The following are my notes from a lecture given March 2005 by Dr.

o Collect urine with a long-handled cup holding device  Use mean or fasting blood glucose and serum fructosamine
Deborah S. Greco. Any inaccuracies contained within are entirely my o May use flat pie tin for collecting urine in female dogs to monitor
responsibility. Please note that this lecture covers both feline and  CATS  May be helpful in identifying hypoglycemia
canine diabetes. o Use plastic wrap over litter and then test urine with dip stick  Cats rarely Somogyi
o Glucotest™ granules in litter – measures various
Rebecca A. Price MD concentrations of glucose in urine, with stablility of 5-8 Glycated Blood Proteins (fructosamine, Hb A1c): Indications
3/24/05 hours  When strict glucose regulation is required
 In subclinical diabetes mellitus
Beyond Glucose Curves Urine Glucose Monitoring with Glucotest™  To differentiate stress hyperglycemia from true diabetes
Deborah S. Greco Begin animal on 2 U BID of insulin and use glucotest to monitor mellitus
The Animal Medical Center urine glucose  To assess long-term glucose regulation
 If glucotest is NEGATIVE for 2 days, decrease dose to 1 U BID
Goals of Insulin Therapy and continue glucotest Fructosamine Monitoring
 Resolution of clinical signs of diabetes! Results can indicate good, intermediate, or poor long-
 If glucotest is NEGATIVE for 2 days, decrease dose to 1 U SID
o Decreased PU/PD term control of blood glucose
and continue glucotest
o Decreased complications, e.g. neuropathy  If glucotest is NEGATIVE for 2 days, discontinue insulin. Reflects recent (1-3 weeks) changes in serum glucose
o Stable body weight concentrations
 Normal glycosylated hemoglobin (Hb a1c) , fructosamine Blood Glucose Curve In recent years, the lab reference values for “normal”
 Trace to 1 plus urine glucose  Feed same amount and type of food that animal receives at home fructosamine levels has risen! This probably indicates that
 Acceptable blood glucose curve or fasting blood glucose (FBG) prior to insulin injection more cats are diabetic and so the bell curve that indicates
 Take initial blood sample “normal” has shifted to include higher values. Twenty years
What does a monitoring parameter tell you?  Have owner administer insulin ago, the upper limit of normal for fructosamine in cats was
 Blood glucose curves  Assess owner injection technique about 100 units lower than today’s upper limit of normal.
o Helps determine dose of insulin There used to be a home fructosamine monitor made
 Take blood samples at two hour intervals for 12-24 hours
o Determines frequency of insulin administration (Duet, by the LXN Corporation) but it has been discontinued
o May identify Somogyi phenomenon Algorithm: Monitoring with serum fructosamine
Ideal Blood Glucose Curve
o Not useful for oral hypoglycemics Measure blood glucose (BG) and serum fructosamine
 You’ll NEVER get the ideal!
(FR) and use the numbers together to determine control of
 Serum fructosamine  Ideally, at the time halfway between shots (6 hours for BID diabetes:
o Helps determine dose of insulin shots), the blood glucose will reach its nadir, or lowest point.
o Determines owner compliance at home After the nadir, the BG will gradually rise until time for the FR<400 BG<180 Excellent control
o Can differentiate stress hyperglycemia from loss of regulation next shot of insulin. This “PS” (preshot) value will ideally be FR>400 BG<180 Owner non-compliance
o Monitoring parameter of choice for oral hypoglycemics the maximum BG and the same as the last PS at time 0.
 The difference between the maximum and minimum values FR<400 BG<60 Over regulation
Monitoring diabetics: Parameters obtained in a blood glucose curve is the GLUCOSE FR<400 BG>180 Stress induced
 Initial regulation DIFFERENCE, or variation. hyperglycemia
o Blood glucose curves o DOGS: The variation should be 100 mg/dl or less
o Urine glucose monitoring (first choice of Dr. Greco) o CATS: The variation should be 150 mg/dl or less FR>400 BG>180 Poor control
 Intermediate regulation
o Serum fructosamine Factors that affect accuracy of glucometers Problems with Fructosamine
o Fasting BG or mean blood sugar (from BG curve)  Whole blood concentrations are lower than serum glucose  Hypoglycemia and over-regulation may be hard to detect
 Long-term regulation  Altitude  Sometimes the fructosamine will remain high despite
o Fructosamine (glycosylated hemoglobin is a poor monitor in  Oxygen therapy resolution of clinical signs – ALWAYS BELIEVE
cats)  Patient hematocrit THE ANIMAL!
 Post prandial state  FALSE LOWS can occur with
Urine Glucose Monitoring  Out of date or improperly stored test strips o Hyperlipidemia
 Measures trends in blood glucose  Below 100-150 mg/dl, most glucometers are calibrated to read o Hyperthyroidism in cats (HT will raise fructosamine in
 Should NOT be used alone to adjust insulin dosages 20 mg/dl LOW! (So look to see if your cat is having dogs)
 Usually performed at home by owner symptoms.) o Hypoalbuminemia
 Not affected by stress
Blood Glucose Curves Diabetic Regulation: GHb (Hb A1c)
 May indicate insulin-induced hyperglycemia
 Generally not helpful in cats due to stress hyperglycemia (this Dependent on mean red blood cell lifespan (cats – 68 days,
refers to at vet glucose curves) dogs – 110 days)
 DOGS

Beyond Glucose Curves 1

More useful for long-term monitoring in well-regulated diabetics
Use for biannual “check-ups” on diabetic
May correlate better with long-term complications such as cataracts
(dogs) and neuropathy (cats)

Glycosylated Hemoglobin
Level of GHB is directly related to degree of hyperglycemia
Relfects glycemic control over the previous 110 days (dogs) or 68
days (cats)

GHB Normal Values

 Normal dogs: 2.9 (0.2)%
o Range 1.8-4.9%
 Diabetic dogs: 5.0 (0.6)%
o Well-regulated - <6.5%
 Normal cats: 1.6 (0.5)%
o Range 0.9-2.5%
 Diabetic cats: 3.0 (0.8)%
o Range 1.3-4.1%

Note the overlap in the ranges for normal cats and diabetic cats. This
overlap makes GHB less valuable for monitoring in cats.

Monitoring diabetics using GHB

Measure GHb:

GHb >7.5% dog

>3.0% cat
Poor control

Assess fructosamine or BG curve

GHB <6.5% dog

<2.5% cat
Excellent control
Continue current regimen

Beyond Glucose Curves 2