Veterinary Medicine - May 2008 - (Page c18) Reliable glucometers Commercial glucometers that can accurately monitor blood glucose information in animals include: • ALPHAtrak (Abbott) • AccuCHEK (Roche Diagnostics) • Glucometer ELITE (Bayer). examination of each single curve in the pair did not agree in 45% of dogs. In dogs where analysis of individual curves resulted in recommendations that did not agree, the recommendations were exactly opposite 65% of the time (e.g., one curve indicated an increase in insulin dose was needed and its paired curve indicated a dose decrease was needed).14 Variability in blood glucose curves is likely to be a factor regardless of the method used to generate them. In people, day-to-day insulin absorption and activity are highly variable (15% to 50%) even under carefully controlled experimental conditions.15 This is thought to represent true biologic variability. Presumably, similar biologic variability is present in dogs. General health Complete diabetic monitoring involves careful attention to the patient’s overall health. Diabetes is a risk factor for cataract formation, urinary tract infection, and neuropathy in dogs.16 Concurrent disorders are relatively common in diabetic dogs, including pancreatitis, renal failure, endocrinopathy (e.g., hyperadrenocorticism or hypothyroidism), or neoplasia.16,17 Veterinarians should perform periodic evaluation and appropriate testing for disorders that may complicate diabetes as part of their diabetic monitoring regimen. Personal perspective Current veterinary literature does not conclusively support any one or a combination 18 of methods to monitor canine diabetics. In my opinion, the recommended program should yield as much objective information about the level of blood glucose regulation and diabetes control as possible, yet it must be exible enough to accommodate the needs of individual patients and owners. Individual cases may require a lesser or greater level of routine monitoring to achieve clinical success. My preferred monitoring approach relies primarily on the results of periodic examination and owner-provided observations and includes the results of at-home urine testing. Observations recorded by the owner include daily assessment of appetite, activity level, water consumption, urine frequency and volume, and weekly measurement of body weight, if possible. I provide test strips and ask owners to perform twice weekly urine testing for glucose and ketones. I don’t permit any adjustment in the insulin dose based on urine test results. Owners are provided with speci c instructions about when it is necessary to contact the veterinarian. These scenarios include changes in the dog’s overall health, decrease in appetite or activity, increase in the degree of polydipsia or polyuria, increase in the amount of glucosuria, absence of glucosuria, and appearance of any degree of ketonuria. I recommend weekly recheck examinations immediately after the diagnosis but gradually extend them to every three months as the diabetes is controlled. I perform laboratory tests as needed at each recheck, especially if concurrent problems are also being managed. The serum fructosamine level may be helpful for documenting trends in diabetic control or when the owner cannot supply pertinent patient information. A glucose curve can be helpful, especially if hypoglycemia is suspected. However, recent
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.