How do I adjust the insulin dose according to blood sugar levels?
How do I adjust the insulin dose according to blood sugar levels?
A blood glucose curve is periodic testing of the blood sugar levels to see what effect the insulin is having. The values will ALWAYS vary; you are looking for values outside of acceptable ranges, which will be approximately 100-200 or maybe up to 300 depending on your cat.
In the initial stages of therapy the usual recommendation is to test blood glucose (BG) three to four times per day. See the section on urine testing for suggestions on when this testing should occur. After regulation has been achieved, routine tests before the morning meal two to three times weekly will be enough to let you know if your pet is staying regulated.
BE VERY CAUTIOUS WHEN MAKING CHANGES IN YOUR CAT'S INSULIN DOSE WITHOUT CONSULTING YOUR VETERINARIAN. My recommendation is to always consult a veterinarian before making a change. Also, once a dose change is made, give your cat 3 to 4 days to adjust to the new dose before considering another change.
Here are some rough guidelines:
- If ALL of the BG readings are HIGH, an approximate 10% INcrease in the insulin dose can be made.
- If ALL of the BG readings are LOW, an approximate 10% DEcrease in the insulin dose can be made. If your cat is symptomatic, the dosage may be reduced further.
- If the readings are HIGH only before insulin is given (or around the time of the morning meal) OR at the time the insulin duration is almost over, do NOT change the dose.
- If the readings are HIGH at BOTH the morning and evening readings, consider Somogyi effect and DECREASE the amount of insulin.
To determine the dosing interval or the type of insulin given, evaluate the peak time.
If the peak time is:
- <5>
- 5-8 hours continue b.i.d. (2/day) administration.
- >8 hours change to s.i.d. (1/day) administration.
To determine the dose of insulin or if dysregulation is a problem, evaluate the nadir and range midpoint.
If the nadir is <>
The ideal range midpoint is 200 mg/dI, and 150-250 mg/dl is acceptable. If the range midpoint is:
- <150>
- 150-250 mg/dl, don't change the dose.
- >250 mg/dI, several possibilities exist:
- The cat may have been stressed when the blood glucose curve was performed.
- The Insulin dose may be too low.
- There may be an insulin problem (inactive insulin, insulin not mixed property, poor injection technique, poor absorption).
- Insulin resistance may be occurring due to concurrent disease (systemic Illness, hyperthyroidism, hyperadrenocorticism, acromegaly) or insulin antibodies.
*Based on twice-daily dosing of insulin.
**The nadir also should be below 100 mg/deciliter.
Adjusting Insulin Dosages Using Urine Strip Results
|
|  | ||||||
 | | |||||||
| |
Adjusting Insulin Dosages Using Urine Strip Results
Some people prefer to check glucose levels in their cats by testing the urine. When blood glucose levels get too high, the kidneys cannot filter all of this and glucose "spills" into the urine. Guidelines indicate that glucose will spill into the urine when blood glucose levels are above 220 mg/dl. Individual cats will have different levels based on age, kidney damage, and other factors. When the blood glucose is within the normal range, no glucose will show up in the urine.
Although this method of monitoring means you can do it at home without sticking your cat for a blood sample, there are some problems.
-
There is a "lag" before the glucose shows up in the urine. This means that if you see glucose in the urine, they may reflect a high blood glucose several hours before, not necessarily currently. However, if you have glucose show up in the urine every time you test, you can be pretty sure that your cat needs an insulin dose adjustment.
-
Also, please be aware that urine strips cannot tell you if your animal is becoming HYPOglycemic (blood sugar too low) and needs a lower insulin dose. Hypoglycemia can be fatal or induce neurological damage.
Once your pet is well regulated, you may want to consider switching to home blood glucose testing. As always, please consult with your veterinarian.
In the initial stages of therapy the usual recommendation is to test three times per day. After regulation has been achieved, routine tests before the morning meal two to three times weekly will be enough to let you know if your pet is staying regulated.
Suggested times for doing urine glucose tests are
-
Directly before the morning meal (e.g. 7-8 a.m.)
-
Around the time of the 2nd meal (e.g. 3-4 p.m.)
-
In the evening when the insulin action declines (familiarize yourself with the insulin curves for your particular type of insulin so you will know when to expect this decline, usually 9-10 p.m. if you give an insulin shot in the morning)
From the results of urine strips, the insulin dose can be adjusted. PLEASE DO NOT MAKE RADICAL CHANGES IN YOUR CAT'S INSULIN DOSE WITHOUT CONSULTING YOUR VETERINARIAN. Also, once a dose change is made, give your cat 3 to 4 days to adjust to the new dose before considering another change.
| Urine Glucose Test Strips | |||
| Results | |||
| Time 1 | Time 2 | Time 3 | Assessment & Adjustment of dose |
| trace | - | - | none: correct dose |
| trace | - | + | none: correct dose |
| + | - | - | none: correct dose |
| + | + | + | +10%: dose too low |
| - | - | - | -10%: dose too high |
| + | - | + | -20%: Somogyi effect |
Tips:
I've seen 2 non-invasive, non-technically challenging ways to easily collect a feline urine sample.
1) Place the kitty litter pan (kitty litter and all) into a plastic garbage bag and tie the bag shut. Place the bagged box back to its normal location and wait. Most cats can still feel the litter through the plastic and accept it as the place to do their business. This results in a nice tidy pool of urine on to of the plastic (unless kitty claws through the bag, double-bagging or a few tries might be needed).
2) Replacing the kitty litter with clean aquarium gravel on testing days.
We've recently started using the first method for owners to collect urine from their cats at home to bring in for urinalysis (mainly to recheck infections and crystals), and fractious cats that would sooner perform blood samples on the staff than allow us to obtain a urine sample without sedation. It works quite well for stick and spindown urinalysis where environmental contaminants are not a major concern. We use human urine sticks for animal tests, which include glucose, so human sticks should be sufficient.
Pet Health: BG Monitoring
|
| | ||||||
| | |||||||
| |
G.D. Norsworthy, DVM, Dipl. ABVP
Acres North Animal Hospital
San Antonio, Texas
The glucose curve is the most effective way to monitor insulin therapy in diabetic cats. But curves are expensive, and many consider euthanasia because of the high cost. In such cases, here are some practical, less expensive alternatives.
From the November 1995 issue of Veterinary Medicine (a peer-reviewed journal)
Diabetes Mellitus in cats is one of the most frustrating diseases faced by veterinarians. Diabetic cats have certain peculiarities not seen in dogs, including the marked effect of stress on glucose concentrations. In addition, a cat's response to insulin is much less predictable than a dog's. We know, in general, what to expect from the different types of insulin. But the same type of insulin may be absorbed and metabolized differently from one cat to the next.
The standard glucose curve and its alternative
A glucose curve is a series of blood glucose determinations made after a dose of insulin is given. Typically, blood samples are taken every 1 1/2 to 2 hours until the effects of the insulin injection can be determined. For ease of understanding, they are often plotted on a graph (Figures 1 & 2).
I use the term "mini-glucose curve" to describe blood glucose determinations made just before an insulin injection is given and at the previously determined peak time This two-point curve should identify the highest and lowest, or peak and trough, blood glucose concentrations. As described below, in certain situations, the mini-glucose curve is a useful substitute for the full glucose curve.
 |
Fig 2. This glucose curve is not suitable. The highest point is 380 mg/deciliter. The nadir is 160 mg/deciliter. The range is 160 to 380 mg/dl, and the range midpoint is 270 mg/deciliter. The peak time is at 4 p.m., or eight hours after the insulin injection. Three blood glucose determinations were made after the nadir, but the concentrations at 4 p.m. and 4:30 p.m. were so similar that it was decided that two subsequent determinations should be made after those two values to verify that the slope was rising. Based on these results, the type of insulin is correct because the peak time occurs eight hours after the insulin injection. The insulin dose be increased because the midpoint of the range is 270 mg/dl and the nadir is not below 100 mg/deciliter. |
Indications for a blood glucose determination
There are three indications for determining blood glucose concentrations:
- To establish initial insulin protocol at the time of diagnosis
- To monitor the degree of regulation and
- To rule in or out rebound hyperglycemia.
Initial regulation
The first indication for a glucose curve is to establish the insulin dose dosing interval, and insulin type during the initial regulation process. The conventional way to regulate a diabetic cat is to choose an insulin type dose, and dosing interval; adjust insulin for at least three days; and perform the glucose curve. If the results indicate that any of these variables is inappropriate, the regimen is altered. The new regimen is then used for at least three more days and the glucose curve is repeated. It is not unusual for three to five glucose curves to be performed before a satisfactory regimen is determined.
Because of the expense of performing multiple glucose curves, many owners are unable to afford the initial regulation process. In lieu of that many diabetic cats are euthanatized. To avoid this unfortunate situation, I have developed an alternative approach in cats that have received the initial conservative dose of insulin and are still consistently showing signs of diabetes, including polyphagia and polyuria. The initial dose is presumed to be inadequate if the blood glucose concentration just before insulin administration is greater than 350 rng/deciliter. In such cases, the serial blood glucose determination is discontinued. The insulin concentration is increased by 10 to 20% and administered for at least three more days, when the cat is returned for another full glucose curve. This process is repeated until the initial blood glucose concentration is below 350 mg/ deciliter. At this time, a full glucose curve is performed.
The goal for regulating a diabetic cat is to keep the blood glucose concentration between 100 and 300 mg/dl throughout the day. If the blood glucose concentration at the time of diagnosis is less than 400 mg/dI, insulin is begun at 1/4 unit/lb given subcutaneously twice daily. An intermediate or long-acting insulin is given. If the blood glucose is more than 400 mg/dI, 1/2 unit/lb is given twice daily.
Monitoring regulation
The second indication for a glucose curve is to monitor a diabetic patient's level of regulation. A glucose curve should be performed at regular intervals as determined by the attending veterinarian (usually every three to six months). A full glucose curve should be performed whenever signs of diabetes or dysregulation occur (erratic fluctuations in clinical signs or behavior from one day to the next). However, if the cat is presented for a routine follow-up and appears well regulated or if there are serious financial constraints that prevent a full glucose curve, I often perform a mini-glucose curve. I recognize that there is some variation in glucose curves from one day to the next, which limits the effectiveness of the mini-glucose curve. But financial constraints often become such an important factor with many owners of diabetic cats that a less expensive alternative to a full glucose curve is often a necessary option.
Documenting rebound hyperglycemia
The third indication for a glucose curve is when rebound hyperglycemia is a consideration. This phenomenon occurs when blood glucose declines to life-threatening concentrations, generally below 65 mg/ deciliter. In response to this crisis, gluconeogenesis and glycogenolysis occur, resulting in glucose formation. The blood glucose concentration rises quickly, but the cat is unable to produce the appropriate amount of insulin because it is diabetic. Within a few hours, the blood glucose concentration may exceed 600 mg/dl and produce the classic signs of diabetes that occur in response to hyperglycemia.1 The best way to document this occurrence is with a full glucose curve. In this situation, the use of the mini-glucose curve is inappropriate.
Contraindications for blood glucose determinations
The primary contraindication for performing a glucose curve is a very fractious cat. Because of the stress response that occurs in cats, blood glucose determinations in such cats are very inaccurate. Sometimes, this situation can be managed by hospitalizing the cat for a few days to acclimate it to the hospital environment. During this time, the cat should be isolated from the sights and sounds of dogs and other cats. The hospital staff should make concerted efforts to befriend the cat. It should be petted, stroked, and talked to in an effort to ease its fear.
Another approach that may work is to do the glucose curve on an outpatient basis. This is successful only if the owner lives nearby and the cat does not become agitated by riding in the automobile. In such cases, the cat is presented for blood collection and taken home. This process is repeated until the glucose curve is completed. The reception staff should be told that this patient should not be kept waiting in the reception area, especially if dogs or other cats are there. Upon arrival, the owner and cat should be sent directly to a quiet, closed examination room, and the blood sample should be taken quickly with as little stress and restraint as possible.
The other contraindication for a glucose curve is the concurrent administration of any drug that would affect glucose concentrations. These drugs include dextrose, glucocorticoids, and progesterones. There is little reason for doing a glucose curve when a cat is receiving intravenous dextrose. Glucocorticoids and progesterones are contraindicated in diabetic cats.
The glucose curve is the beat tool we have to understand how a diabetic cat reacts to any given type and dose of insulin. However, it is not infallible. Great emphasis should also be placed on the cat's total clinical picture. If the cat is maintaining proper weight or gaining weight and is not polydipsic, polyuric, or polyphagic, its state of regulation should be considered adequate regardless of the results of the glucose curve.
The steps in the procedure
The cat should be fed immediately before leaving home. Upon arrival at the hospital, the owner should be escorted directly to an examination room, or the cat immediately admitted to minimize waiting. The first blood sample should be taken without delay. It is important that this step not be skipped because, generally, this sample will yield the highest concentration on the glucose curve - a value you need to know and record. This approach differs from the standard recommendation of fasting the cat until after the first blood sample is taken and the insulin is administered. I prefer this approach because of the difficulty I have getting the cat to eat the proper food in the amount that it would at home. If the owner cannot bring the cat to the hospital immediately after feeding it (e.g. because it eats at 6 a.m. and your hospital does not open until 8 a.m.), the conventional approach should be taken.
I prefer using the cephalic vein when collecting blood for a glucose curve. Use of a small tourniquet, alcohol to wet the hair, a 25-ga. needle, and a heparinized syringe will permit repeated blood collections from most cats, I take my first sarnple from the right cephalic vein just above the carpus. Subsequent samples are taken from alternating legs and slightly proximal to the previous one. By using this rotational pattern, 10 samples or more can be taken in one day from most cats. Other clinicians prefer the jugular or femoral vein. I find the jugular vein harder to see without clipping hair, which most clients find objectionable. The femoral vein is much smaller than the cephalic and tends to form hematomas very easily. However, in some cats it is necessary to use a combination of all of these.
Some clinicians prefer to place a jugular catheter so that multiple blood samples can be taken without repeated venipuncture. The advantages of this approach are that blood collection is very easy and inflicts minimal or no stress on the patient. The disadvantages are the cost and technical difficulty of placing this type of catheter.
Treating a diabetic cat for several years may require that several hundred blood samples be taken. Because of the small size and limited number of accessible veins in cats, it is important that you minimize trauma to the veins. Generally, I do not place a cephalic catheter in a nonketoacidotic diabetic cat because an intravenous catheter will render the vein unusable for blood collection for several days to weeks. To minimize hematoma formation, I cover the venipuncture sites with tape after each sample. Another disadvantage of using the jugular or femoral vein is the inconvenience of applying appropriate pressure; these veins should receive direct pressure for five minutes or more to avoid hematomas.
Next, insulin is given. It should be the same dose and type as has been used for the last three days. It is highly preferable to have the owner bring his or her bottle of insulin to prevent adding another possible variable.
The blood glucose is then measured every 1 1/2 to 2 hours until the nadir (the lowest point on the glucose curve) is reached. After that, one or two blood glucose determinations are made to be sure that the blood glucose is on the increase. The second sample is taken because of possible variation in blood glucose determinations, regardless of the method used, as discussed below.
The ideal way to perform a glucose curve is to continue taking blood samples until it is time for the next insulin injection. This is feasible in hospitals staffed at least 12 hours a day, if insulin administration coincides with the hospital schedule. But most private veterinary hospitals, including mine, are not open 12 hours a day. So, because the key determinants have been made once the nadir is passed and because glucometers can produce variable readings, I prefer to make two blood glucose determinations, at 30-minute intervals, past the nadir.
Laboratory methods for making glucose readings
Several means for making blood glucose determinations are available. You can submit the samples to a reference laboratory. However, this is the most expensive way, and it will not allow you to know when adequate samples have been taken.
Blood glucose determinations can be made using dry chemistry machines, which are found in many veterinary hospitals. This method is much cheaper than using a reference laboratory, and it will permit readings to be made as the glucose curve is in progress. Some of these machines perform best using serum instead of whole blood or plasma. If so, larger blood samples are needed, and more time is required for clotting and separating the serum from the clot.
A third option is a hand-held reflectance meter. This instrument is designed for use by human diabetics. Its retail price is about $100, but it is often heavily discounted. Reflectance meters have been shown to be accurate for veterinary use. They require only two or three drops of whole blood and about 60 seconds in operation time. They are less expensive to operate than a dry chemistry machine, both in labor cost and cost of the operating supplies. However, newer models, calibrated for capillary blood are not as accurate when venous blood is used. These models should be avoided since we use venous samples.
Regardless of the method used, glucose determination by laboratory methods is not an exact science. One study found that glucose concentrations above 180 mg/dl could vary as much as + or - 90 points from one machine sampling to another.
TABLE I |
Ways to Increase the Accuracy of Reflectance Meters*
Keep the glucometer in good condition.
Recognize disease influences.
*Adapted from Hoyson, P.M.: Diabetes 2000: Oral Medications. RN 58(5):34-39; 1995. |
TABLE II |
| Interpreting the Glucose Curve* To determine the dosing interval or the type of insulin given, evaluate the peak time. If the peak time is:
To determine the dose of insulin or if dysregulation is a problem, evaluate the nadir and range midpoint. If the nadir is <> The ideal range midpoint is 200 mg/dI, and 150-250 mg/dl is acceptable. If the range midpoint is:
*Based on twice-daily dosing of insulin. **The nadir also should be below 100 mg/deciliter. |
Interpreting the curve
Four values are important in interpreting the glucose curve (Table 2). They are as follows:
- The highest blood glucose concentration, which is usually the one taken just before insulin is given. In some cases, the morning meal and the stress of riding in the car will cause the blood glucose concentration to rise slightly on the second sample, but it should decline from that point.
- The nadir, which is the lowest blood glucose concentration.
- The peak time, which is the time from the insulin injection until the nadir. It is expressed in hours.
- The midpoint, which falls halfway between the highest and lowest blood glucose concentrations in the range.
Once these values are determined, they can be used to determine the dosing interval, the type of insulin, and the dose. The guidelines below are based on the assumption that insulin is being given twice daily.
To determine the dosing interval and the type of insulin, follow these steps:
- If the peak time is less than five hours, a longer-acting insulin is given, or the current insulin is given more frequently, generally three times a day.
- If the peak time is five to eight hours, the current insulin is continued on a twice-daily schedule.
- If the peak time is greater than eight hours, the current insulin is continued, but is given once daily.
To determine the dose of insulin or if dysregulation problems exist, use these guidelines:
- If the nadir is less than 100 mg/dI, the dose should be decreased. You should assume that the nadir in the hospital is somewhat higher than what it will be at home because of stress. If this assumption is incorrect, you will err so that the blood glucose concentrations are too high. This is always the better way to err. Hypoglycemia can be fatal; mild to moderate hyperglycemia is not.
- The ideal midpoint of the range is 200 mg/deciliter. However, the midpoint is satisfactory if it is from 150 to 250 mg/deciliter. If the midpoint is less than 150 mg/dI, the dose of insulin is too high and should be reduced. The nadir also should be below 100 mg/dl when the dose of insulin is too high.
- If the midpoint is greater than 250 mg/dI, several possibilities exist: 1) The cat may have been stressed when the glucose curve was performed. Recount the cat's attitude during the blood sampling process and the hospital stay. 2) The dose of insulin may be too low; if so, increasing it will solve the problem. 3) If increasing the dose does not bring the midpoint into the desired range, insulin problems should be considered. These include inactive insulin, insulin that is not mixed properly, poor injection technique, and poor absorption. 4) If this does not seem feasible, consider concurrent infectious disease. Many infectious diseases can cause temporary insulin resistance. A two-week course of a broad-spectrum antibiotic should be considered if your physical examination and other laboratory tests do not indicate a specific problem. 5) If these approaches are unsuccessful, you should consider insulin resistance due to hyperthyroidism, hyperadrenocorticism, acromegaly, or insulin-antibody formation.
Regulating a diabetic cat can be difficult, and the glucose curve is the foundation for understanding how any given insulin works in an individual cat. It is one of the first steps in achieving regulation. It is used to determine proper insulin type and dose and proper administration interval. The glucose curve is also used as a monitoring tool for regulated cats and as a diagnostic tool for cats in dysregulation. Four values are used to interpret the glucose curve: the highest concentration, the lowest concentration (nadir), the midpoint of the range, and the peak time. Generally, these values can be determined in six to eight hours. Taking the time to properly perform a glucose curve can save a great deal of time and money for the client.
REFERENCES
1. McMillan, F.D.; Feldman, E.C.: Rebound Hyperglycemia Following Overdosing of Cats with Diabetes Mellitus. JAVMA 188: 1426-1430:1986.
2. Joseph, R.J. et al: Evaluation of Two Reagent Strips and Three Reflectance Meters for Rapid Determination of Blood Glucose Concentrations. J. Vet. Intern. Med. 1: 170-175; 1987
Pet Health: BG Monitoring
|
| | ||||||
| | |||||||
| |
| "Mini" Blood Glucose Curves A blood glucose curve is periodic testing of the blood sugar levels to see what effect the insulin is having. The values will ALWAYS vary; you are looking for values outside of acceptable ranges, which will be approximately 100-200 or maybe up to 300 depending on your cat. Once you're getting fairly consistent results with blood glucose (BG) levels, just spot check now and then (once or twice a week at one or two times in his cycle that you feel will give you the most valuable information). Or, of course, if your cat acts strangely and you want to know if it's a hypoglycemic reaction. If your cat is well-regulated, (staying within the desirable range of blood sugars), you only need to do a mini-curve once a month or so.
|
Home Blood Glucose Testing of the Diabetic Cat
Home Blood Glucose Testing of the Diabetic Cat
If you have a diabetic cat, consider doing home blood glucose testing. After a few tests, the vast majority of cats won't mind this at all. Advantages of home testing include less stress to your cat, considerably decreased costs and time of monitoring compared to vet visits, closer control of your cat's blood glucose level by more frequent monitoring, and possible avoidance of deadly hypoglycemic episodes.
This technique and the results should be discussed with your vet before any changes in the amount of insulin you give your cat.
Materials for home testing
- Glucometer
- If your instruction book confuses you, see if there is an 800 number to call so a company representative can guide you through the first-time setup and calibration.
- Test strips
- Lancets; a lancet pen probably came with your meter. You can use this pen or just hold the lancet for a "free hand" stick. Starting with the lancet pen is recommended.
- OPTIONAL:
- Warm washcloth or a rice-filled sock that has been heated in microwave for 15 seconds - CHECK THE TEMPERATURE ON YOUR WRIST
- Facial tissue or cotton ball to apply pressure to the puncture site after the test
- Small flashlight
Tips for Success
- Read your glucometer manual.
- Put all the materials on your right if you're right handed or on your left if you're left-handed.
- Begin by petting and stroking your cat, speaking in affectionate tones
- Do NOT clean the stick area with alcohol. If dirty, use water and then dry thoroughly.
- Use the cloth or sock to warm the ear or paw pad before pricking to increase blood flow and enlarge the capillaries and veins. Alternatively, gently massage the area with your fingertips.
- If you use the lancet manually (not in a pen), prick at a 45 degree angle.
- Praise your pet and consider giving a treat.
Method
- Assemble all your materials and wash your hands.
- Position your cat so both of you are comfortable.
- Locate a vein on your cat's ear by shining a flashlight behind it. The vein will look like a red string and should be near the edge of the ear. If you are using a paw pad, use the large pad.
- Use the cloth or sock to warm the ear or paw pad before pricking to increase blood flow and enlarge the capillaries and veins. Alternatively, gently massage the area with your fingertips.
- Position the lancet and do the prick.
- Touch the tip of the test strip to the top of the blood drop at a slight angle.
- If necessary apply slight pressure to the prick site for a few seconds to stop the bleeding.
- Wait for the glucometer to give the final reading. Most glucometers will warn you if there is insufficient blood on the test strip.
- Record the date, time, and glucose reading in a notebook. Your meter will store a lot of data, but you should always back up your data manually or, if available with your meter, download the data to your computer periodically.
Photo courtesty of Pawprints and TEN
Links and tips from others:
Testing for Feline Blood Glucose - the Movie!
Ear sticks: 5 contributions
Footpad sticks: 2 contributions
I. Contributed by Julie Paque
Supplies needed:
Blood glucose monitor that requires a small amount of blood. (I use the Precision Blood Glucose Monitor made by Medisense. It needs only 5 micro liters of blood, vs. up to 30 micro liters for other monitors. Their customer service at their 800 number is great, too.) These are available from your local pharmacy, and a rebate is also often available, bringing the price down considerably. The companies make their money with the test strips, not the meters.
Test strips for monitor (most come with a learning supply.) These run about $35-40 for a supply of 50 strips.
Microcapillaries, 75 mm long by 1 mm diameter. You can use heparinized or non-heparinized, it doesn't matter, so go for what you can find or is cheaper. Your vet may be able to help you get some, or a medical or chemistry supply store. Use one per test.
A bulb with a hole for the end of the microcapillary (optional, to blow the blood out of the capillary onto the test strip.)
Tissue or gauze pads
Outline of procedure:
You will use the lancet included in the blood glucose monitor kit to prick the ear of your cat. The microcapillary will pick up the blood drop from the ear and you will put it on the test strip.
Detailed steps:
Learn how to use the meter, testing on yourself.
Getting blood from the cat:
a. Look carefully around the edge of the ear, you'll see a vein running just inside the edge. You may need a flashlight to see the vein, shine the flashlight from under the ear and the vein is visible even on dark haired cats.
b. When learning it is best to test the cat when he's warm. Such as when he's been sitting in the sun, or curled up in a particularly warm spot. You'll notice a big difference in the temperature of the ears, and it is much easier to get blood from warm ears than from cold ones! Later on when you have the technique down you'll be able to do it even when they're cold, but make it easy on yourself by optimizing conditions for you and the cat.
c. Have a folded tissue or gauze pad, the lancet, and the capillary ready. Put the cat between your knees, facing away from you. Keep your feet together so he can't back out. Don't wash the ear with water or alcohol before you prick it, you'll never be able to collect the blood.
d. You're going to use the lancet to prick the ear near the vein, if you hit the vein you'll get plenty of blood, if you're near it you'll still be able to get enough. Put the tissue underneath the ear so you don't prick yourself and contaminate the blood sample. You may need to prick more than once initially to get enough blood, gentle massage around the site will also encourage the blood to come out. After you've done a series of tests in the same area it becomes slightly swollen and it is easier to get the blood on one prick.
e. Pick up the blood with the capillary. For the Precision monitor I need a little more than 5 mm of blood in the capillary in order to perform the test. It just so happens that the capillaries that I am using have a line at the 5 mm mark. Set the capillary with the blood aside and use the tissue to apply pressure to stop any bleeding on the cat's ear. Give him a big hug for cooperating and let him free.
f. Put the test strip in the monitor and wait for the ready signal. Put the blood on the strip. If you have a bulb for the end of the capillary cover the hole and squeeze to get the blood out of the capillary. If you don't have one you can blow through the opposite end. Record the results in the booklet.
If the results of any test seem unusual it is always a good idea to repeat the test. Don't ever make radical changes in what you're doing based on a single results. And it's always a good idea to keep your vet up to date on the results of your testing and work with him or her to determine any changes necessary to your cat's regimen.
II. Contributed by Darlene
I have a Glucometer Elite, and love it. All you need is a drop of blood the size of an "o" in newspaper print. No separate capillary tubes -- it's built right into the test strip. I do ear sticks when I test, which isn't often these days because Pooter is doing so well. Before he was regulated, I did my own curves and plotted them for the vet to look at rather than taking the cat in for a whole day, and spot-checked once in a while when he wasn't acting right.
The chemical reaction in the test strip is very sensitive to humidity and anything else that can get into that little slot, so you have to be both careful and quick. Once you put the test strip into the machine, you only have three minutes to get the sample, which may not be enough while you're still learning how to keep the cat from flicking his ear and sending the blood drop off into space.
Here's my sequence. First I open an alcohol swab and twirl the lancet in it a few times to clean it off, then I open the foil test strip packet and put the strip into the meter just far enough to sit there but not far enough to activate it. Then I use the swab to sterilize the closed end of the packet and a patch of table for the cleaned packet to rest on.
Then I snuggle the cat and massage his ear until its good and warm (bleeds easier then ... some people bring a lamp down close to warm up the ear). Then I stick him, and if he doesn't bleed right away I massage the ear from the base up towards the pinhole and that sometimes brings up a small drop, otherwise he gets stuck again. Now you have to be quick, because that tiny drop congeals fast.
I scoop the drop up onto the sterilized end of the foil packet and release the cat -- takes both hands to slip the open end of the packet back over the test strip to protect it from contamination while you push it the rest of the way into the meter (without losing the drop of blood on the other end). In a couple of seconds the meter says it's ready, and you just touch the droplet to the end of the test strip until it's sucked up and you hear the beep.
If your cat is more cooperative than Pooter, you'll find that in no time you can warm the cat's ear up first, then start the meter, do the stick, and take the sample right off the cat's ear. More often than not, the irritation of the poke and the blood sitting there will bring on twitches, so I had to find a way of getting the sample onto a sterile surface before he bled all over the kitchen.
Oh -- I was told not to use alcohol or anything to clean the cat's ear for this, since it just inhibits bleeding and might contaminate the sample. The bleeding stops in seconds, and he's had no infection or irritation despite the kazillion times I poked him in same spots. I do re-use the lancets, and clean them with alcohol before and after each use. I tried using the spring-loaded pen that jabs the lancet quickly, but the noise made him jump, so now I just hold the lancet itself. It's easier to aim right at the little vein if you can see the sharp tip and exactly where it's going, too.
The glucometer is a great idea, and Pooter wasn't even close to regulated until I curved him with it several times. You'll know exactly what's going on with his blood sugars at the exact time you need to know -- this means you can tell when his insulin peaks, how far down it's taking the BG and for how long, and adjust his feeding (quantity and quality) to perfectly cover the insulin. Urine testing never gives you this precision -- it only tells you that at some point over the last X hours, the BG did or didn't get high enough to cause glucose dumping (and if it did, you don't know when or for how long -- all you know is that the BG was high enough for dumping to occur, which is the same level at which organic damage is being done). The meter will pay for itself in reduced vet visits, too. The main benefit for Pooter is that with close monitoring, a lot of the damage done to his body by poorly controlled diabetes is reversing -- his legs are stronger, his kidneys are concentrating urine instead of washing out glucose, etc. etc.
The main benefit for me is is that I got my life back -- I can inject him, feed him, and take off for the day without worrying whether he died in agony while I was out. For several months I absolutely had to be there when the insulin peaked, because he had so many reactions, or over-feed him to make sure there wasn't one, so he got fatter and fatter and sicker and sicker. We're both much happier now!
Darlene
III. Contributed by Kathy
Procedure for Home Testing of Blood Glucose using a Glucometer Elite Meter and a Lancet Device: Ear Sticks or Paw Sticks
. The "Follow-up" section of this monograph has an excellent description of using a spreadsheet to track your cat's progress.
IV. Contributed by Donna B.
A nice comprehensive write-up of this caretaker's approach to glucose monitoring.
V. Contributed by Eileen Swords RN, BA, BSN
I recommend the Fast Take monitor & the Soft Touch automatic lancet. (I am an NICU RN with 20 years of experience).
It is a very good idea to do all glucose testing in a "procedure room" in the house (in our case, it's our spare bedroom & we now call it the "torture room"). The rationale for this is that the cat will be able to truly relax in the "safe" areas of the house. We use this technique in the hospital with our Peds patients so that they feel more relaxed in their hospital room. Our kitty gives us a very pained look when he is taken in "the room", but he is VERY HAPPY when he is ANYWHERE else. We have not done this with the Insulin injections because he really does not seem to mind them.
Footpad Sticks
I. Contributed by Jerry
I just wanted to add my endorsement of the Glucometer Elite brand for home glucose testing. I tried another (cheaper) brand but was not able to obtain a large enough drop of blood for a reliable test. Glucometer Elite requires about one-fifth as much blood, making sampling much less traumatic on cat and owner.
I don't use the lancing device supplied with the Elite. Rather, I use a standard pen-shaped lancing device. I use the head attachment intended in humans for thick, calloused skin - for a bit deeper puncture. Press this FIRMLY into the big pad on kitty's rear foot. My cat had not cried nor flinched with this method. Finally, transferring the tiny drop of blood to the strip is easy; the strip itself wicks the sample into a little chamber. There is no continued bleeding, by the way. ***layman's experience only - your results may vary*** - I offer this as an alternative to using the marginal ear vein.
Best of luck to all, Jerry
II. Contributed by Kathy
You may need to stick with the lancet manually or use a lancet device that gives deeper penetration (e.g., SoftClix with adjustable depth) and larger lancets to get enough blood. Otherwise it shows real promise as an alternate site to give the ears a break. Our cat doesn't even move, like she doesn't even feel the stick.
First wipe off the large pad on one of the paws with warm water and dry it. Press the lancet device FIRMLY against the pad and release the lancet. Then squeeze the pad to get a blood drop. Continue as described with ear sticks.
Feline Diabetes Pet Health Terms
|
| | |||||||
| | ||||||||
| |
A1C:
a test that measures a cat's average blood glucose level over the past 2 to 3 months. Hemoglobin (HEE-mo-glo-bin) is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. Also called hemoglobin A1C or glycosylated (gly-KOH-sih-lay-ted) hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood. Glycosolated hemoglobin (A1c) at a normal level for cats (<3.0>
acute:
describes something that happens suddenly and for a short time. Opposite of chronic.
adipose tissue:
fat tissue
AGEs (A-G-EEZ):
stands for advanced glycosylation (gly-KOH-sih-LAY-shun) endproducts. AGEs are produced in the body when glucose links with protein. They play a role in damaging blood vessels, which can lead to diabetes complications.
albuminuria (al-BYOO-mih-NOO-ree-uh):
a condition in which the urine has more than normal amounts of a protein called albumin. Albuminuria may be a sign of nephropathy (kidney disease).
alpha (AL-fa) cell:
a type of cell in the pancreas. Alpha cells make and release a hormone called glucagon. The body sends a signal to the alpha cells to make glucagon when blood glucose falls too low. Then glucagon reaches the liver where it tells it to release glucose into the blood for energy.
alpha-glucosidase (AL-fa-gloo-KOH-sih-days) inhibitor:
a class of oral medicine for type 2 diabetes that blocks enzymes that digest starches in food. The result is a slower and lower rise in blood glucose throughout the day, especially right after meals. (Generic names: acarbose and miglitol.)
amylin (AM-ih-lin):
a hormone formed by beta cells in the pancreas. Amylin regulates the timing of glucose release into the bloodstream after eating by slowing the emptying of the stomach.
amyloid (a-muh-LOID):
a waxy translucent substance consisting of protein in combination with polysaccharides that is deposited in some animal organs and tissues under abnormal conditions
amyloidosis (a-muh-LOI-doh-sus):
a disorder characterized by the deposition of amyloid in bodily organs and tissues
amyotrophy (a-my-AH-truh-fee):
a type of neuropathy resulting in pain, weakness, and/or wasting in the muscles.
anemia (uh-NEE-mee-uh):
a condition in which the number of red blood cells is less than normal, resulting in less oxygen being carried to the body's cells.
angiopathy (an-gee-AH-puh-thee):
any disease of the blood vessels (veins, arteries, capillaries) or lymphatic vessels.
anorexia (an-uh-REX-ee-uh):
a loss of appetite
antibodies (AN-ti-bod-eez):
proteins made by the body to protect itself from "foreign" substances such as bacteria or viruses. People get type 1 diabetes when their bodies make antibodies that destroy the body's own insulin-making beta cells.
arteriosclerosis (ar-TEER-ee-oh-skluh-RO-sis):
hardening of the arteries.
artery:
a large blood vessel that carries blood with oxygen from the heart to all parts of the body.
aspart (ASS-part) insulin:
a rapid-acting insulin. On average, aspart insulin starts to lower blood glucose within 10 to 20 minutes after injection. It has its strongest effect 1 to 3 hours after injection but keeps working for 3 to 5 hours after injection.
atherosclerosis (ATH-uh-row-skluh-RO-sis):
clogging, narrowing, and hardening of the body's large arteries and medium-sized blood vessels. Atherosclerosis can lead to stroke, heart attack, eye problems, and kidney problems.
autoimmune (AW-toh-ih-MYOON) disease:
disorder of the body's immune system in which the immune system mistakenly attacks and destroys body tissue that it believes to be foreign.
autonomic (aw-toh-NOM-ik) neuropathy (ne-ROP-uh-thee):
a type of neuropathy affecting the lungs, heart, stomach, intestines, bladder, or genitals.
B
background retinopathy (REH-tih-NOP-uh-thee):
a type of damage to the retina of the eye marked by bleeding, fluid accumulation, and abnormal dilation of the blood vessels. Background retinopathy is an early stage of diabetic retinopathy. Also called simple or nonproliferative (non-pro-LIF-er-uh-tiv) retinopathy.
basal rate:
a steady trickle of low levels of longer-acting insulin, such as that used in insulin pumps.
beta cell:
a cell that makes insulin. Beta cells are located in the islets of the pancreas.
BG: see blood glucose.
biguanide (by-GWAH-nide):
a class of oral medicine used to treat type 2 diabetes that lowers blood glucose by reducing the amount of glucose produced by the liver and by helping the body respond better to insulin. (Generic name: metformin.)
blood glucose:
the main sugar found in the blood and the body's main source of energy. Also called blood sugar.
blood glucose curve:
A series of seqential tests for blood glucose levels. These levels are then plotted onto a graph to help determine the range of glucose levels for a cat on insulin and also to determine the time when the insulin is at peak activity. Also see "curve."
blood glucose level:
the amount of glucose in a given amount of blood. It is noted in milligrams in a deciliter, or mg/dL. Normal blood glucose for a cat is between 70-120. For diabetic cats, the preferred range is between 100 (at peak) and 300.
blood glucose meter:
a small, portable machine used by people with diabetic cats to check the cat's blood glucose levels. After pricking the skin (usually in the ear or leg) with a lancet, one places a drop of blood on a test strip in the machine. The meter (or monitor) soon displays the blood glucose level as a number on the meter's digital display.
blood glucose monitoring:
checking blood glucose level on a regular basis in order to manage diabetes. A blood glucose meter (or blood glucose test strips that change color when touched by a blood sample) is needed for frequent blood glucose monitoring.
blood pressure:
the force of blood exerted on the inside walls of blood vessels. Blood pressure is expressed as a ratio (example: 120/80, read as "120 over 80"). The first number is the systolic (sis-TAH-lik) pressure, or the pressure when the heart pushes blood out into the arteries. The second number is the diastolic (DY-uh-STAH-lik) pressure, or the pressure when the heart rests.
blood sugar:
see blood glucose.
blood sugar level:
see blood glucose level.
blood urea (yoo-REE-uh) nitrogen (NY-truh-jen) (BUN):
a waste product in the blood from the breakdown of protein. The kidneys filter blood to remove urea. As kidney (renal) function decreases, the BUN levels increase. Often seen abbreviated as BUN and frequently reported with "creatinine," another measure of kidney function.
blood vessels:
tubes that carry blood to and from all parts of the body. The three main types of blood vessels are arteries, veins, and capillaries.
BMI:
see body mass index.
body mass index (BMI):
a measure used to evaluate body weight relative to a person's height. BMI is used to find out if a person is underweight, normal weight, overweight, or obese.
bolus (BOH-lus):
an extra amount of insulin taken to cover an expected rise in blood glucose, often related to a meal or snack.
borderline diabetes:
a former term for type 2 diabetes or impaired glucose tolerance.
brittle diabetes:
a term used when a cat's blood glucose level moves often from low to high and from high to low.
BUN:
see blood urea nitrogen.
C
calorie:
a unit representing the energy provided by food. Carbohydrate, protein, fat, and alcohol provide calories in the diet. Carbohydrate and protein have 4 calories per gram, fat has 9 calories per gram, and alcohol has 7 calories per gram.
capillary (KAP-ih-lair-ee):
the smallest of the body's blood vessels. Oxygen and glucose pass through capillary walls and enter the cells. Waste products such as carbon dioxide pass back from the cells into the blood through capillaries.
capsaicin (kap-SAY-ih-sin):
an ingredient in hot peppers that can be found in ointment form for use on the skin to relieve pain from diabetic neuropathy.
carbohydrate (kar-boh-HY-drate):
one of the three main nutrients in food. Foods that provide carbohydrate are starches, vegetables, fruits, dairy products, and sugars. Many cat foods contain high amounts of carbohydrates at the expense of protein.
cardiologist (kar-dee-AH-luh-jist):
a doctor who treats people who have heart problems.
cardiovascular (KAR-dee-oh-VASK-yoo-ler) disease:
disease of the heart and blood vessels (arteries, veins, and capillaries).
cataract (KA-ter-act):
clouding of the lens of the eye.
cc (see-see):
Cubic centimeter. Same as milliliter or ml. Medication doseages and sbcutaneous fluid amounts are often measured in cc or ml.
cerebrovascular (seh-REE-broh-VASK-yoo-ler) disease:
damage to blood vessels in the brain. Vessels can burst and bleed or become clogged with fatty deposits. When blood flow is interrupted, brain cells die or are damaged, resulting in a stroke.
Charcot's (shar-KOHZ) foot:
a condition in which the joints and soft tissue in the foot are destroyed it results from damage to the nerves.
cheiroarthropathy (KY-roh-ar-THRAHP-uh-thee):
see limited joint mobility.
cheiropathy (ky-RAH-puh-thee): see limited joint mobility.
chlorpropamide (klor-PROH-pah-mide):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose levels by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Belongs to the class of medicines called sulfonylureas. (Brand name: Diabinese.)
cholesterol (koh-LES-ter-all):
a type of fat produced by the liver and found in the blood; it is also found in some foods. Cholesterol is used by the body to make hormones and build cell walls.
chronic:
describes something that is long-lasting. Opposite of acute.
chronic renal failure (CRF):
persistent, usually worsening over time, failure of kidney function. A common cause of death in cats over six years of age.
circulation:
the flow of blood through the body's blood vessels and heart.
civie or civvie:
see civilian
civilian:
a companion animal without diabetes. Used as in: My civvie, unlike my diabetic cat, is jealous.
coma:
a sleep-like state in which a cat is not conscious. May be caused by hyperglycemia (high blood glucose) or hypoglycemia (low blood glucose) in cats with diabetes.
combination oral medicines:
a pill that includes two or more different medicines. See Glucovance.
combination therapy:
the use of different medicines together (oral hypoglycemic agents or an oral hypoglycemic agent and insulin) to manage the blood glucose levels of people with type 2 diabetes.
complications:
harmful effects of diabetes such as damage to the eyes, heart, blood vessels, nervous system, teeth and gums, feet and skin, or kidneys. Studies in people with diabetes show that keeping blood glucose, blood pressure, and low-density lipoprotein cholesterol levels close to normal can help prevent or delay these problems.
congenital (kun-JEN-ih-tul) defects: problems or conditions that are present at birth.
congestive heart failure:
loss of the heart's pumping power, which causes fluids to collect in the body, especially in the feet and lungs.
conventional therapy:
a term used in clinical trials where one group receives treatment for diabetes in which A1C and blood glucose levels are kept at levels based on current practice guidelines. However, the goal is not to keep blood glucose levels as close to normal as possible, as is done in intensive therapy. Conventional therapy includes use of medication, meal planning, and exercise, along with regular visits to health care providers.
coronary artery disease: see coronary heart disease.
coronary (KOR-uh-ner-ee) heart disease:
heart disease caused by narrowing of the arteries that supply blood to the heart. If the blood supply is cut off the result is a heart attack.
C-peptide (see-peptide):
"Connecting peptide," a substance the pancreas releases into the bloodstream in equal amounts to insulin. A test of C-peptide levels shows how much insulin the body is making.
creatinine (kree-AT-ih-nin):
a waste product from protein in the diet and from the muscles of the body. Creatinine is removed from the body by the kidneys; as kidney disease progresses, the level of creatinine in the blood increases.
CRF: see chronic renal failure.
curve:
a blood glucose curve. A curve is done to determine a cat's reaction to the insulin dosage. A blood glucose (BG) test is generally taken every 2 hours for a 12-hour period. The curve can also be a full 24-hour curve or a "mini curve." [Cat Blood Glucose Curves Education]
D
dawn phenomenon (feh-NAH-meh-nun):
the early-morning (4 a.m. to 8 a.m.) rise in blood glucose level.
dehydration (dee-hy-DRAY-shun):
the loss of too much body fluid through frequent urinating, sweating, diarrhea, or vomiting.
dermopathy (dur-MAH-puh-thee):
disease of the skin.
desensitization (dee-sens-ih-tiz-A-shun):
a way to reduce or stop a response such as an allergic reaction to something. For example, if someone has an allergic reaction to something, the doctor gives the person a very small amount of the substance at first to increase one's tolerance. Over a period of time, larger doses are given until the person is taking the full dose. This is one way to help the body get used to the full dose and to prevent the allergic reaction.
dextrose (DECKS-trohss), also called glucose:
simple sugar found in blood that serves as the body's main source of energy.
diabetes:
see diabetes mellitus, or sugar diabetes,
diabetes insipidus (in-SIP-ih-dus):
a condition characterized by frequent and heavy urination, excessive thirst, and an overall feeling of weakness. This condition may be caused by a defect in the pituitary gland or in the kidney. In diabetes insipidus, blood glucose levels are normal.
diabetes mellitus (MELL-ih-tus):
a condition characterized by hyperglycemia resulting from the body's inability to use blood glucose for energy. In type 1 diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy. In type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly.
diabetic diarrhea (dy-uh-REE-uh):
loose stools, fecal incontinence, or both that result from an overgrowth of bacteria in the small intestine and diabetic neuropathy in the intestines. This nerve damage can also result in constipation.
diabetic eye disease:
see diabetic retinopathy.
diabetic ketoacidosis (KEY-toe-ass-ih-DOH-sis) (DKA):
an emergency condition in which extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Signs of DKA are nausea and vomiting, stomach pain, fruity breath odor, and rapid breathing. Untreated DKA can lead to coma and death.
diabetic myelopathy (my-eh-LAH-puh-thee):
damage to the spinal cord found in some diabetics.
diabetic nephropathy: see nephropathy.
diabetic neuropathy:
see neuropathy.
diabetic retinopathy (REH-tih-NOP-uh-thee):
diabetic eye disease; damage to the small blood vessels in the retina. Loss of vision may result.
diabetogenic (DY-uh-beh-toh-JEN-ic):
causing diabetes. For example, some drugs cause blood glucose levels to rise, resulting in diabetes.
diabetologist (DY-uh-beh-TAH-luh-jist):
a doctor who specializes in treating people who have diabetes.
diagnosis (DY-ug-NO-sis):
the determination of a disease from its signs and symptoms.
dialysis (dy-AL-ih-sis):
the process of cleaning wastes from the blood artificially. This job is normally done by the kidneys. If the kidneys fail, the blood must be cleaned artificially with special equipment. The two major forms of dialysis are hemodialysis and peritoneal dialysis.
1. hemodialysis (HE-mo-dy-AL-ih-sis): the use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer (DY-uh-LY-zur), a machine that removes wastes and extra fluid. The cleaned blood then goes back into the body.
2. peritoneal (PEH-rih-tuh-NEE-ul) dialysis: cleaning the blood by using the lining of the abdomen as a filter. A cleansing solution called dialysate (dy-AL-ih-sate) is infused from a bag into the abdomen. Fluids and wastes flow through the lining of the belly and remain "trapped" in the dialysate. The dialysate is then drained from the belly, removing the extra fluids and wastes from the body.
DKA:
see diabetic ketoacidosis.
E
edema (eh-DEE-muh):
swelling caused by excess fluid in the body.
electromyography (ee-LEK-troh-my-AH-gruh-fee) (EMG):
a test used to detect nerve function. It measures the electrical activity generated by muscles.
EMG:
see electromyography.
endocrine (EN-doh-krin) gland:
a group of specialized cells that release hormones into the blood. For example, the islets in the pancreas, which secrete insulin, are endocrine glands.
endocrinologist (EN-doh-krih-NAH-luh-jist):
a specially trained veterinarian who treats animals who have endocrine gland problems such as diabetes.
end-stage renal disease (ESRD):
see kidney failure.
enzyme (EN-zime):
protein made by the body that brings about a chemical reaction, for example, the enzymes produced by the gut to aid digestion.
essential fatty acid (EFA):
fat necessary for proper metabolism. EFA help to burn body fat (adipose tissue) and they help build muscle.
endogenous: (en-DAH-juh-nuhs)
Used or made within the body. Insulin is an endogenous hormone.
euglycemia (you-gly-SEEM-ee-uh):
a normal level of glucose in the blood.
exogenous (ek-SAH-juh-nuhs) :
Subscribe to:
Comments (Atom)
