Veterinary Medicine - May 2008 - (Page c15) Strategies for monitoring diabetes mellitus in dogs veterinarians must carefully consider the pros and cons of intensive monitoring and management before routinely recommending such a strategy for canine diabetics. Table 1 (page 16) summarizes a comparison of moderate and intensive monitoring approaches. or the preservation of appetite is a common nding in dogs with uncomplicated diabetes. In untreated dogs, weight loss may occur despite adequate nutritional intake as a result of the catabolic state induced when circulating insulin is de cient. Thus, an increase in body weight or maintenance of body weight is expected during insulin therapy. Persistence of polyphagia and failure to gain or maintain body weight are indirect indicators of inadequate blood glucose regulation in an otherwise uncomplicated diabetic dog. Urine monitoring Clinical and laboratory parameters Clinical signs Common signs of diabetes in dogs, particularly polyuria and polydipsia, are directly related to hyperglycemia and glucosuria, which in turn are direct consequences of absolute or relative insulin de ciency. One or more of the clinical signs of diabetes are usually listed among the major complaints at the time of diagnosis. Owners may be taught to observe these clinical signs at home to monitor the e ectiveness of diabetic therapy. For dogs with long-term diabetes, owner observations of clinical signs and physical examination ndings correlate well with objective criteria of glucose management, such as the serum fructosamine level and mean eight-hour blood glucose concentration.4 As part of the monitoring program, instruct the owner to observe the dog for speci ed clinical signs of diabetes and record the observations for later review. Water consumption, urination habits, appetite, activity level, and body weight are usually the easiest parameters for most dog owners to observe at home. Because glucosuria occurs once the threshold for renal resorption of glucose is exceeded, polyuria roughly corresponds to the degree of hyperglycemia. Likewise, polydipsia is related to the degree of hyperglycemia. Polydipsia results from activation of thirst mechanisms by plasma hypertonicity and mild volume reduction caused, respectively, by hyperglycemia and increased renal uid loss. Polyphagia Some clinicians recommend at-home monitoring of glucose and ketone concentrations in urine as part of a diabetic monitoring program. Recommendations for the frequency of urine testing vary from weekly to multiple times daily.2,5 Although its e ectiveness has not been rmly established by research studies, the rationale for urine testing is improvement of patient management by alerting owners to changes in diabetic status before clinical signs appear. Metabolic changes relevant to patient management that may be detected in urine before clinical signs appear include large uctuations in glucosuria, sudden absence of glucosuria, or development of ketonuria. Potential drawbacks of urine testing as a monitoring tool include:5 • It may be di cult to obtain a sample for testing. • Urine metabolite concentrations may not re ect serum levels at the time of testing. • Test strip results are only semiquantitative. • It may be di cult for owners to discern color di erences on test strips. Whether urine glucose measurements should be used to adjust the insulin dosage is a matter of legitimate debate. The practice of having owners adjust the daily “Water consumption, urination habits, appetite, activity level, and body weight are usually the easiest parameters for most dog owners to observe at home. “ 15
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