The best way to monitor your doga€™s diabetes is with home blood glucose testing, which is a lot easier to do than you might think! This type of testing gives you the most information about your doga€™s blood glucose levels and is the only way to determine at home whether his blood sugar level is too low. People who have diabetes monitor their blood sugar with a small portable meter that tests a tiny drop of blood for the amount of glucose it contains.
Meters that have been frequently and successfully used to test a doga€™s blood sugar include the OneTouch Ultra, Ascensia Contour, Freestyle, and Precision Xtra.
In addition to purchasing these meters and test strips at pharmacies, they can be ordered online, often at better prices. AlphaTrak (also available online from Amazon and many of the pet retailers), is an animal-adjusted meters that has been calibrated to more closely approximate a dog's blood sugar. Regardless of which type of meter you choose, you should have a handful of comparisons done between your metera€™s readings and a lab analyzer.
There is considerable variation dog to dog and meter to meter and the readings your meter gives can be anywhere from equal to lab values to slightly different (usually lower) to significantly different (again, usually your meter will give lower readings than the lab).
In Chrisa€™ case, the OneTouch Ultra gave the most accurate readings for the meters we tried. This chart shows comparisons made by testing Chris with different meters on a single sample of blood where the OneTouch Ultra was compared to the animal-adjusted AlphaTrak. Again, it's important to understand that you will have to test your meter with your dog to know how accurate it is for you. Even if your meter readings are quite a bit different than lab values, a meter tells you one thing that no other testing or monitoring tool can—when your doga€™s blood sugar is low. Elbow callous – For medium to large dogs with a callous on the elbow, this is a popular place to test.
Ear – Vets often suggest the ear for testing but generally ita€™s not the easiest place to obtain a drop of blood from a dog.
A less informative way to measure your doga€™s average blood sugar over a few hours at a time is urine testing. Urine testing is most useful as an inexpensive way to monitor a dog whose blood sugar levels are already controlled. The least technical and least detailed way is simply to observe your doga€™s behavior and monitor his weight.
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The final destination of a journey is not, after all, the last item on the agenda, but rather some understanding, however simple or provisional, of what one has seen. In these modern times, with the plethora of blood-sugar-related diseases, we need tools like GI and GL to help us understand ways to control blood sugar. The self-testing, graphic approach to food testing developed in the balance of the newsletter is a less scientific but a more dynamic way to explore postprandial (post-meal) blood glucose levels (BGLs).
GI measures the blood glucose impact of foods eaten in isolation, yet we rarely consume foods this way. GI readings vary with the individual—blood sugar and insulin reactions are more extreme for diabetics, for example (See Charts 2A and 2B). GIs are calculated in the science lab as the day’s first meal after a 12-hour fast and using a fixed serving that includes 50 grams of carbohydrate.  Most of our daily calories, however, are consumed in combination and throughout the day, when our blood sugar is affected by other foods that we have eaten earlier, as well as by our level of activity.
Of the following numbered charts, the first three are based upon scientific research journal articles (Charts 1, 2A, 2B), while the last four (Charts 3-6) are constructed from my own self-testing of foods4 using a simple blood glucose monitor.
Chart 1:  Blood Sugar Curves of White Bread Compared to Bread with Added Fiber, Sourdough, and Vinegar. Chart 3:  Instant Oatmeal, Whole Oats (Soaked and Not Soaked), and Whole Oats Combined with a Protein and Fat. To fully appreciate the impact of two back-to-back carbohydrate breakfasts please notice that the scale used for Chart 6 is twice that of Charts 3-5. Resetting the Table–to Control Blood Sugar (For a discussion of other strategies, see April 2011). Ramekins filled with condiments like nuts and seeds (GI=0).  Nuts and seeds provide healthy fats, fiber, vitamins, minerals, and antioxidants, while they slow digestion and curb blood sugar. Sourdough bread or whole-grain bread with whole kernels; butter from grass-fed cows and organic nut and seed butters such as tahini and pumpkin seed butter. A pitcher of water and glasses for all—sometimes we mistake hunger for what is in fact thirst.  You might flavor the water with a little lemon juice or other flavoring.
Because 12-hour fasting, pre-meal blood sugar reading can vary, all data points at time zero prior to the first morning meal were indexed to zero in order to illustrate the change from a neutral starting point. I use the label “traditional” carbohydrates, just as we call unrefined fats, “traditional” fats. A colleague of mine recently told me of an encounter with a new elderly patient referred to her practice.
The American Geriatrics Society (AGS) is hoping to help influence this type of behavior with a newly released 2012 Updated Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adult. I do want to highlight one of my favorite new additions to the 53 medications and classes of medications listed as potentially problematic - the insulin sliding scale. Yes, the venerable insulin sliding scale is on the chopping block thanks to this new Beers criteria.
So in honor of the new Beers criteria, I’m asking all the GeriPal readers to submit their craziest medication cocktails that they have seen in the comment section of this blog post.
We definitely need to reiterate the need for physicians to keep from going overkill with their medical prescriptions.
GeriPal (Geriatrics and Palliative care) is a forum for discourse, recent news and research, and freethinking commentary. Write your meal or daily targets for each food choice in the section below.Plan your meals by choosing foods you like from this Food List for Diabetes. 4.When your meal is completed, simply wipe off the laminated Nutrition Place Mat with a Tissue!
5.Use the Nutrition Place Mat to help follow healthy nutrition guidelines and portion control. Please do not record person-identifiable clinical or staff information and other sensitive information in this field.
Thyroid hormones thyroxine (T4) and tri-iodothyronine (T3) are produced, stored, and secreted by the thyroid gland. The protein thyroglobulin (Tg) is produced and used by the thyroid gland to produce T4 and T3. T3 and T4 circulate in peripheral blood bound to proteins (thyroxine-binding globulin [TBG], pre-albumin [transthyretin], and albumin). According to population studies in the US and the UK, the prevalence of overt hypothyroidism varies from 0.1% to 2%, and of subclinical hypothyroidism from 4% to 10% of adults, with possibly a higher frequency in older women. In the US, the American Thyroid Association suggested that all adults should have serum TSH concentration measured at 35 years of age and every 5 years thereafter. In pregnancy, oestrogen levels increase and thyroid-binding globulin concentrations rise, which leads to an increase in T4 and T3. Universal screening compared with case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy did not result in a decrease in adverse outcomes. TFTs should be monitored closely in pregnant women with hypothyroidism because thyroxine replacement often needs to be increased by 30% to 50% during the first trimester. A serum TSH assay is the test of choice to screen for thyroid function disorders in the absence of hypothalamic or a pituitary pathology.


Previously, before improved FT4 and FT3 assays, total T4 and total T3 assays were ordered to evaluate an abnormal TSH assay.
Illness, starvation, and poor nutrition may also decrease total T4 and total T3 levels by decreasing albumin and transthyretin levels and possibly interfering with the binding capacity of the carrier proteins.
TSH-receptor antibodies (TRAb) are not routine tests but may be of use in selected cases where diagnosis is equivocal. Thyroid peroxidase antibodies (TPOAb) are also helpful in identifying thyroid disease aetiology. Tg antibody test is used primarily to help diagnose autoimmune conditions involving the thyroid gland.
Usually ordered for surveillance in patients with differentiated thyroid cancer when the patient does not have Tg autoantibodies in the serum. An increase in serum Tg occurs in 33% to 88% of patients who undergo thyroid fine needle biopsy (FNB). Usually ordered in the setting of thyrotoxicosis to help identify the underlying aetiology. A single, unstimulated calcitonin measurement can be used in the initial work-up of thyroid nodules. Suggests secondary (central) hypothyroidism, which is associated with pituitary or hypothalamic dysfunction. Other causes of these results include non-thyroid illness (sick euthyroid syndrome) where abnormalities in thyroid tests secondary to acute systemic illness are observed with no true thyroid dysfunction. In the second and third trimesters of pregnancy, FT4 and FT3 decrease, sometimes below the non-pregnant woman's reference level.
In the absence of non-thyroidal illness or relevant drug therapy, these results suggest subclinical (or mild) hyperthyroidism. In non-thyroid illness (sick euthyroid syndrome), TSH can be normal or low followed by rebound elevation during recovery from acute illness. The following drugs may cause these results: dopamine, dopaminergic agonists, glucocorticoids, cytokines, or octreotide, because they inhibit pituitary TSH secretion.
Recent treatment of hyperthyroidism with antithyroid medication may also cause these results. In the first trimester of pregnancy, serum TSH falls due to the effect of human chorionic gonadotrophin.
African-American people may have slightly lower TSH reference ranges for normal FT4 and FT3 compared with white people. If assay results are correct, the major diagnoses are a TSH-secreting pituitary tumour (TSH-oma) or a syndrome of resistance to thyroid hormone.
Thyroid hormone resistance syndrome can be confirmed by positive family history, absence of adenoma on pituitary MRI, and normal levels of serum alpha subunit glycoprotein.
Thyroxine replacement therapy (for possible hypothyroidism) taken within a few hours of TFT can raise FT4 levels. Other causes include thyroidectomy or radioactive iodine treatment of the thyroid without adequate thyroid hormone replacement. Subclinical (or mild) hypothyroidism occurs when TSH is above reference range with a normal FT4 and FT3. Other differentials include poor adherence to thyroxine replacement therapy or its mal-absorption: for example, in coeliac sprue, or as a result of interference from other co-administered medications, such as calcium carbonate, ferrous sulphate, and colestyramine. These results may occur following secondary (central) hypothyroidism, which is associated with pituitary or hypothalamic dysfunction. Dopamine and its agonists, as well as glucocorticoids, cytokines, or octreotide, decrease TSH secretion.
Rifampicin (rifampin), phenytoin, carbamazepine, or barbiturates increase hepatic metabolism.
Beta-blockers, glucocorticoids, amiodarone, propylthiouracil, or radiocontrast dyes impair T4 to T3 conversion.
Oestrogens, tamoxifen, heroin, methadone, or raloxifene increase thyroxine binding globulin (TBG), total T4, and total T3 levels. Androgens, anabolic steroids, or glucocorticoids decrease TBG, total T4, and total T3 levels.
Colestyramine, aluminium hydroxide, ferrous sulphate, sucralfate, calcium carbonate, or proton-pump inhibitors impair absorption of thyroxine.
Interleukin-1, interferon-alfa, interferon-beta, and TNF-alpha are associated with risk of autoimmune thyroid dysfunction. In addition to checking your doga€™s blood sugar when you are concerned about it, you can complete blood glucose curves at home to assess how well balanced your doga€™s food and insulin are. You can use the same meters to test your dog, with some comparisons and possibly adjustments to the readings to account for some differences between the blood cells of dogs and people.
You can have your vet draw blood and put a drop of that blood on a strip in your meter or you can test your doga€™s blood sugar with your meter during the vet visit. In his case, the OneTouch Ultra is a reliable average of 30 points lower than lab values, with the range of individual values being between 15 and 45. If your dog is trembling, stumbling, or antsy, for example—some common signs of a dog with low blood sugar—you can test to find out for sure.
You can shave a small patch of skin so that the fur wona€™t interrupt the bead of blood and a very thin layer of Vaseline on the skin will allow the blood to bead nicely. Usually the skin will be too thick to use a lancing pen so you will probably have to use the lance freehand. It works well with cats, which have a strong supply of blood vessels in the margin of the ear. Also, there isna€™t a direct correlation between the reading on the strip and your doga€™s blood sugar at the moment.
If you doga€™s diabetes is well controlled so that the blood sugar is nearly always below that threshold, he will always have a negative urine test.
The excessive thirst and resulting need to urinate that characterize uncontrolled diabetes subsides once you start giving insulin and, when the insulin dose is adequate, your dog will be able to maintain a stable weight and look and feel healthy. While we make every effort to present information that is accurate and reliable, the views expressed here are not meant to be a substitute for the advice provided by a licensed veterinarian.
The second factor—the postwar shift from traditional to refined carbohydrates—is largely due to the growing role of the commercial food industry and processed, convenience foods.  Convenience foods must have a long shelf-life, so food companies rely upon refined flours and oils, which do not go rancid.
Visual pictures of postprandial blood sugar behavior, while less scientific than GI measurements, are nevertheless powerful learning tools, providing a real flavor for how our body reacts when we eat different kinds of foods.
This chart illustrates the second meal effect– that what we eat at one meal affects postprandial blood sugar behavior at the next. What we do to our children when we give them a sugary cereal or a Pop-tart for breakfast extends beyond this first meal to affect their blood sugar, hunger, concentration, and desire to overeat throughout the rest of the day.
One of the best herbs and spices to moderate blood sugar.  It can be sprinkled on hot cereals and desserts such as puddings, custards, and stewed fruits. This document and the website that is associated with the updated Beers criteria is a wealth of both clinical and teaching resources, so I encourage you all to check it out the AGS website.
They should realize that even just one drug off (or too much) of a patient's usual meds could cause serious repercussions.
Develop and individualized meal plan with your Registered Dietitian, Nurse, Physician or Health Educator. Neither the service provider nor the domain owner maintain any relationship with the advertisers. These hormones, particularly T3, play a major role in multiple biological and metabolic processes.


Hypothalamic thyrotropin-releasing hormone (TRH) stimulates pituitary thyrotropin (TSH) synthesis and secretion. T3 is the biologically active form of thyroid hormone whereas T4 is considered a prohormone to T3.
In the first trimester, serum TSH also falls due to the effect of human chorionic gonadotrophin (hCG), which may be associated with a slight and transient increase in FT4. However, total T4 and total T3 levels can be affected by changes in the levels of circulating thyroid hormone-binding protein levels. Tg is usually elevated in primary hyperthyroidism and thyroiditis but not in factitious thyrotoxicosis (excessive use of thyroid hormone medication causing thyrotoxicosis).
It measures the amount of radioactive iodine (usually I-123) that is taken up by the thyroid gland. It may also help differentiate TSH secretory tumour from resistance to thyroid hormone syndrome (RTH). The most common causes include Graves' disease, toxic multinodular goitre, toxic adenoma, and thyroiditis. Patients with subacute thyroiditis have elevated thyroid hormone levels initially, secondary to excessive release of stored T4 and T3 from the thyroid gland. The finding of an elevated serum sex hormone-binding globulin (SHBG) and circulating free alpha subunit may support the diagnosis of TSH-oma, as may the finding of hyper- or hyposecretion of other pituitary hormones.
By contrast, with a TSH-oma where TSH production is autonomous, T4 or T3 administration eventually suppresses the high TSH in thyroid hormone resistance syndrome. Underproduction of the thyroid hormones (T4 and T3) may occur with autoimmune thyroiditis (Hashimoto's disease), which is the most common cause of primary hypothyroidism. Then check the blood sugar again every hour or two hours until the next meal and injection, longer if possible. We have been using this meter since 2004 with excellent results and have performed all of his curves since we began home testing. Actually, dogs have very few nerves in that area and they generally have no problem with being tested there.
For this spot, you may need to use a lance freehand rather than in a pen-type lancing device.
The bladder collects excess sugar from the blood over however many hours it has been since your dog last emptied her bladder. Please consult your veterinarian for specific advice concerning the medical condition or treatment of your dog and before administering any medication or pursuing any course of treatment that you may read about on this site. In case of trademark issues please contact the domain owner directly (contact information can be found in whois).
These changes are small and in most of the pregnant women, FT4 concentrations remain within the normal range for non-pregnant women. A free T3 assay would be the preferred test over a total T3 assay; however, some commercially available free T3 assays are variable and unreliable. The degree of increase in serum Tg after FNB is highly variable (ranging from 35% to 341%) and not a predictor of whether the biopsied nodule is benign or malignant. Later, thyroid hormone levels decrease below normal, before returning to normal when inflammation subsides. However, since your dog may not fit the average and these meters are much more expensive to purchase and use, we recommend starting home blood glucose testing with a regular meter set for humans. Chris is tested on the inside upper lip on both sides of his nose, usually about a half an inch in from the edge of the lip around the vicinity of the canine tooth. You then can collect a little urine (a soup ladle works well for this and you dona€™t need very much at all; in fact, you can insert the test strip directly into the stream of urine if your dog is cooperative) and test it with the strip, checking the color change that indicates how much glucose is in your doga€™s urine. Plus there is lag time between high levels of blood sugar and that sugar being flushed into the urine.
So you have no way of knowing if your doga€™s blood sugar is going too low using strictly urine testing. This is why diabetes and obesity often go hand-in-hand (90% of diabetics are either overweight or obese). David Ludwig regarding high-glycemic foods and overeating, cited in the Recommended Reading section at the conclusion of this newsletter. Typically, this process regulates gene transcription and the subsequent production of various proteins that are involved in development, growth, and cellular metabolism. Once released, T4 and T3 exert a negative feedback mechanism on the production of TRH and TSH. The remaining 80% of T3 is produced by the conversion of T4 to T3 in the peripheral tissues.
Therefore, any changes in the quantity or quality of thyroid-binding proteins will produce changes in circulating thyroid hormone levels.
After delivery, thyroxine should be reduced to pre-pregnancy dose and TSH rechecked at 6 weeks to further adjust thyroxine if needed.
Free T3 should be measured in evaluating patients with thyrotoxicosis, and when the FT4 is not elevated in the presence of a subnormal TSH.
Thyroid-stimulating immunoglobulin (TSI) is an example of a stimulatory TRAb and is usually elevated in Graves' disease. The increased uptake may be diffuse and homogeneous as seen in Graves' disease, or take on the appearance of hot nodules, as seen in multinodular toxic goitre.
Hormone tests should include: ACTH with cortisol, FSH, LH, estradiol (female), testosterone (male), prolactin, GH, and insulin-like growth factor 1 (IGF1).
Hormone tests should include: ACTH with cortisol, FSH, LH, estradiol (female), testosterone (male), prolactin, GH, and (insulin-like growth factor 1 (IGF1).
Acute illnesses, as well as certain drugs, may inhibit the process of converting T4 to T3 and, therefore, affect their serum levels.
Therefore, it is recommended to check TSH levels 6 to 8 weeks after thyroxine adjustment or any antithyroid drug treatment. FT4 and FT3 assays are a good measure of thyroid gland output and are independent of thyroid hormone-binding protein concentrations. Low uptake may indicate thyroiditis or factitious thyrotoxicosis in the appropriate clinical setting. For this condition, thyroid replacement therapy is monitored by checking the levels of FT4 and FT3. The test strips, which are the long-term cost of home testing, are much less expensive for the meters people use.
This location is most often used with medium to large dogs but can also be used with small dogs. Furthermore, in Graves' disease, thyroid stimulating immunoglobulins (TSI) are present in about 90% of patients, though usually not required for diagnosis. Once you are proficient at home testing, you can always transition to an animal-adjusted meter if you are not satisfied with your results using a regular one.
Rarely, TSH alterations can be caused by assay interference with heterophilic antibodies (antibodies to mouse IgG or other human anti-mouse monoclonal antibodies [HAMAs]).
This may result in falsely low or high TSH results, although usually it causes elevated serum TSH. Repeat TSH testing using different commercial assays can neutralise the effect of heterophilic antibodies.



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Comments

  1. 03.02.2015 at 22:57:42


    Ardilouze J, Roy your energy, your mood, and even your able to produce insulin or use.

    Author: Ayxan_Karamelka
  2. 03.02.2015 at 17:37:22


    Level of glucose in the blood within a range should try to keep.

    Author: Jetkokos
  3. 03.02.2015 at 15:41:32


    Factors can affect blood glucose ??a promotion.

    Author: WARLOCK_MAN
  4. 03.02.2015 at 18:34:16


    Damage blood vessels over time, both 2-hour OGTT with glucose and insulin measurements and.

    Author: salam