Veterinary Medicine - May 2008 - (Page c16) Keys to managing of select features of moderate and intensive canine Table 1. Comparisoncanine diabetes mellitus diabetes monitoring programs Moderate program Goal of monitoring program Use in veterinary medicine At-home observation of clinical parameters Urine testing for glucose and ketones Serum fructosamine determination Glucose curve determination Blood samples drawn and tested at home? Glucose curve performed at home? Daily blood glucose monitoring? Daily insulin dose adjustments? Technical skills needed Level of owner compliance required Frequency of recheck examinations Cost to owner Suppress clinical signs of diabetes Common Frequency of monitoring Intensive program Obtain optimal diabetic control Uncommon Daily Daily Every one to three months in a stable patient Regularly Yes Yes (CBGM may be used at home) Yes (very intensive programs) Maybe, if blood glucose is tested daily Daily Several times per week Every three months in a stable patient As needed Blood glucose sampling No No (CBGM* may be used at home) No No Owner considerations Minimal Average Intermittent (every three months in a stable patient) Modest Intermediate/high High More frequent than a moderate program High *CBGM – Continuous blood glucose monitor insulin dose based on urine glucose measurements has fallen from favor in veterinary medicine. The veterinarian may nd urine testing results helpful for formulating a change in insulin dose; however, as with any results, these should be viewed in the context of other ndings.5 Glycated serum proteins Fructosamine is formed by a nonenzymatic glycation reaction between glucose 16 and serum proteins (especially albumin).6 Glycated proteins circulate for approximately the lifetime of the parent protein. Albumin, the principal glycated serum protein, has a lifetime in serum of about two weeks. The serum fructosamine level in dogs re ects the mean blood glucose level for the preceding two to three weeks.6 A dog with diabetes mellitus is likely to have an elevated serum fructosamine level if clinical signs have
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