Blood glucose and subcutaneous continuous glucose monitoring in critically ill horses: A pilot study

Abstract

This pilot prospective study reports the feasibility, management and cost of the use of a continuous glucose monitoring (CGM) system in critically ill adult horses and foals. We compared the glucose measurements obtained by the CGM device with blood glucose (BG) concentrations. Neonatal foals (0–2 weeks of age) and adult horses (> 1 year old) admitted in the period of March-May 2016 with clinical and laboratory parameters compatible with systemic inflammatory response syndrome (SIRS) were included. Glucose concentration was monitored every 4 hours on blood samples with a point-of-care (POC) glucometer and with a blood gas analyzer. A CGM system was also placed on six adults and four foals but recordings were successfully obtained only in four adults and one foal. Glucose concentrations corresponded fairly well between BG and CGM, however, there appeared to be a lag time for interstitial glucose levels. Fluctuations of glucose in the interstitial fluid did not always follow the same trend as BG. CGM identified peaks and drops that would have been missed with conventional glucose monitoring. The use of CGM system is feasible in ill horses and may provide clinically relevant information on glucose levels, but there are several challenges that need to be resolved for the system to gain more widespread usability.

Use of FreeStyle Libre for continuous glucose monitoring in adult horses

“…Except for T90, glucose values measured between T60 and T135 neonatal foals, 23 adult horses, 9 dogs and cats, 25 and human patients. 29 In a previous study 16 with the CGMS, oral dextrose administration (ie, by nasogastric tube) was used to induce hyperglycemia in healthy adult horses.…”

“…Blood glucose monitoring is also required in critically ill patients with changes in interstitial glucose concentrations in response to dehydration, pH fluctuations, and exchange of fluid and plasma protein between the intravascular and extravascular compartments, mainly in foals. 9 Low-starch diets (ie, diets with low glycemic index) can be used in the management of diseases associated with insulin dysregulation or as a safer alternative for athletes with high energy needs. 1,10 Continuous blood glucose monitoring for extended periods of time is also required for food development research.…”

“…Blood glucose monitoring is also required in critically ill patients with changes in interstitial glucose concentrations in response to dehydration, pH fluctuations, and exchange of fluid and plasma protein between the intravascular and extravascular compartments, mainly in foals 9 …”

“…Studies in dogs, 12 cats, 13 pigs, 14 dairy cattle, 15 and horses 9,16 have suggested interstitial glucose is correlated with blood glucose. Because the CGM sensor remains in the patient's body, stress is reduced and risks associated with repeated blood collections are eliminated.…”

Correlation analysis of NT-proBNP (N-terminal probrain natriuretic peptide), 25-Hydroxyvitamin D, HMGB1(High-mobility group box 1), ACTA (endogenous activin A), blood glucose level, and electrolyte level with developmental quotient scores in neonates with hypoxic-ischemic encephalopathy

“…Previous studies have pointed out that neonates with HIE may suffer from glucose metabolism disorders due to energy metabolism disorders. Neonates with HIE are prone to stress hypoglycemia or hyperglycemia, and the blood glucose level of children is related to the prognosis [ 27 ]. Other study pointed out that clinicians should closely monitor the blood glucose level of neonates with hypoxic-ischemic encephalopathy and provide timely treatment measures for neonates with HIE, so as to improve their prognosis [ 28 ].…”