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Glucose Curve 1119

Glucose Curve Client Education Bonus Material
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Possible Complications and
Difficulty level: ♦
Common Errors to Avoid ○ If the BG measurement is unexpected,
recheck using a different sample to confirm
Synonyms • Unless hypoglycemia suspected, wait 5-7 days that it is an accurate reading.
Blood glucose curve (BGC), serial blood glucose after each change in insulin dosage before
monitoring performing a BGC. Postprocedure
• Stress-induced hyperglycemia (especially in Interpretation of BG curve: BGC results MUST
Overview and Goal cats) can lead to blood glucose (BG) con- be interpreted in conjunction with the patient’s
A BGC is used in conjunction with clinical centrations that are higher than the patient’s clinical signs and weight changes. Insulin dose
signs and changes in body weight to help normal daily BG range. If a patient is easily should not be increased based on results of
monitor patients with diabetes mellitus (DM) stressed in a veterinary hospital, at-home the BGC alone.
and to guide changes to an insulin therapy monitoring and/or fructosamine measure- • Ideal curve Procedures and Techniques
protocol. ment (p. 1345) should be considered. ○ All values between 100 and 250 mg/dL
○ Many cat owners can be taught to perform ○ No precipitous decline in BG after insulin
Indications a BGC at home, with results provided to administration
• Initial regulation of DM (p. 251) the veterinarian for interpretation. ○ Duration of insulin action (time from
• Poorly regulated DM • Ensure that a glucometer calibrated for administration through nadir and until
• Suspected hypoglycemia canine/feline patients is used because glucom- BG > 250 mg/dL) ≈12 hours in patients
eters designed for humans vary significantly receiving insulin q 12h.
Contraindications in accuracy when used for dogs and cats. • Short duration of insulin action
• Bleeding disorder • If insulin is administered in the hospital as ○ If duration of action is < 8-10 hours and
• Concurrent illness (insulin requirement likely part of the BGC, ensure the correct insulin the patient has clinical signs of unregulated
to decrease when the illness resolves) syringe type is used (U-40 vs. U-100) to DM, consider changing to a longer-acting
• Fractious/stressed patient avoid overdosing/underdosing of insulin. insulin.
• Persistent hyperglycemia
Equipment, Anesthesia Procedure ○ If the BG level is persistently > 250 mg/
• No sedation or anesthesia required • If the patient is unlikely to eat in the hospital, dL (never below 100-150 mg/dL) and
• Glucose monitor: as of this writing, Alpha- feeding and insulin administration at home clinical signs are present, the insulin dose
TRAK 2 (Zoetis) is the only glucometer is acceptable, following the normal schedule should be increased (usually 1 2 unit per
calibrated for dogs and cats and tested in and presenting for the BGC immediately dose in cats and 10%-25% per dose in
peer-reviewed publications. afterward. dogs).
• Glucose test strips ○ This results in missing the pre-insulin BG • Hypoglycemia
• Adequate restraint measurement but is preferable to doing a ○ If the BG is < 70-80 mg/dL at any time
• Needle or lancet for obtaining capillary BGC when the patient will not eat. (value confirmed), the insulin dose should
blood or needle and syringe to obtain venous • If the animal is to be fed and given insulin be decreased.
blood in the clinic, obtain a pre-feeding and pre- ○ Hypoglycemia often occurs between
• Insulin (follow pet owners’ normal regimen) insulin BG concentration, and record the midnight and 3 AM. If a patient’s clinical
value. signs get worse despite increasing insulin
Anticipated Time ○ If BG < 150 mg/dL, do not give insulin. doses, the patient may be experiencing
• If on twice-daily insulin, a 10-12 hour BGC Recheck BG throughout the day to insulin-induced hyperglycemia (formerly
typical identify hypoglycemia. thought to be the Somogyi effect), in
• A 24-hour BGC may be necessary for pet ○ Reduce the dose of insulin, and give the which the BGs are high during the day
receiving once-daily insulin, if overnight new insulin dose at the next 12-hour inter- but drop below acceptable concentrations
hypoglycemia is suspected, or if the val during which the BG > 200-250 mg/ at night. If this is suspected, a 24-hour
glucose nadir has not occurred within dL. BGC or continuous BG monitoring is
12 hours. ○ Consider remission in cats in which the recommended.
BG does not increase within 12 hours. Timing of the next BGC
Preparation: Important • Feed the dog/cat its normal diet (same • One to 2 weeks after each insulin dose
Checkpoints quantity) and give its normal insulin dose adjustment until regulated
• Obtain a history, and perform a physical in the same order as usually done at home. • If signs of hypoglycemia (lethargy, seizures,
examination; specifically note changes • If using a canine/feline glucometer, ensure ataxia, coma) or hyperglycemia (polyuria and
in urination, water intake, appetite, and that the code entered into the glucometer polydipsia [PU/PD], weight loss, polyphagia)
weight. matches that of the correct species. are recognized
• Determine if the pet will be fed/given insulin ○ The calibration code for dogs and cats is • If there are no clinical signs of DM and the
at home or in clinic. If at home, confirm that often different and is typically listed on patient is on an established insulin dose,
the patient has eaten and received morning the test strip vial. consider fructosamine measurement or repeat
insulin per the normal routine. ○ Obtain blood samples every 2 hours, and BGC q 3-6 months.
• Ensure that the glucometer is calibrated for record the BG concentration.
the correct species (enter the relevant code on ○ Common sites for BG sampling include Alternatives and Their Relative
the vial into the glucometer before reading the inner pinna (cats and dogs), inside of Merits
samples). the upper lip and the elbow pad (dogs), Clinical signs:
• Run a control solution on your glucom- and the pisiform metacarpal pad (cats). • BGCs and other monitoring tools must
eter once per month to ensure accurate ○ When the BG is less than 150 mg/dL, be interpreted in conjunction with clinical
readings. check the BG hourly. signs.

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