The Pulse Of Veterinary Medicine
Vet-To-Vet Conversation With IDEXX
Fructosamine testing looks beyond the hour-to-hour and day-to-day blood glucose fluctuations, to provide the patient's average glucose over the previous 2–3 weeks. Fructosamine testing is integral to a thorough assessment of glycemic control. The bottom line: fructosamine is big picture, whereas blood glucose curves (BGCs) are hour-to-hour, and both are important.
Stress or diabetes mellitus?
Blood glucose concentration is mediated by adrenaline, lactate, and a host of other compounds that also rise with stress.1 When cats arrive at your clinic after having been corralled into carriers and driven to the clinic for even a routine examination, there’s a good chance that their glucose levels will be sky high. And restraint during venipuncture is only going to make it worse. A patient-side fructosamine test may help you quickly and confidently differentiate a temporary, stress-related, visit-induced spike in blood glucose from diabetes mellitus in a patient with no diabetic signs at home. This is particularly pertinent for the patient about to undergo general anesthesia. Of course, test results always mean more when you know a patient's clinical signs and have done a physical examination.
Share this snippet with your staff to show how fructosamine can differentiate stress-induced hyperglycemia from diabetes mellitus.
Optimal glycemic control and the client-centered practice
In dogs and cats alike, the blood or serum fructosamine concentration—along with the patient’s clinical signs, BGCs, and other laboratory testing—provides critical information to guide decisions about diabetic therapy. Important as these assessments are, the time commitment can strain the most compliant of owners.
A diabetic clinic may be the answer to improving the customer experience in a meaningful way. Diabetic clinics are growing in popularity on the human side, and some client-focused veterinarians have adopted the model for their own patient care, using it to drive healthcare benefits, compliance, and profitability. Of the successful diabetic clinics, in my experience, there are four core components:
- Technician-led questionnaire on diet, exercise, medication, and other factors with pet owner
- Assorted beverages on hand while the client waits for her patient’s blood draw, testing, and results
- Immediate review of all laboratory testing at discharge by the veterinarian, including the fructosamine trend
- Hands-on tutorial/demonstration of how to properly administer medication—no more "telephone tennis" to try and explain the new regimen!
Fructosamine is an important part of the glycemic puzzle. Start using it today, whether via your reference laboratory or in-house, using the Catalyst Dx or Catalyst One analyzer during a patient visit.
1. Rand JS, Kinnaird E, Baglioni A, Blackshaw J, Priest J. Acute stress hyperglycemia in cats Is associated with struggling and increased concentrations of lactate and norepinephrine. J Vet Intern Med. 2002; 16(2):123-132.