So in summary, then insulin injections are far from ideal. You need to monitor the effect of those, using urine tests and glucose tests, be they blood glucose test or or skin glucose tests. We need to communicate within the practise about how we are trying to stabilise an animal.
And we need to communicate it with our owners trying to reduce their worries. And glucometers can be these. These at home glucometers can be a big, big, big help at reassuring owners.
But there are some owners. It can make it worse. It can make them less sure.
And I think you have to have an honest conversation with your owners about whether they are benefiting from this or or not. Keep things simple. Avoid over interpreting, tests and trust your owners and your own clinical judgement more than any machine until you are sure you have a problem.
And then blood glucose curves and continuous glucose monitoring may both be very useful. Diagnostic aids, uncomplicated diabetes. It's more common in older dogs in entire female dogs.
In certain breeds, 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 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, cats but not dogs. It's important to demonstrate that it's a chronic problem. Liver enzymes in both species are always increased or nearly always increased, and cholesterol is often increase, too.
Point of care tests are faster, often cheaper, and because you do them immediately, the sample quality tends not to be so much of an issue. On the other hand, these point of care metres have to be maintained and if they're not maintained, their reliability can become an issue. In some instances, we have to spend a lot of money on the point of care metre and particularly if you're using one point of care metre for individual tests, then you're going to end up with lots of these point of care metres and finally, because you're not involving the A main laboratory, the interpretation of the results is all down to you.
Some of these machines are poorly correlated with laboratory reference methods. That's not to say it's necessarily bad or wrong, but they will give you different results. But you should always check new devices for yourself to give yourself the confidence and to understand what the differences are.
So when you assess a test, you're going to compare it, first of all, to the gold standard, the reference measure. But then you can also compare to itself to see how precise it is, how repeatable it is and whether the results are linear. What is a stable diabetic?
Is it a fructosamine concentration? A haemoglobin concentration? A animal that doesn't have ketones, an animal that's not losing weight, an animal that's not bothering you and you're not bothering it except to sell it?
Insulin and needles? Is it a blood glucose curve? Like whatever you fancy, it is really important that we establish in our own minds what a state diabetic dog is now.
I'm not going to say that there is one of these that is absolutely the right answer here. But the wrong answer is not to have an answer for me. At any rate, the main thing is, a stable diabetic is an is a diabetic that is being treated for diabetes and has no significant clinical signs of that diabetes.
This urine testing is sometimes, forgotten by a lot of people. I I It's useful. It's very much cheaper than any other form of testing.
It's important to check the date on the, urine dipstick, and it works quite well. If there there is no glucose on average in the urine, you don't know if that dog is well stable. Or it is over treated.
Whereas if there is glucose in the urine, you don't really know how unstable it is. But when we look at a a blood glucose curve, then we're getting far more information because we are getting information that can be interpreted in terms of the pattern more than the single value diabetic dogs do not want to have do not like having normal glucose, and that's because the insulin is not there all the time. It is important not to try to overtreat these dogs because you risk hypoglycemia.
Blood glucose curves cannot be seen in isolation. They must be interpreted with other evidence. If the animal is unstable, are there clinical signs?
If the animal is stable, how good is is the information about that stability. And if the animal is stable, I wouldn't worry what the blood glucose curve is showing. I hope that was useful.
I'd be happy to take any. Any questions. I've put my email address up there.
Thank you for listening.
