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Investigation and management of unstable diabetics
/content/chapter/10.22233/9781910443866.chap25
Investigation and management of unstable diabetics
- Author: Federico Fracassi
- From: BSAVA Manual of Canine and Feline Endocrinology
- Item: Chapter 25, pp 227 - 242
- DOI: 10.22233/9781910443866.25
- Copyright: © 2023 British Small Animal Veterinary Association
- Publication Date: August 2023
Abstract
This chapter emphasizes the importance of achieving good quality of life for diabetic animals and their owners by eliminating clinical signs, preventing complications and maintaining stable bodyweight. Topics covered include insulin therapy, diet, exercise, insulin resistance and the use of continuous glucose monitoring systems. The chatrovides practical advice on managing common causes of instability in diabetic animals, such as issues with insulin administration and concurrent disorders.
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Figures
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25.4
Blood glucose curves in a 10-year-old diabetic neutered female Domestic Shorthaired cat weighing 5.4 kg. The red curve indicates the blood glucose values when the cat was receiving veterinary porcine lente insulin (2.5 IU/cat twice a day). It is evident that the blood glucose values decrease to within the desired range (5–14 mmol/l) for only a few hours and then increase. The reason is a short duration of insulin action. In this cat, switching to insulin glargine (3 IU/cat twice a day) led to a marked improvement in the duration of the effect (green curve). © 2023 British Small Animal Veterinary Association
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25.4
Blood glucose curves in a 10-year-old diabetic neutered female Domestic Shorthaired cat weighing 5.4 kg. The red curve indicates the blood glucose values when the cat was receiving veterinary porcine lente insulin (2.5 IU/cat twice a day). It is evident that the blood glucose values decrease to within the desired range (5–14 mmol/l) for only a few hours and then increase. The reason is a short duration of insulin action. In this cat, switching to insulin glargine (3 IU/cat twice a day) led to a marked improvement in the duration of the effect (green curve).
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25.5
Continuous glucose measurement carried out using the Freestyle Libre over 2 days in a healthy 5-year-old mixed-breed male dog. Glycaemic variability is almost absent. © 2023 British Small Animal Veterinary Association
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25.5
Continuous glucose measurement carried out using the Freestyle Libre over 2 days in a healthy 5-year-old mixed-breed male dog. Glycaemic variability is almost absent.
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25.6
Continuous glucose measurement carried out using the Freestyle Libre in a 12-year-old neutered male Yorkshire Terrier with diabetes mellitus. The dog is given its meal and porcine lente insulin (3.5 IU) in the morning (8 am) and in the evening (6 pm). The curve shows glucose fluctuations (glycaemic variability) that are larger than those in healthy dogs (see
Figure 25.5
), but that can be considered appropriate for a diabetic animal. © 2023 British Small Animal Veterinary Association
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25.6
Continuous glucose measurement carried out using the Freestyle Libre in a 12-year-old neutered male Yorkshire Terrier with diabetes mellitus. The dog is given its meal and porcine lente insulin (3.5 IU) in the morning (8 am) and in the evening (6 pm). The curve shows glucose fluctuations (glycaemic variability) that are larger than those in healthy dogs (see
Figure 25.5
), but that can be considered appropriate for a diabetic animal.
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25.7
Continuous glucose measurements carried out using the Freestyle Libre over 4 days in an 8-year-old neutered male diabetic dog. Each day, the dog is given the same type and amount of food at the same time; the insulin type (porcine lente), time and amount is also kept consistent. High glycaemic variability is evident. © 2023 British Small Animal Veterinary Association
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25.7
Continuous glucose measurements carried out using the Freestyle Libre over 4 days in an 8-year-old neutered male diabetic dog. Each day, the dog is given the same type and amount of food at the same time; the insulin type (porcine lente), time and amount is also kept consistent. High glycaemic variability is evident.
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25.8
Continuous glucose measurements carried out using the Freestyle Libre in an 11-year-old neutered mixed-breed bitch weighing 6.1 kg with diabetes mellitus. The dog is given its meal and porcine lente insulin (4 IU) in the morning (7:30 am) and in the evening (7:30 pm). Post-hypoglycaemic hyperglycaemia is evident. © 2023 British Small Animal Veterinary Association
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25.8
Continuous glucose measurements carried out using the Freestyle Libre in an 11-year-old neutered mixed-breed bitch weighing 6.1 kg with diabetes mellitus. The dog is given its meal and porcine lente insulin (4 IU) in the morning (7:30 am) and in the evening (7:30 pm). Post-hypoglycaemic hyperglycaemia is evident.
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25.11
An 11-year-old neutered mixed-breed bitch. (a) After 5 months of treatment for diabetes mellitus with poor control, the dog exhibited weight loss, severe polyuria, polydipsia, polyphagia, cataracts, alopecia, and persistently high blood glucose and fructosamine concentrations despite increased insulin doses. (b) A diagnosis of concomitant hypercortisolism and treatment with trilostane twice a day resulted in resolution of the clinical signs and marked improvement in glycaemic control. © 2023 British Small Animal Veterinary Association
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25.11
An 11-year-old neutered mixed-breed bitch. (a) After 5 months of treatment for diabetes mellitus with poor control, the dog exhibited weight loss, severe polyuria, polydipsia, polyphagia, cataracts, alopecia, and persistently high blood glucose and fructosamine concentrations despite increased insulin doses. (b) A diagnosis of concomitant hypercortisolism and treatment with trilostane twice a day resulted in resolution of the clinical signs and marked improvement in glycaemic control.
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25.12
A 10-year-old neutered Labrador Retriever bitch that had been undergoing treatment for diabetes mellitus for 1 year with poor control of the disease. (ai–iii) When referred, the dog exhibited weight loss, severe polyuria, polydipsia, lethargy, cataracts, alopecia, and persistently high blood glucose and fructosamine concentrations despite receiving 22 IU of porcine lente insulin twice a day. (bi–iii) A diagnosis of concomitant hypothyroidism and treatment with levothyroxine resulted in the resolution of the majority of clinical signs after 2 months. At that time, the dog had achieved a marked improvement in glycaemic control and required a lower insulin dose (19 IU of porcine lente insulin twice a day). © 2023 British Small Animal Veterinary Association
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25.12
A 10-year-old neutered Labrador Retriever bitch that had been undergoing treatment for diabetes mellitus for 1 year with poor control of the disease. (ai–iii) When referred, the dog exhibited weight loss, severe polyuria, polydipsia, lethargy, cataracts, alopecia, and persistently high blood glucose and fructosamine concentrations despite receiving 22 IU of porcine lente insulin twice a day. (bi–iii) A diagnosis of concomitant hypothyroidism and treatment with levothyroxine resulted in the resolution of the majority of clinical signs after 2 months. At that time, the dog had achieved a marked improvement in glycaemic control and required a lower insulin dose (19 IU of porcine lente insulin twice a day).
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25.13
Application of the Freestyle Libre in dogs. (a) Shave a rectangular area at the level of the dorsal portion of the neck, at the point where there are fewer skin folds. The area must be large enough to allow the application of the sensor and a protective adhesive patch. Cleanse the shaved skin with chlorhexidine and alcohol, then dry with a clean gauze. (b) Assemble the sensor: open the sensor box by completely removing the cap and unscrew the cap from the sensor applicator. (c) Align the dark mark on the sensor applicator with the dark mark on the sensor box. Press firmly on the sensor applicator until a confirmation click is heard. (d) Place the sensor applicator on the clean shaved area. (e) Press firmly on the skin. Gently remove the sensor applicator from the neck. Check that the sensor is correctly positioned. (f) Apply an adhesive patch covering the sensor and the skin around it. (g) Apply a protective bandage with cotton and a cohesive layer to the area and take the first scan with the reader. © 2023 British Small Animal Veterinary Association
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25.13
Application of the Freestyle Libre in dogs. (a) Shave a rectangular area at the level of the dorsal portion of the neck, at the point where there are fewer skin folds. The area must be large enough to allow the application of the sensor and a protective adhesive patch. Cleanse the shaved skin with chlorhexidine and alcohol, then dry with a clean gauze. (b) Assemble the sensor: open the sensor box by completely removing the cap and unscrew the cap from the sensor applicator. (c) Align the dark mark on the sensor applicator with the dark mark on the sensor box. Press firmly on the sensor applicator until a confirmation click is heard. (d) Place the sensor applicator on the clean shaved area. (e) Press firmly on the skin. Gently remove the sensor applicator from the neck. Check that the sensor is correctly positioned. (f) Apply an adhesive patch covering the sensor and the skin around it. (g) Apply a protective bandage with cotton and a cohesive layer to the area and take the first scan with the reader.
/content/figure/10.22233/9781910443866.chap25.fig25_14
25.14
A 12-year-old neutered male English Setter with diabetes mellitus. (a) The dog is being monitored using the Eversense XL. The graphs obtained from the device software show (b) the glucose ranges recorded for 60 days and (c) the seven glucose curves recorded in a week (each day is represented by a different colour). © 2023 British Small Animal Veterinary Association
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25.14
A 12-year-old neutered male English Setter with diabetes mellitus. (a) The dog is being monitored using the Eversense XL. The graphs obtained from the device software show (b) the glucose ranges recorded for 60 days and (c) the seven glucose curves recorded in a week (each day is represented by a different colour).