Veterinary Medicine - September 2007 - (Page 610)

Diabetes management O P E E R - R E V I E W E D FIGURE 3 Monitoring diabetic cats receiving glargine Check the blood glucose concentration before glargine administration. If the glucose concentration is 360 mg/dl, increase the dose by 0.5 U. Evaluate for diabetic remission. Check the glucose concentration four, eight, and 12 hours after insulin administration, and identify the nadir glucose value. If the glucose nadir is 180 mg/dl, increase the dose by 0.5 U. Repeat the glucose curve weekly for the first month and then every six weeks. In-clinic monitoring Serial glucose assays provide the most detailed evaluation of a patient’s response to insulin. Food and insulin should be given on the usual schedule, and blood should be drawn for glucose measurement every two hours. If the glucose drops precipitously, more fre- quent monitoring may be necessary to identify the nadir. For patients receiving once-daily insulin, the glucose curve should be continued for 24 hours; for patients receiving twice-daily therapy, it is acceptable to measure glucose concentrations over 10 to 12 hours. Checking the glucose concentration every FIGURE 4 Are serum fructosamine assays sufficient to monitor glycemic control? If the responses to all of the following questions are “No,” a serum fructosamine concentration can be performed in place of a serial blood glucose measurement. A single “Yes” response suggests poor control of the diabetes, so a glucose curve is indicated. No Yes J J J J J J J J J J J J Is unexplained weight loss noted? Is the patient drinking excessively? Does the patient get up at night to urinate? Does the patient urinate in the house? Is the patient excessively hungry? Is the patient ever weak or disoriented? four hours is generally sufficient in patients receiving glargine since glargine has a slow onset of action (Figure 3). Ideally, blood glucose concentrations should stay within the normal range, but this rarely occurs. As veterinary patients do not suffer from the retinal, renal, and vascular complications seen in people, blood glucose concentrations do not need to be as rigidly controlled. However, even mild persistent hyperglycemia can cause cataracts (in dogs) and peripheral neuropathy (in cats). Hypoglycemia should be avoided, and prolonged or extreme hyperglycemia is undesirable. As a general rule, if the lowest blood glucose concentration recorded in the clinic is < 70 mg/dl, the insulin dose should be reduced by 25%. If the glucose concentration is more than 250 mg/dl on two or more readings, a 10% increase in insulin is appropriate. It is important to remember that acute and severe hypoglycemia can trigger rebound hyperglycemia (the Somogyi effect), so never use a single high glucose measurement as an indication to increase the insulin dose. 610 September 2007 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - September 2007

Contents Letters Leading Off The Veterinary Medicine Interview: Dr. William J. Kay Idea Exchange Practical Matters Salivary Mucoceles in Cates: A Retropspective Study of Seven Cases Hyperlipidemia in Dogs and Cats Purina Insert The Latest Management Recommendations for Cats and Dogs with Nonketotic Diabetes Mellitus CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - September 2007

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