Comparison of continuous and intermittent glucose monitoring systems in a dog with diabetic ketoacidosis: a case report

https://doi.org/10.17221/25/2017-VETMEDCitation:Kim W., Kim H., Kang S., Bae J., Choi J., Park J., Yu D. (2017): Comparison of continuous and intermittent glucose monitoring systems in a dog with diabetic ketoacidosis: a case report. Veterinarni Medicina, 62: 285-291.
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A Miniature schnauzer (12 years old, neutered male) was referred for lethargy, anorexia, and oral bleeding. On initial evaluation, severe hyperglycaemia (blood glucose concentration of 34.9 mmol/l), ketonuria, systemic inflammation (fever, panting, left-shift neutrophilia, and a high C-reactive protein level of 980.97 nmol/l, abnormal pancreatic lipase immunoreactivity, and periodontitis were found. With consideration of possible insulin resistance, blood glucose (BG) levels were monitored using a portable glucose meter (q 1–3 h) and a continuous glucose monitoring system (CGMS) for 72 h (three consecutive trials); intensive insulin therapy was initiated using regular insulin (2.2 IU/kg intravenously). The insulin doses needed, based on the nadir, peak, and duration of insulin action from a traditional intermittent glucose curve were higher than those based on the CGMS results. Meanwhile, transient hyperglycaemic and hypoglycaemic periods, occurring between the intermittent measurements, were easily identified with the CGMS. Therefore, insulin resistance and the Somogyi phenomenon are less likely to occur with use of the CGMS than with intermittent BG measurements. By comparing data from a CGMS to those from an intermittent portable BG measurement system, this case report emphasises the importance and usefulness of a CGMS.
References:
Affenzeller N., Thalhammer J. G., Willmann M. (): Home-based subcutaneous continuous glucose monitoring in 10 diabetic dogs. Veterinary Record, 169, 206-206  https://doi.org/10.1136/vr.d4315
 
Brunner Richard, Kitzberger Reinhard, Miehsler Wolfgang, Herkner Harald, Madl Christian, Holzinger Ulrike (2011): Accuracy and reliability of a subcutaneous continuous glucose-monitoring system in critically ill patients*. Critical Care Medicine, 39, 659-664  https://doi.org/10.1097/CCM.0b013e318206bf2e
 
Choudhary P., Ramasamy S., Green L., Gallen G., Pender S., Brackenridge A., Amiel S. A., Pickup J. C. (): Real-Time Continuous Glucose Monitoring Significantly Reduces Severe Hypoglycemia in Hypoglycemia-Unaware Patients With Type 1 Diabetes. Diabetes Care, 36, 4160-4162  https://doi.org/10.2337/dc13-0939
 
Collings A. J., Gow A. G., Marques A., Yool D., Furneaux R., Mellanby R., Watson P. J. (2012): A prospective study of basal insulin concentrations in dogs with congenital portosystemic shunts. Journal of Small Animal Practice, 53, 228-233  https://doi.org/10.1111/j.1748-5827.2011.01192.x
 
Corradini S., Pilosio B., Dondi F., Linari G., Testa S., Brugnoli F., Gianella P., Pietra M., Fracassi F. (2016): Accuracy of a Flash Glucose Monitoring System in Diabetic Dogs. Journal of Veterinary Internal Medicine, 30, 983-988  https://doi.org/10.1111/jvim.14355
 
Corstjens AM, Ligtenberg JJM, van der Horst ICV, Spanjersberg R, Lind JSW, Tulleken JE, Meertens JHJM, Zijlstra JG (2006): Accuracy and feasibility of point-of-care and continuous blood glucose analysis in critically ill ICU patients. Critical Care 10, R135.
 
DeClue Amy E., Cohn Leah A., Kerl Marie E., Wiedmeyer Charles E. (2004): Use of Continuous Blood Glucose Monitoring for Animals With Diabetes Mellitus. Journal of the American Animal Hospital Association, 40, 171-173  https://doi.org/10.5326/0400171
 
Dunayer EK (2004): Hypoglycemia following canine ingestion of xylitol-containing gum. Veterinary and Human Toxicology 46, 87–88.
 
Garg S., Zisser H., Schwartz S., Bailey T., Kaplan R., Ellis S., Jovanovic L. (): Improvement in Glycemic Excursions With a Transcutaneous, Real-Time Continuous Glucose Sensor: A randomized controlled trial. Diabetes Care, 29, 44-50  https://doi.org/10.2337/diacare.29.01.06.dc05-1686
 
Harris Deborah L., Battin Malcolm R., Weston Philip J., Harding Jane E. (2010): Continuous Glucose Monitoring in Newborn Babies at Risk of Hypoglycemia. The Journal of Pediatrics, 157, 198-202.e1  https://doi.org/10.1016/j.jpeds.2010.02.003
 
Hess Rebecka S. (2010): Insulin Resistance in Dogs. Veterinary Clinics of North America: Small Animal Practice, 40, 309-316  https://doi.org/10.1016/j.cvsm.2009.12.001
 
Hoedemaekers Cornelia W. E., Klein Gunnewiek Jacqueline M. T., Prinsen Marieke A., Willems Johannes L., Van der Hoeven Johannes G. (2008): Accuracy of bedside glucose measurement from three glucometers in critically ill patients*. Critical Care Medicine, 36, 3062-3066  https://doi.org/10.1097/CCM.0b013e318186ffe6
 
Holzinger Ulrike, Warszawska Joanna, Kitzberger Reinhard, Herkner Harald, Metnitz Philipp G. H., Madl Christian (2009): Impact of shock requiring norepinephrine on the accuracy and reliability of subcutaneous continuous glucose monitoring. Intensive Care Medicine, 35, 1383-1389  https://doi.org/10.1007/s00134-009-1471-y
 
Hume Daniel Z., Drobatz Kenneth J., Hess Rebecka S. (2006): Outcome of Dogs with Diabetic Ketoacidosis: 127 Dogs (1993-2003). Journal of Veterinary Internal Medicine, 20, 547-555  https://doi.org/10.1111/j.1939-1676.2006.tb02895.x
 
Joubert M., Reznik Y. (2012): Personal continuous glucose monitoring (CGM) in diabetes management: Review of the literature and implementation for practical use. Diabetes Research and Clinical Practice, 96, 294-305  https://doi.org/10.1016/j.diabres.2011.12.010
 
Loose Natara L., Rudloff Elke, Kirby Rebecca (2008): Hypoglycemia and its effect on the brain. Journal of Veterinary Emergency and Critical Care, 18, 223-234  https://doi.org/10.1111/j.1476-4431.2008.00308.x
 
Miller Samuel I., Wallace Richard J., Musher Daniel M., Septimus Edward J., Kohl Steve, Baughn Robert E. (1980): Hypoglycemia as a manifestation of sepsis. The American Journal of Medicine, 68, 649-654  https://doi.org/10.1016/0002-9343(80)90250-8
 
Nelson RW, Reusch CE (2014): Animal models of disease: classification and etiology of diabetes in dogs and cats. Journal of Endocrinology 222, T1–T9.
 
Prabhudesai Sumant, Kanjani Amruta, Bhagat Isha, Ravikumar KarnamG, Ramachandran Bala (2015): Accuracy of a real-time continuous glucose monitoring system in children with septic shock: A pilot study. Indian Journal of Critical Care Medicine, 19, 642-  https://doi.org/10.4103/0972-5229.169331
 
Reineke Erica L., Fletcher Daniel J., King Lesley G., Drobatz Kenneth J. (2010): Accuracy of a continuous glucose monitoring system in dogs and cats with diabetic ketoacidosis. Journal of Veterinary Emergency and Critical Care, 20, 303-312  https://doi.org/10.1111/j.1476-4431.2010.00538.x
 
Surman Sean, Fleeman Linda (2013): Continuous Glucose Monitoring in Small Animals. Veterinary Clinics of North America: Small Animal Practice, 43, 381-406  https://doi.org/10.1016/j.cvsm.2013.01.002
 
(2012): Hypoglycemia and Risk of Death in Critically Ill Patients. New England Journal of Medicine, 367, 1108-1118  https://doi.org/10.1056/NEJMoa1204942
 
Wiedmeyer C.E., DeClue A.E. (2008): Continuous Glucose Monitoring in Dogs and Cats. Journal of Veterinary Internal Medicine, 22, 2-8  https://doi.org/10.1111/j.1939-1676.2007.0001.x
 
Zini Eric, Glaus Tony M., Minuto Francesco, Arvigo Marica, Hauser Beat, Reusch Claudia E. (2007): Paraneoplastic Hypoglycemia Due to an Insulin-Like Growth Factor Type-II Secreting Hepatocellular Carcinoma in a Dog. Journal of Veterinary Internal Medicine, 21, 193-195  https://doi.org/10.1111/j.1939-1676.2007.tb02946.x
 
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