Why do we need to monitor diabetic patients?
- To make sure we are giving enough insulin to prevent hyperglycaemia (high blood sugar)
- To make sure we aren’t giving too much insulin and getting hypoglycaemia (low blood sugar)
To monitor complications associated with diabetes such as:
- skin infections
- high blood pressure
- kidney disease
- liver disease
How often should my pet be seen and what will happen at each visit?
The frequency of visits will depend on how stable your pet’s diabetes is. Newly diagnosed, or unstable animals may be seen every 2-4 weeks. Very stable patients may be seen every 3-6 months.
Your pet will definitely have a clinical examination at each visit, including being weighed.
Your pet will probably have a blood test to look at blood sugar levels and monitor kidney and liver health.
Your pet will probably have a urine test to look for infection and monitor kidney health.
Your pet may have their blood pressure measured.
How do you make sure I am giving the right dose of insulin to my pet?
In an ideal world, once you have fed and injected your pet, their blood glucose would fall and rise.
We used to monitor this by bringing pets in for a glucose curve but we now only do this when starting insulin, as stress can interfere with the results. Owners can buy a blood glucose measuring device to create curves at home, but his involves pricking your pets ear every hour for 12 hours, which some pets do not like.
In the last few years, we have measured something call fructosamine. This is made when glucose binds to blood proteins and gives us an idea of average blood sugar over the last 2 weeks. It is simple to measure but has some limitations. In the first graph below the dog is not getting enough insulin so the blood sugar stays high, if we measure fructosamine it is also high and so we need to increase the dose.
The blood glucose falls rapidly after insulin is administered and then rises very suddenly. This is an overdose and the body has protective mechanisms to prevent fatal hypoglycaemia. If we measure fructosamine in this patient it will be high, because for most of the day blood sugar is high. This may make us think we need to increase the dose, when actually we need to decrease the dose.
New option for monitoring your pets blood glucose
The Freestyle Libre 2 is the latest blood glucose monitor designed for people with diabetes and tests have shown it also works well in pets.
It is a little sensor which is fitted to your pets' skin, and a reader device or app on your phone that measures the blood glucose. In humans they are designed to stay on for 10 days, unfortunately because of the hairy nature of our pets they usually last for 5 days, but this gives us a good idea of what your pets blood sugar is doing each day, and allows us to adjust their doses accordingly.
What do I need to do if I want to use one for my pet?
Firstly, you need to speak to your vet to see if your pet is suitable. If a glucose monitor is recommended then you will need to purchase a sensor:
The sensors are single use.
We will then fit the sensor to your pet. They are well tolerated in most pets, though some may need sedation for sensor placement, and some may need a t-shirt covering it to prevent interference.
How do I use the glucose monitor?
To read the monitor you either need the Freestyle Libre monitor, or you can download the Freestyle Libre app onto your phone. We have a monitor you can borrow but there is a refundable deposit of £85.60.
You must initialise the app/monitor by placing it near the sensor and following the instructions in the app/monitor.
You must then make sure you take a new reading from the sensor every 8 hours (or less), by placing the monitor near the sensor as before.
Please notify us when the sensor either falls off, or after 10 days so we can remove it.
If you are using the app you will need to email a copy of the reports to firstname.lastname@example.org
If you are using our monitor, you can just hand it back in.
A vet will then analyse the data and contact you to discuss the results.
DO NOT LET THE SENSOR GET WET.
How much does this cost?
We ask you to buy the sensors yourselves, they are approximately £58 each.
We charge £157.35 for fitting and then assessing the data.
PRICES CORRECT AS OF 19/09/2022