Monitoring feline diabetic patients (Proceedings)

Start Insulin Therapy…Now What?

      1. General Guidelines

           a. 4-6 weeks for control

           b. 7-10 days for animal to adjust to insulin

           c. Insulin requirements will be higher at home

           d. No need to hospitalize if stable

           e. Adjust therapy to owner

               i. Frequency of insulin administration

                ii. Frequency of monitoring

      2. Monitoring Parameters

           a. Ketodiasticks

               i. Call if 2 or more negative glucose readings

                ii. Check urine 4-8 hours after insulin

                iii. Hypoglycemia

                iv. Ketonuria

           b. Home Blood Glucose Monitoring

                i. Blood sampling sites

                     1. Ear pinnae

                     2. Foot pads

                     3. Gums

                ii. Blood glucose monitors

                     1. Which to choose – human or veterinary (alpha-trak)

                iii. Blood Sampling

                     1. Curl pinna back over gauze

                     2. Warm in hands

                     3. Vaseline

                iv. First Week

                     1. Spot checks

                     2. No hypoglycemia

           c. Physical examination

               i. Resolution of clinical signs

                     1. PU/PD

                     2. Polyphagia

           d. Fructosamine

                i. Fructose + albumin

                ii. Average serum glucose for previous 2-3 weeks

                iii. R/O stress hyperglycemia

                iv. Stable diabetics

                v. Not appropriate for unstable diabetics

                vi. Somogyi effect

      3. The Glucose Curve

           a. Information you cannot get any other way

           b. Insulin information

                i. Onset of action

                ii. Duration of action

                iii. Time of peak action

                iv. Nadir

           c. Tells you

                i. Type of insulin

                ii. Dose of insulin

           d. Do glucose curves on

                i. Difficult to regulate patients

                ii. Suspected cases of insulin resistance

                iii. Suspected Samogyi effect

           e. When to do glucose curves

                i. 7-10 days after insulin change

           f. Why glucose curves don't work

                i. May need at 48 hrs to get an accurate curve

                ii. Stress

                iii. Post-insulin overdose (hypoglycemia)

           g. How To's

                i. Blood Q 2 hours

                ii. Minimize stress

                     1. Sampling catheters

                     2. Home generated

                     3. At Home Monitoring

      4. Interstitial Glucose Monitoring

           a. A more accurate glucose curve

           b. Used in human medicine since 2000

           c. Standard of care

           d. Flexible electrode

           e. Glucose oxidase

           f. Implanted subcutaneously

           g. 72 hours

           h. Minimed Guardian system

                i. Intersitial glucose sensor implanted

                ii. Attached transmitter

                iii. Interstitial glucose measured q 5 min

                iv. Information transmitted wirelessly

                v. Receiver within 6 feet

                vi. Can be separated 45 min

           i. Real Time Glucose Monitoring

                i. Components

                     1. Tiny glucose sensor

                     2. Radiotransmitter

                     3. Monitor updates blood glucose measurement q 5 minutes

                     4. Beeps when outside BG parameters

           j. Problems

                               i. Measures blood glucose 40-400 mg/dl

                               ii. Calibrate q 12 hours