The secret to successful at-home glucose monitoring: Simplicity

November 17, 2020
Rebecca A. Packer, MS, DVM, DACVIM (Neurology/Neurosurgery)
Rebecca A. Packer, MS, DVM, DACVIM (Neurology/Neurosurgery)

Dr. Packer is an associate professor of neurology/neurosurgery at Colorado State University College of Veterinary Medicine and Biomedical Sciences in Fort Collins, and is board certified in neurology by the American College of Veterinary Internal Medicine. She is active in clinical and didactic training of veterinary students and residents and has developed a comparative neuro-oncology research program at Colorado State University.

When you make it as easy as possible, owners of pets with diabetes are more likely to comply with at-home blood glucose monitoring recommendations. (Sponsored by Trividia Health Inc)

According to the Banfield Pet Hospital State of Pet Health 2016 Report, the prevalence of diabetes mellitus in dogs increased by nearly 80% between 2006 and 2015.1 The disease is about 3 times more common among cats, for which prevalence increased by about 18% over the same time period.1 The disease manifests as prolonged periods of hyperglycemia due to loss or dysfunction of pancreatic beta cells such that insulin secretion decreases or insulin sensitivity in tissues is reduced.2

The aim of diabetes management, which consists of insulin administration and dietary modification, is to reduce clinical signs, avoid hypoglycemia, and maintain the blood glucose concentration below the renal threshold of 200 mg/dL in dogs and 250 to 300 mg/dL in cats.2 Diabetes affects quality of life for both pets and their owners, in part because managing the disease requires significant owner commitment.

This article is sponsored by Trividia Health Inc, maker of the Test Buddy™ Pet-Monitoring Blood Glucose Meter. To download, click the PDF below.

Pet-specific glucose monitoring

Home monitoring of blood glucose has become a mainstay of veterinary diabetes management. In the past, this meant using glucose meters designed for humans, which are not accurate for animals due to differences in the distribution of glucose among red blood cells versus plasma.2-4

In humans, glucose is distributed evenly throughout the blood, with about 50% in red blood cells and 50% in plasma, and the ratio remains fairly constant. However, in dogs 12.5% of glucose is in red blood cells and 87.5% is in plasma, and in cats the distribution is 7% in red blood cells and 93% in plasma.3-5 Using a glucose meter intended for humans on a dog or cat means that the glucose concentration is often underestimated, sometimes significantly so, because these monitors typically measure plasma glucose after separating the 2 blood components. Now that pet-specific glucose meters are available, it is important that clients use a device designed and validated specifically for dogs and cats.

Although it is an easy process, monitoring urine glucose has low accuracy because it only reflects glucose level during the bladder filling period. The 2018 American Animal Hospital Association (AAHA) Diabetes Management Guidelines for Dogs and Cats recommend against relying solely on urine glucose measurements.2

Advantages of at-home monitoring

Both the AAHA Diabetes Management Guidelines for Dogs and Cats and the International Society of Feline Medicine (ISFM) Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats recommend that blood glucose curves and some spot checks occur in the home environment.2,6 There are several advantages to doing this:

  • For patients with a single report of hyperglycemia without clinical signs, stress hyperglycemia may be the issue. Rechecking glucose levels in the home environment, where stress is reduced, may help differentiate transient hyperglycemia from clinical diabetes.2
  • At-home glucose monitoring appears to contribute to a favorable treatment outcome by identifying hypoglycemia and enabling better overall glycemic control.2,6
  • Among hospitalized pets, the influence of stress (particularly for cats), decreased food intake due to being in a nonfamiliar environment, and abnormal activity while in a cage or run may influence blood glucose curves and make their interpretation inaccurate.7
  • Many owners prefer home blood glucose monitoring over hospital monitoring because it allows them to monitor their pet more often, identify changes in blood glucose concentrations earlier, and correlate whether blood glucose changes are related to changes in their pet’s well-being. At-home monitoring also reduces stress for the pet and costs a bit less for the owner.7
  • Home monitoring may help identify spontaneous remission of diabetes.6

Some veterinarians have concerns about compliance with home monitoring and worry that their patients with diabetes will fail to return for recheck examinations and appointments. The reality, however, is that most clients do return as recommended and, with very rare exceptions, continue to wait for professional guidance before making adjustments to their pet’s insulin dosing based on the data they collect at home.7

Timing of glucose curves

According to AAHA and ISFM recommendations, performing blood glucose curves often serves 2 important purposes.2,6 First, they can reveal subclinical hypoglycemia, so that adjustments can be made to the insulin dose before clinical signs or critical situations develop. Second, in patients whose diabetes is not well controlled, it can be challenging to determine whether the reason is too high or too low of an insulin dose.2 Detailed blood glucose curves provide information that can be used in making treatment decisions and dose adjustments.2,6

The timing of glucose curves varies slightly among patients depending on the type of insulin and dosing regimen used. Detailed recommendations are described in the AAHA guidelines.2

In general, when acquiring a blood glucose curve, glucose is measured every 2 to 4 hours for 12 to 24 hours. If the blood glucose concentration is below 150 mg/dL, measurements should be taken hourly.2

AAHA and ISFM offer similar but slightly different guidelines for when to perform blood glucose curves, but both recommend that they be performed at home. According to the AAHA guidelines, blood glucose curves should be done after the first dose of a new type of insulin is administered, 7 to 14 days after a dose adjustment, if clinical signs recur in a patient whose disease was controlled previously, any time hypoglycemia is suspected, and then regularly at 3-month intervals.2

For feline patients, ISFM guidelines recommend performing blood glucose curves weekly following diagnosis until the patient’s glycemic control is stable, and then every 3 to 4 weeks. They further recommend checking isolated blood glucose measurements any time the owner is concerned about the cat’s well-being.6 If intensive management is necessary, several daily blood glucose measurements may be taken. If less frequent monitoring is recommended, blood glucose curves may be performed every 2 to 6 weeks, with single measurements obtained whenever there are concerns, and before insulin dosing when recommended.6

Compliance made easy

Due to the frequent need for sampling, having an easy-to-use system for home blood glucose monitoring is crucial to maintaining owner compliance and ensuring accurate sampling.

This includes not only the meter and test strips but also ancillary items such as lancets and a lancing device. The associated software app must be intuitive, easy to set up and connect to the meter, and provide ample storage for sample values so that data are useful to veterinarians when downloaded. If owners struggle with any of these components, compliance declines and data quality suffers.

Home glucose monitoring using the Test Buddy™ Pet-Monitoring Blood Glucose System and Healthy Tracks for Pets™ ancillary products can be instrumental in the comprehensive management of your diabetic patients. The portfolio features high-quality,5 affordable products designed and calibrated specifically for dogs and cats with diabetes.

Developed with specific chemistry and a unique algorithm, the Test Buddy™ Pet-Monitoring Blood Glucose Meter allows clients to track and monitor their pet’s blood glucose levels at home with confidence. Unlike some other pet-specific glucose monitors on the market, Test Buddy™ offers simple pet selection with no coding necessary, stores up to 1000 results with corresponding dates and test times, and includes 4 event and meal tags to combine the pet’s activities (e.g., exercise, mealtimes) with their results. Bluetooth compatibility allows clients to sync the data smoothly with the Test Buddy™ App on a mobile device and send accurate results to their veterinarian quickly and easily. Ancillary products are also available to make the job easier, including Healthy Tracks for Pets™ Syringes (U-40 and U-100), Lancing Device, and Sterile Lancets. For more information, visit www.testbuddymeter.com.

References

1. State of pet health 2016 report. Banfield Pet Health. 2016. Accessed Sept 24, 2020. https://www.banfield.com/banfield/media/pdf/downloads/soph/banfield-state-of-pet-health-report-2016.pdf

2. Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc. 2018;54(1):1-21. doi:10.5326/JAAHA-MS-6822

3. Coldman MF, Good W. The distribution of sodium, potassium and glucose in the blood of some mammals. Comp Biochem Physiol. 1967; 21(1):201-206. doi:10.1016/0010-406x(67)90129-6

4. Surman S, Fleeman L. Continuous glucose monitoring in small animals. Vet Clin North Am Small Anim Pract. 43(2):381-406. doi:10.1016/j.cvsm.2013.01.002

5. Data on file. Trividia Health, Inc.

6. Sparkes AH, Cannon M, Church D, et al. ISFM consensus guidelines on the practical management of diabetes mellitus in cats. J Feline Med Surg. 2015; 17(3):235-250. doi:10.1177/1098612X15571880

7. Kley S, Casella M, Reusch CE. Evaluation of long-term home monitoring of blood glucose concentrations in cats with diabetes mellitus: 26 cases (1999-2002). J Am Vet Med Assoc. 2004;225(2)261-266. doi:10.2460/javma.2004.225.261