Home Monitoring of BGs article in Vet
Posted By: Nancy & Peanut (& Harry GA)
Date: Wednesday, 11 July 2001, at 9:01 p.m.
In Response To: Meter assessment in Vet journal (Terry and Punkin)
"Home Monitoring of Blood Glucose Concentration in the Management of Diabetes Mellitus" by Claudia E. Reusch, DVM, PhD, Gerhard Wess, DVM and Martina Casella appears in the June 2001 issue of 'Compendium on Continuing Education for the Practicing Veterinarian' Vol 23(6). These vets are at the University of Zurich, in Zurich, Switzerland and have been involving clients in Home BG testing for 2 years, with 70% being capable and willing to do so (actual number not given).
Small blood sample size was not a primary concern in the 5 meters utilized, although the Elite got bonus points for simplicity, only needing a 2 ul drop, and it's sipping style strip. FDMB users prefer a small sample size and only the Bayer Elite and Dex, and Precision QID meters take a sample size of 3.5 ul or less and the Precision QID strips don't sip-up. The LifeScan SureStep and AccuChek Simplicity need >10 ul drops and don't sip-up and are not recommended by FDMB users. These 5 meters were evaluated in earlier articles by the authors, published separately for cats and for dogs in 2000. These studies were done before most of our currently recommended meters were available.
The authors do earpricks for both cats and dogs and recommend the Bayer Microlet Vaculance lancing device that "does not require warming of the ear, and generates a drop of blood of adequate size within about 30 seconds"--they have used it exclusively in their clinic for several years. I can get an ear warm and lance freehand or with a normal lancing device and be done with the test in far less than 30 sec. Holding still while being tested is the part my cats have objected to the most. Interestingly, 2 of the 3 most common technical problems are with getting a blood drop using the Vaculance device, cited in yet another of their articles published in 2000. The 3rd problem is that short-fills give low, inaccurate BG readings on the Elite and other meters (not all).
Although the authors advocate home BG testing, they don't introduce it until a month after diagnosis, after 2 in-clinic curves (at 1 week, and 1 month post diagnosis) and 3 fructosamine tests (at diagnosis, 1 week and 1 month) have been done. "Home monitoring is not started before this time to allow the owner to become familiar with the disease and to gain experience with the injection of insulin and may be delayed to a later date if the owner does not seem ready". Then they recommend morning pre-shots twice a week and a 12 hour curve once a month ("all our diabetic animals receive insulin twice daily").
They don't suggest spot-checking BGs at insulin peak (BG nadir) to compare with pre-shot values. I guess the in-clinic curves are expected to provide accurate insulin peak and duration information despite the fact that "stressors or inappetence can markedly influence BG concentration" and "in-hospital BGCs (Blood Glucose Curves) can be difficult to interpret or may even be useless".
I believe that most FDMB members would advocate tackling home BG testing as soon as possible, to use it as an aid in regulation. Pre-shot (pre-food) tests and peak-checks give a lot of information and can be plotted over time to show patterns of response to insulin and food changes.
11. Wess G, Reusch C: Capillary blood sampling from the ear of dogs and cats and use of portable meters to measure glucose concentration. J. Small Animal Practice 43:60-66, 2000.
12. Casella M, Reusch C: Home monitoring of capillary blood glucose in dogs and cats: Technical aspects [abstract]. Proc ACVIM 18:754, 2000.
20. Wess G, Reusch C: Evaluation of five portable blood glucose meters for use in dogs. JAVMA 216(2):203-209, 2000.
21. Wess G, Reusch C: Laboratory assessment of five portable blood glucose meters for use in cats. Am J Vet Res 61:1587-1592, 2000.
summarized by Nancy Johnson
Nancy & Peanut (& Harry GA)
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