Veterinary Medicine - May 2008 - (Page c17) Strategies for monitoring diabetes mellitus in dogs been present for longer than three to four days. The fructosamine concentration should decrease with successful therapy, and monitoring serum fructosamine levels is an e ective way to evaluate glycemic control and response to insulin in diabetic dogs;6 however, the fructosamine level can be a ected by concurrent conditions. Low serum fructosamine levels are found in as many as 70% of nondiabetic dogs with hypoproteinemia or hypoalbuminemia, as well as in dogs with hyperlipidemia and azotemia.7 Glycated hemoglobin, a complex of glucose and hemoglobin, is formed similarly to fructosamine. Because of the longer serum lifetime of hemoglobin, glycated hemoglobin re ects glycemic control over the previous ve to nine weeks.1 Because of its widespread availability and ability to provide a more clinically relevant window into glycemic history, the serum fructosamine test is preferred over the glycated hemoglobin test in veterinary medicine. Blood glucose monitoring Blood glucose monitoring is the de facto gold standard for determining daily insulin requirements in clinical patients; however, it is a poor method in many cases. Information about insulin e ectiveness, onset of action, time to peak e ect, peak e ect, and duration of action can be derived from a properly performed glucose curve, but the method is fraught with potential error. Several options for patient glucose monitoring are available to veterinarians. The traditional blood glucose curve involves frequent glucose sampling (as often as hourly) of a hospitalized patient. New technology designed for continuous glucose monitoring has been employed in recent years and may prove superior to intermittent sampling.8 Home glucose monitoring, in which owners obtain and analyze samples, is another option for obtaining blood glucose information.9,10 One study showed that about 85% of dog owners successfully performed longterm home glucose monitoring and reported little or no di culty performing the procedure.11 Protocols for at-home glucose monitoring in dogs have been presented in detail elsewhere.10,12 At least three sources of variability can a ect a glucose curve: human error, variability in technology, and biological variability. Human error can be minimized when trained personnel perform the technique, the technology is easy to use, and minimal interventions are required to complete the testing. Veterinary studies have shown that many commercial glucometers designed for use in people are accurate enough for clinical use in dogs and cats; however, some models have performed much better than others.13 Some companies make glucometers designed for use in dogs and cats (see Reliable glucometers, page 18). When glucometers from di erent manufacturers were compared in dogs, the results of a single blood glucose determination would have led to an inappropriate therapy change up to 20% of the time for the most accurate units highlighting the variability inherent in technology.13 Another study examined the variability of serial glucose curves in diabetic dogs.14 Paired glucose curves from the same dog (two 12-hour glucose curves obtained 24 hours apart) were examined to determine variability in important glucose curve parameters (e.g., minimum, maximum, and mean blood glucose concentrations, time from injection to nadir). The signi cant confounding e ect of variability on clinical decision making was readily demonstrated by the nding that treatment recommendations made after “At least three sources of variability can a ect a glucose curve: human error, variability in technology, and biological variability.“ 17
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