Hello there, my name's Ian Ramsey and I work at the University of Glasgow vet school where I run a diabetic clinic as well as being a specialist in internal medicine. Today I'd like to talk about diabetes in small animals and in particular the use and assessment of point of care glucometers, and our experiences with the new glucometer that's called the pet tracker. Conflict of interest, are important in these statements.
This, webinar is sponsored by, the company that make, the pet tracker, but I also have, relationships with Siemens, Woodley's, Idex, Decker, Boeingeringle. And a variety of other in a variety of roles. None of these I think have any impact, particularly on what we're speaking today, but obviously as it's been sponsored by the the the people who make pet Tracker, that that that has to be borne in mind.
I'm gonna divide this talk into four sections. The first, an introduction and, covering, the, the presenting signs of diabetes and how we diagnose it. Then we're going to talk a little bit about point of care tests and specifically the glucometers in diabetes about their assessment and so forth.
And then talk about how we can use those in the stabilization and monitoring of diabetes. And finally, I'll finish with the summary. Let me start by saying, diabetes isn't complicated.
There is a great tendency to overcomplicate it, to make it difficult for our owners, and for ourselves. This, the Large Hadron Collider in CERN in Switzerland, this is complicated. But diabetes really isn't.
And the three take home messages I want you to take away are insulin injections are not ideal, they're not even close to ideal. So we're always going to have to be a bit of compromise. Everything to do with diabetes is about communication with the owners and communication within the veterinary team.
And yes, keeping things simple until you need to do something different, let's keep it simple. So uncomplicated diabetes is a condition that we can see in any age, either sex, any breed. But it's more common in older dogs.
It's more common in entire female dogs, it's more common in certain breeds, terriers and samoyeds, and in cats, Burmeses. Interestingly, there are some breeds that are genetically resistant to diabetes, and for this, you go to the boxer. Normally, any predisposition list, the boxer is always on it.
This one, the boxer is definitely not on it. Boxers very, very, very rarely get diabetes, and it's kind of interesting to wonder what genetic factors might lead to that. And there are people looking at that.
The diagnosis of diabetes hasn't changed in 100 years. It is still all about animals that are polyuric, polydipsic, polyphagic, and losing weight, starving and urinating in the face of plenty. There may be other things, such as the presence of weakness or exercise intolerance.
In dogs, they may develop cataracts, so they may even present as being blind. And in cats, they get this distinctive neuropathy sometimes with this planty grade stance in the hind limbs. It's important to ask, in, in dogs particularly about, recent, history of estrus.
All recent histories of recurrent urinary tract infections. Once you have a suspicion of diabetes, then you should test for it straight away. And that means testing the urine, is probably the easiest and quickest to do.
If there is no glucose in the urine, the animal is not diabetic. But if there is glucose in the urine, it may be diabetic. Renal problems such as primary renal glucose ureas or contamination problems of the sample can lead to false positives.
So it's important not to treat the blood, the, the, the glucose in the urine until you've confirmed that there's high blood glucose as well. Urine dipsticks are also useful for assessing for ketosis, and for presence of cystitis. To confirm the diagnosis, we want to demonstrate that the blood glucose is over the renal threshold, which is 10 millimoles in dogs and 12 millimoles in cats.
If you have a dog that has a blood glucose of 20 has glucose in its urine. You have a diagnosis. But in cats.
That situation can arise with stress. So in cats, but not dogs, it's important to demonstrate that it's a chronic problem. And for that, you need to measure fructosamines in cats.
Liver enzymes in both species are always increased or nearly always increased, and cholesterol is often increased too. So if you have a diabetic animal, ignore the liver enzymes until you've got that diabetes under control. So can we just diagnose diabetes with a spot glucose?
Well, in cats, the answer's emphatically no. That result of 20.9 in a cat might be stress.
But in dogs, providing there is a consistent clinical history, then yes, I think if you've got a blood glucose of 20.9 in a dog and it's got a consistent clinical history, you really don't need anything more than that, and you could therefore save quite a bit of money. For the owners by, by, moving straightforward on to some treatment.
If you're waiting for other bloods to come, or waiting for other urine tests to come, then it is perfectly acceptable to a start administering insulin to a dog with a blood glucose of 20.9. In cats, you need to measure fructosamines.
These are formed by the chemical reaction of aldehyde forms of glucose with proteins to produce a special fructosamine bond, and this is what is being detected. And we know that, from the work done, in the 1990s, that fructosamines are a good way of telling the difference between, sick, non-diabetic cats and untreated diabetic cats.
