Interpreting glucose curves in cats

Re: Interpreting glucose curves in cats

Martin Atkinson — Fri, 21 Jun 2013 18:55:58 GMT

[quote user="Gillian Mostyn"]

Always remember to treat the cat, not the numbers. A good chat with the owners will give you as much information as the tests - and you need to make decisions based on both of these things. It is very easy to fall into the habit of treating the lab results otherwise. If the cat is well, stable weight, not PUPD etc, then don't change doses based on some screwy numbers.....and vice versa!

[/quote] I do have to constantly remind myself of this and if you worry too much you will never have a truly stable animal based just on lab results. It is true that there is a danger of losing the art of veterinary science especially amongst new graduates but lets not forget that owners sometimes seem to go to great lengths to send us off on wild goose chases by telling porkies to cover their errors or simply not noticing changes in the animal's condition, or neglecting to advise us for example that Tiddles didn't get his injection last night and by suddenly losing the ability to inject properly when they've demonstrated how to do it in front of you adequately previously. Over the years I've managed to take most these factors into consideration before making decisions but every now and again someone still finds a new way to confound me.

Re: Interpreting glucose curves in cats

Gillian Mostyn — Fri, 21 Jun 2013 17:39:41 GMT

Re: Interpreting glucose curves in cats

Martin Atkinson — Fri, 21 Jun 2013 12:38:33 GMT

[quote user="Mark Holmes"]usually find that with a md type diet,bid dosing, water measurement and very gradual dose changes I do fine without them.[/quote] It would be interesting to know how long your cases live post initial diagnosis. In the days before I knew better and followed a similar protocol I would say it averaged 2 years. Now I do regular monitoring with curves. those with owners who comply fully will have very much fewer bouts of instability and live indefinitely - that is until they are due to throw off their mortal coil from unrelated causes.

Re: Interpreting glucose curves in cats

Mark Holmes — Fri, 21 Jun 2013 10:38:20 GMT

[quote user="James Laidlaw"]

[quote user="Mark Holmes"]The last diabetes talk I went on said the stress effect on glucose curves was so great it made them next to worthless. > 50% of the time a different clinical decision would be made if it were eliminated. Consequently I rarely perform them and interpret them with extreme caution and a significant dose of scepticism.

[/quote]

Is that irrespective of the patient's apparent "stress" level? Some cats are quite relaxed about blood sampling, just wondering if the same effect regardless of how the patient appears.

[/quote] The figures quoted said 50% of the time you would make a different clinical decision. The cat may have stress from sampling, background stress from hospitalisation or "hangover" circulating cortisol and catecholamines from the stress of transport. I prefer owners to measure at home, but usually find that with a md type diet,bid dosing, water measurement and very gradual dose changes I do fine without them.

Re: Interpreting glucose curves in cats

Anthony Dennison — Fri, 21 Jun 2013 09:57:01 GMT

[quote user="Stephen Courtney"]

How is the cat doing clinically? Weight, appetite, and thirst? does it look as though the cat has improved on the current dose rate?

[/quote]

Cat is better than it was, more active and happier in herself but still very polyphagic (despite being on RCW Satiety diet), and still PU/PD, but not as markedly so since starting treatment. I think there is a little further to go with stabilisation but we're close.

Glucose at 17.30 was 16.3mmol/L

I agree with Martin about cats in for curves. We had one (now in remission - only discovered because we did repeated curves) that use to come in and just lounge in one of the dog kennels. He would actually get up and come to the kennel door when he was due his next blood sample!

Re: Interpreting glucose curves in cats

Martin Atkinson — Fri, 21 Jun 2013 09:24:09 GMT

[/quote]I think that is far too sweeping a statement and IME many cats are fine, some actually enjoyed their day at the vets. I believe I can identify a stress curve and those I feel are too stressed I would get the owner to do a curve at home. Quite frankly there is no other reliable tool.

Re: Interpreting glucose curves in cats

James Laidlaw — Fri, 21 Jun 2013 09:01:04 GMT

[/quote]

Is that irrespective of the patient's apparent "stress" level? Some cats are quite relaxed about blood sampling, just wondering if the same effect regardless of how the patient appears.

Re: Interpreting glucose curves in cats

Mark Holmes — Fri, 21 Jun 2013 08:01:04 GMT

The last diabetes talk I went on said the stress effect on glucose curves was so great it made them next to worthless. > 50% of the time a different clinical decision would be made if it were eliminated. Consequently I rarely perform them and interpret them with extreme caution and a significant dose of scepticism.

Re: Interpreting glucose curves in cats

Stephen Courtney — Thu, 20 Jun 2013 17:00:49 GMT

How is the cat doing clinically? Weight, appetite, and thirst? does it look as though the cat has improved on the current dose rate?

Re: Interpreting glucose curves in cats

John Flynn — Thu, 20 Jun 2013 16:49:01 GMT

[quote user="Anthony Dennison"]Would anyone be happy to increase the insulin dose because of this[/quote]

I would up to 1.5units twice daily and repeat curve ideally in a week or so. Try to get final BG before discharge.

(That said, I tend to use glargine in cats, so probably not the best person to give advice!)

Re: Interpreting glucose curves in cats

Martin Atkinson — Thu, 20 Jun 2013 16:44:33 GMT

Given the onset of duration of the insulin is 2 hrs it is not unusual to see glucose levels rise for a couple of hours post dose so as it then falls steadily this seems a natural curve, without stress your nadir may have appeared before 6 hrs post dose. Unfortunately without a test after the 15.30 we can't see if this continued to fall you do need more tests to give more information but I would say that at 1iu bid this is unlikely to be a Somogyi effect and that the cat is being under-dosed so you could comfortably increase by 50%. Fructosamine is not a reliable indicator of response to treatment in cats, I would try and teach the client to do a curve at home if you're worried about stress.