WHAT’S NEW IN DIABETIC MONITORING IN DOGS AND CATS? CONTINUOUS GLUCOSE
MONITORING AND MORE J. CATHARINE SCOTT-MONCRIEFF, MA, MS, VET MB, DACVIM, DECVIM (continued)
Monitoring the diabetic patient The ideal monitoring strategy should be multimodal and individualized for the patient and owner(s). Parameters that can help in assessing the adequacy of diabetic control include clinical signs, serial blood glucose concentrations measured at home or in the clinic, fructosamine concentrations, glycosylated hemoglobin concentration (HbAIC), and urine glucose concentrations. The presence of ketones in the blood or urine can also be useful to indicate the presence of impending diabetic ketoacidosis. The most important factor in assessing diabetic control is whether clinical signs are well controlled. Blood glucose concentrations, urine glucose concentrations and glycated proteins should be interpreted in the light of the clinical signs. Monitoring should be individualized to meet the needs of the patient and owner. Although blood glucose curves have been considered to be the gold standard for evaluating glycemic control, they have some serious limitations. Blood glucose curves are affected by stress and there can be marked day to day variability. Blood glucose curves are expensive and require collection of multiple blood samples that can be stressful to the patient even when performed by the owner at home. Misinterpretation of blood glucose curves due to the effects of occult hypoglycemia can lead to incorrect treatment decisions. Newer continuous interstitial glucose monitoring techniques are changing the approach to blood glucose monitoring. These systems allow continuous evaluation of
interstitial blood glucose concentration for up to 14 days via a small flexible subcutaneous catheter, replacing the blood glucose curve. The newer systems are affordable, easy to use, and well tolerated by patients. The reports can be downloaded as a pdf and allow an integrated analysis of changes in blood glucose over a 14- day period. Glycosylated proteins also allow assessment of longer-term glycemic control and can aid in interpretation of blood glucose curves. Glucose binds irreversibly to serum proteins and hemoglobin and these products persist for the life of the proteins. The resultant products can be measured
in serum or whole blood respectively. Fructosamine indicates adequacy of glycemic control over the previous 2-3 weeks, while HbA1C reflects glycemic control for the previous 4-6 weeks. Urine glucose concentrations can also be used to assess glycemic control and are particularly helpful in cats to assess for the presence of diabetic remission as well as to detect relapse. Urine glucose should not be used to determine the daily dose of insulin but trends in urine glucose can be very helpful in assessing diabetic control especially if assessed on a consistent basis and recorded in a diary or log. (continued)
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