Monitoring System (CGMS); FreeStyle Libre The FreeStyle Libre (FSL) is a CGMS that measures interstitial glucose (IG) every 15 minutes for up to 14 days. Sensors are easily placed, even in less agreeable patients, and generally as affordable as a BGC (late 2019 with GoodRX: reusable reader--$65-$85; 14-day sensor--$65). The FSL can be purchased from a human pharmacy, with a prescription; vets may also obtain them from a distributer, usually at a higher cost. A 2016 paper (Corradini et al, JVIM) reported successful use of the FSL in dogs. We have been using them instead of traditional BGCs and also in hospitalized DKA patients (following rehydration). They appear to be accurate for the most part, but we have identified discrepancies in some patients. In particular, sometimes the FSL will read as hypoglycemic when the BG is actually 120 mg/dL or more. There is no study in cats yet, but our experience is that they are particularly helpful in “stressed” cats in which a BGC is impossible. More studies are needed to assess the accuracy of the FSL. However, we use the FSL extensively, with positive results. A video for placement of the sensor on a dog can be found here: https://www. youtube.com/watch?v=ytkcjpdxtKY Note that the sensor used in this video is different than the 14 day sensor that we currently use. The 14 day sensor starts reading 1 hour after placement.
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