Day-to-day variability of blood glucose concentration curves generated at home in cats with diabetes mellitus

Alt, Nina; Kley, Saskia; Haessig, Michael; Reusch, Claudia E

doi:10.2460/javma.230.7.1011

Cited by 41 publications

(33 citation statements)

References 21 publications

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“…[34][35][36]85 U s e o f b l o o d g l u c o s e c u r v e s BGCs can be very useful in the assessment of feline DM ( Figures 4 and 5), although they have limitations and there is considerable day-to-day variation in results, especially in cats with poor glycaemic control. 96 Compared with home BGCs, those performed in-clinic may either over-or underestimate glycaemic control (Figure 4), perhaps reflecting natural daily variation but also the influence of stress, variations in insulin dose and possibly variable food intake. 92 In-clinic BGCs should, therefore, be interpreted with great caution and in the light of the clinical data.…”

Section: Home Monitoring Of Blood Glucosementioning

confidence: 99%

ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats

Sparkes

Cannon²,

Church

et al. 2015

Journal of Feline Medicine and Surgery

110

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Practical relevance: Diabetes mellitus (DM) is a common endocrinopathy in cats that appears to be increasing in prevalence. The prognosis for affected cats can be good when the disease is well managed, but clinical management presents challenges, both for the veterinary team and for the owner. These ISFM Guidelines have been developed by an independent, international expert panel of clinicians and academics to provide practical advice on the management of routine (uncomplicated) diabetic cats. Clinical challenges: Although the diagnosis of diabetes is usually straightforward, optimal management can be challenging. Clinical goals should be to limit or eliminate clinical signs of the disease using a treatment regimen suitable for the owner, and to avoid insulin-induced hypoglycaemia or other complications. Optimising bodyweight, feeding an appropriate diet and using a longer acting insulin preparation (eg, protamine zinc insulin, insulin glargine or insulin detemir) are all factors that are likely to result in improved glycaemic control in the majority of cats. There is also some evidence that improved glycaemic control and reversal of glucose toxicity may promote the chances of diabetic remission. Owner considerations and owner involvement are an important aspect of management. Provided adequate support is given, and owners are able to take an active role in monitoring blood glucose concentrations in the home environment, glycaemic control may be improved. Monitoring of other parameters is also vitally important in assessing the response to insulin. Insulin adjustments should always be made cautiously and not too frequently -unless hypoglycaemia is encountered. Evidence base: The Panel has produced these Guidelines after careful review of the existing literature and of the quality of the published studies. They represent a consensus view on practical management of cats with DM based on available clinical data and experience. However, in many areas, substantial data are lacking and there is a need for better studies in the future to help inform and refine recommendations for the clinical management of this common disease.

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Section: Home Monitoring Of Blood Glucosementioning

confidence: 99%

ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats

Sparkes

Cannon²,

Church

et al. 2015

Journal of Feline Medicine and Surgery

110

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“…Cats with diabetes rarely achieve the levels of glycemic control considered satisfactory because of prolonged hyperglycemia that can last 20 to 24 hours after a single meal, and variability of the blood glucose concentration during the day (Rand 2006). Recent studies reported the considerable day-to-day variability in BGCs in diabetic cats, even when factors such as insulin dose and meal size remain constant and the cat is at home in a stress-free environment (Alt et al 2007). Causes of persistent day-to-day variability in glucose concentration include rate of insulin absorption when different sites are used, variation in the length of insulin activity, variation in insulin sensitivity among individuals, and variation of residual beta-cell function.…”

Section: Discussionmentioning

confidence: 96%

Glargine insulin and high-protein-low-carbohydrate diet in cats with diabetes mellitus

et al. 2008

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“…The theoretical advantages over performing the same procedure at the hospital include increased reliability of the results since there is no significant change of daily routine (feeding, exercise) or interference by the stress of hospitalization, and the reduced cost (Alt et al, 2007;Ford and Lynch, 2013). Serial blood glucose curves at the hospital suffer from day to day variation in both diabetic dogs and cats; their repeatability, even when performed on consecutive days, is that low that may result in opposite recommendations for adjustment of insulin dose (Alt et al, 2007;Ford and Lynch, 2013). However, even at the home environment day to day variation is also expected, although it is less problematic in well regulated diabetic animals (Alt et al, 2007).…”

Section: Home Monitoring Of Blood Glucose Concentrations By the Ownermentioning

confidence: 99%

“…Serial blood glucose curves at the hospital suffer from day to day variation in both diabetic dogs and cats; their repeatability, even when performed on consecutive days, is that low that may result in opposite recommendations for adjustment of insulin dose (Alt et al, 2007;Ford and Lynch, 2013). However, even at the home environment day to day variation is also expected, although it is less problematic in well regulated diabetic animals (Alt et al, 2007).…”

Section: Home Monitoring Of Blood Glucose Concentrations By the Ownermentioning

confidence: 99%

Update on insulin treatment of dogs and cats with non-complicated diabetes mellitus

Saridomichelakis

Chatzis

2018

J Hellenic Vet Med Soc

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ABSTRACT. Diabetes mellitus is a common endocrine disease of dogs and cats. Treatment is mainly based on insulin administration and dietary modifications. The aim of this review is to provide updated information on insulin treatment of dogs and cats with non-complicated diabetes mellitus. During the last years, there has been significant progress in the management of this disease, thanks to the use of long-acting insulin preparations that do not cause pronounced fluctuations of blood glucose concentrations (insulin glargin and detemir) and because of the widespread use of home glucose monitoring by the owners of diabetic pets. Home glucose monitoring is based on capillary blood sampling from the ear pinnae or the foot pad and measurement of blood glucose concentration with a portable blood glucose meter. This can be done periodically (e.g. every week) to replace the traditional in-clinic blood glucose curve; in this case, blood glucose concentration is measured just before the morning insulin administration and then every 1-2 hours until the next dose (usually for 12 hours). Furthermore, especially for the cat, home glucose monitoring can be performed 3-5 times per day, on a daily basis, in order to safely adjust insulin dose and achieve tight control of hyperglycemia (i.e. blood glucose concentration between 50 and 200 mg dl -1 throughout the day). The combination of dietary management, of insulin glargine or detemir administration and of the tight control of hyperglycemia has substantially increased the proportion of cats that enter into temporal or permanent diabetic remission and can be further managed without insulin. Another important achievement is the use of continuous glucose monitoring systems to monitor interstitial fluid glucose concentrations. These devices can be used in the clinic and at home and they can measure glucose concentration every 5 minutes for up to 72 consecutive hours, thus facilitating optimal adjustment of insulin treatment.

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Day-to-day variability of blood glucose concentration curves generated at home in cats with diabetes mellitus

Abstract: Considerable day-to-day variability was detected in BGCs generated at home. Cats with good glycemic control may have more reproducible curves generated during blood collection at home than cats with poorer control.

Cited by 41 publications

References 21 publications

ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats

ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats

Glargine insulin and high-protein-low-carbohydrate diet in cats with diabetes mellitus

Update on insulin treatment of dogs and cats with non-complicated diabetes mellitus

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