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Lantus Dosing Cats

Tilly's Diabetes Homepage

Tilly's Diabetes Homepage

Home Story 6 important factors Blood glucose values The future? Links Guestbook About this site Disclaimer • see your vet and get his or her approval of this protocol before you start!!! • talk to your vet regularly about your cat's progress • see your vet immediately if your cat develops additional problems (e.g. ketones, hypoglycemia, vomiting, fever, bladder infections, etc) Read this first • this protocol was developed by lay people, including myself, who are members of the German Diabetes-Katzen Forum. It has since been published in the Journal of Feline Medicine and Surgery. • the majority of cats do very well on this protocol, some cats do not (generally these are hard-to-regulate cats) • it is more time-consuming than most other protocols, but still definitely doable if you work a regular full-time work week • it is more expensive than most other protocols, but costs can be reduced by e.g. buying glucose test strips from online pharmacies or reputable sellers at eBay • members of the German Diabetes-Katzen Forum buy 3 ml Lantus/Levemir cartridges, refrigerate them after opening and routinely use them for 6 months or more - when refrigerated, opened cartridges of these insulins are extraordinarily stable • you will need to test the blood glucose levels of your cat multiple times per day • you will need to know about hypoglycemia and be prepared to deal with it • you will need to test for ketones regularly to start with and know about ketoacidosis, but be aware that ketones don't occur once a cat is (and remains) properly regulated • you will need a brand-name glucometer made for human diabetics that measures whole blood (not plasma-equivalent) and which uses 0.6 µL of blood per test or less • you will need to use syringes which allow yo Continue reading >>

Giving Your Client's Cat Insulin For Treating Feline Diabetes

Giving Your Client's Cat Insulin For Treating Feline Diabetes

...managing and tracking the cat's progress Giving your client's cat insulin to treat feline diabetes can begin to get difficult as most of the work begins after leaving the practice... Using Insulin to treat diabetes in felines Once you have to give them insulin, if you have an owner who is not terribly confident that they are going to be able to pick up a hypoglycaemic event, then I will use Caninsulin (a mix of porcine insulin’s 40iu/ml) because it is shorter acting and does not build up over the 18 – 24 hour period like the Glargine does (and which often results result in a hypoglycaemic event, that can last for hours). Nevertheless, Marshall and Rand think it is a risk worth taking. The cats usually only end up needing 1 – 4 units of either kind of insulin twice a day – the Glargine especially seems to keep them stable at 2 units twice a day. Once you push up into the 3 or 4 units, you can bring them into remission, but it is often via a sudden hypoglycaemic event, which is unpleasant all round. And is, I guess, the reason that the Glargine insulin protocol recommends treating them in hospital. After giving the cat insulin, the process to stabilise Fluffy at home, usually starts at 1 or 2 units of either kind of insulin twice a day. You need to get the owners to bring the cat in after a couple of days to measure its blood glucose 3 hours after their insulin dose and breakfast. It does not matter about meal-feeding cats, as they do not get the post-prandial glucose spike (ref: The Cat as Model for Human Obesity and Diabetes; Hoenig) – because they are digesting protein and balancing out the glucose release after it has been deconstructed from protein in the liver. It is more natural for a cat to graze-feed anyway, so if that is what the cat wants to do, th Continue reading >>

Proceedings Of The 34th World Small Animal Veterinary Congress

Proceedings Of The 34th World Small Animal Veterinary Congress

Close this window to return to IVIS www.ivis.org WSAVA 2009 São Paulo, Brazil - 2009 Next WSAVA Congress : Reprinted in IVIS with the permission of the Congress Organizers NEW STRATEGIES IN THE MANAGEMENT OF FELINE DIABETES MELLITUS Michael E Herrtage MA BVSc DVSC DVR DVD DSAM DECVIM DECVDI MRCVS Department of Veterinary Medicine, University of Cambridge Incidence Diabetes mellitus (DM) is the second most common endocrine disorder in cats, with an estimated incidence of 0.5% (1 in 200-250 cats). Its incidence appears to be increasing, probably due to an increase in obesity in the cat population. Several risk factors for DM have been identified: age, obesity, neutering and gender. Age has been identified as the single most important risk factor. Diabetes occurs in a wide age range of cats, but most cats are over 6 years of age when diagnosed. The average age at diagnosis is 10 years and the peak incidence is between 9 and 13 years. Diabetes in young cats is extremely rare. Obesity increases the risk of developing diabetes 3- to 5-fold. Given that the prevalence of obesity in cats between 5 and 11 years old is over 40%, the high prevalence of feline diabetes mellitus is understandable. Neutered cats have nearly twice the risk of developing DM and male cats 1.5 times the risk. Genetics may play a role in some breeds (e.g., Burmese cats in Australia). Pathophysiology Diabetes mellitus is classified into insulin-dependent (type 1) and non-insulin dependent (type 2) diabetes mellitus. Type 1 diabetes, resulting from immune-mediated destruction of beta cells, appears to be quite rare in cats. Type 2 diabetes, the most common form of DM in cats, is characterised by variable loss of insulin secretory capacity and insulin resistance. Secondary forms of diabetes can develop wit Continue reading >>

2010 Aaha Diabetes Management Guidelines For Dogs And Cats

2010 Aaha Diabetes Management Guidelines For Dogs And Cats

Renee Rucinsky, DVM, ABVP (Feline) (Chair) | Audrey Cook, BVM&:S, MRCVS, Diplomate ACVIM-SAIM, Diplomate ECVIM-CA | Steve Haley, DVM | Richard Nelson, DVM, Diplomate ACVIM | Debra L. Zoran, DVM, PhD, Diplomate ACVIM | Melanie Poundstone, DVM, ABVP - Download PDF - Introduction Diabetes mellitus (DM) is a treatable condition that requires a committed effort by veterinarian and client. This document provides current recommendations for the treatment of diabetes in dogs and cats. Treatment of DM is a combination of art and science, due in part to the many factors that affect the diabetic state and the animal's response. Each animal needs individualized, frequent reassessment, and treatment may be modified based on response. In both dogs and cats, DM is caused by loss or dysfunction of pancreatic beta cells. In the dog, beta cell loss tends to be rapid and progressive, and it is usually due to immune-mediated destruction, vacuolar degeneration, or pancreatitis.1 Intact females may be transiently diabetic due to the insulin-resistant effects of the diestrus phase. In the cat, loss or dysfunction of beta cells is the result of insulin resistance, islet amyloidosis, or chronic lymphoplasmacytic pancreatitis.2 Risk factors for both dogs and cats include insulin resistance caused by obesity, other diseases (e.g., acromegaly in cats, hyperadrenocorticism in dogs), or medications (e.g., steroids, progestins). Genetics is a suspected risk factor, and certain breeds of dogs (Australian terriers, beagles, Samoyeds, keeshonden3) and cats (Burmese4) are more susceptible. Regardless of the underlying etiology, diabetic dogs and cats are hyperglycemic and glycosuric, which leads to the classic clinical signs of polyuria, polydipsia (PU/PD), polyphagia, and weight loss. Increased fat mobi Continue reading >>

Lantus Insulin - Managing Diabetes Mellitus In Dogs & Cats | Petcarerx

Lantus Insulin - Managing Diabetes Mellitus In Dogs & Cats | Petcarerx

Lantus is a brand of insulin used to treat diabetes mellitus . An insulin glargine -- a type of insulin that is structurally identical to, but not, human produced insulin -- Lantus is designed to be longer lasting than other insulins, lasting up to 24 hours (however, in dogs it typically does not last more than 16 hours). Like all other forms of insulin, Lantus is taken subcutaneously (an injection), and can be a critical part of treating your dog or cats diabetes . Injections should not be administered in the same spot every day, as this could cause scarring, which will dampen the bodies ability to absorb the medication. Use with anabolic steroids, adrenergic blockers, MAOIs, aspirin (or other salicylates), phenylbutazone, or tetracycline might increase the effects of Lantus, and should be monitored, while DOBUTamine, EPINEPHrine, furosemide, thiazide, progesterone, glucocorticoids, and estrogen, may decrease the effects. Taking with burdock (a plant with diuretic and blood purifying properties) may have a hypoglycemic effect, and the dosage of insulin may need to be adjusted accordingly. Pets taking digoxin should have their potassium levels monitored. Typically eliciting a much stronger reaction from dogs than from cats, the dosage will typically start out much lower than with other types of insulin, roughly .1 unit/kg twice a day. Hypoglycemia (dangerously low blood sugar), Somogyi effect hyperglycemia, insulin resistance, or a rapid insulin metabolism (using too much insulin too quickly) are all potential adverse reactions of Lantus. An overdose is likely to result in hypoglycemia, and in some cases, even death. Continue reading >>

Feline Diabetes Mellitus

Feline Diabetes Mellitus

In Part 1 of this article (IVC, Winter 2012), I covered the diagnosis of feline diabetes mellitus, and how early DM can be managed with diet, medication and herbs. Now Ill discuss insulin stabilization and home monitoring, the complications that can occur with the disease, and the reasons why some cats dont recover. Feline DM is treated with Rx insulin injections twice a day (BID) combined with home BG monitoring. Cats metabolize insulin twice as fast as dogs or humans, and ideally, a cat with DM should be eating a very low carbohydrate diet twice a day. Hence the ultra-long-acting human insulins, Glargine Lantus or Detemir Levemir, work best for these cats. Rx Glargine = Lantus: This acid pH insulin precipitates in the neutral pH of the body and is absorbed slowly. The initial dose is 1 to 2 IU/cat twice a day. It lasts 12 to 18 hours. The bottles are 10 ml and fairly expensive. Rx Detemir = Levemir: The Detemir insulin is strongly protein bound (that is, albumin bound) and slowly released. The initial dose is 1 to 2 IU/cat twice a day. It lasts 18 to 21 hours. One box contains 5 x 3 ml vials. Detemir appears to be better tolerated than Levemir in some cats, and may have less variability. As Detemir is strongly protein bound, there is the potential for drug interactions. Other drugs commonly used in cats that are also strongly protein bound include the injectable long-acting penicillins, long-acting cephalexin, and Rx Propofol, an injectable anesthetic. I now prefer Levemir insulin in my diabetic cats. I find the BG nadir occurs, on average, about three to six hours after injection, and there is a fairly flat BG curve. On Lantus and Levemir, over 80% of my newly diagnosed diabetic cats recover within three months. I purchase the box of Levemir and dispense the 3 ml vi Continue reading >>

How Do I Get Lantus Insulin Less Expensively?

How Do I Get Lantus Insulin Less Expensively?

November 2, 2013-- How do I get Lantus Insulin Less Expensively? DCIN receives this question a few times a week from US caregivers of diabetic cats. I am often amazed by the question because of the “good” insulins for diabetic cats, Lantus can be the least expensive per unit. The problem often lies in knowing how to find the insulin inexpensively. (The hints I give also apply to Levemir, another human insulin often used by diabetic cats.) Your vet gave you a prescription that probably read “U100 Glargine/Lantus 10ml vial.” Lantus is the brand name for the generic insulin Glargine. Lantus is an insulin for humans and is only available from a human pharmacy (although some vets do hold some in stock). The company Sanofi makes Lantus, and no other companies currently make a generic Glargine because Sanofi still has an international patent on the insulin. That may change in 2014, and by then Sanofi may have developed a “second-generation” Lantus that is patent protected. Lantus is a U100 insulin, which describes the concentration of the insulin in the liquid suspension. A 10ml vial is the insulin’s containment device. It is a small glass bottle with a rubber stopper at the end that you pierce with a syringe. At a US retail pharmacy, a 10ml vial of Lantus can cost about $180 to $200. WOWZA! That does seem cause for sticker shock. A 10ml vial of U100 insulin holds 1000 units of insulin. At $200/vial, that is a price of $.20/unit. If your cat gets 2 units of insulin twice a day, that is $.80/day for its insulin (if you could completely use a vial of Lantus insulin). It would cost less each day to give your cat its life-saving medicine that to buy a soda from a vending machine. However, the problem with buying Lantus in a 10ml vial is that, properly handled, Lantus Continue reading >>

Feline Diabetes Mellitus Updates On Diagnosis & Treatment

Feline Diabetes Mellitus Updates On Diagnosis & Treatment

David Bruyette, DVM, Diplomate ACVIM, and Karen Eiler, DVM, MS, Diplomate ACVIM Feline diabetes mellitus, one of the most commonly encountered feline endocrine diseases, is comprehensively reviewed, with an emphasis on providing up-to-date information on diagnosis and treatment based on current literature and research. The article outlines the insulins available for therapeutic use in cats and the nuances of each; a table provides insulin doses. Pathogenesis, diagnostics, other management modalities, and monitoring are also addressed. Diabetes mellitus (DM) is a commonly encountered feline endocrine disease.1 DM is defined as persistent hyperglycemia and glycosuria due to an absolute or relative insulin deficiency. The most common causes of feline DM are: Islet cell amyloidosis Obesity Chronic pancreatitis. CLASSIFICATION Insulin is secreted exclusively from beta cells in the pancreas’ Islets of Langerhans. Insulin deficiency occurs when beta cells are destroyed or their function impaired, and the pathogenesis of beta cell dysfunction is used to classify DM. In humans, DM is classified as: Type I (insulin dependent): Results from autoimmune damage to the Islets; associated with complete lack of insulin Type II (noninsulin dependent): Characterized by abnormal insulin secretion and peripheral insulin resistance Gestational, congenital, neonatal, or monogenic. Most feline diabetics have type II DM,2 and may have underlying susceptibilities to this type due to genetic predisposition and decreased insulin sensitivity (seen with obesity).3,4 Type III DM is similar to impaired glucose tolerance in humans. Medications or diabetogenic hormones (epinephrine, cortisol, glucagon, and growth hormone) interfere with the action of insulin, result in glucose intolerance, and ultimat Continue reading >>

Update On Insulin Treatment For Dogs And Cats: Insulin Dosing Pens And More

Update On Insulin Treatment For Dogs And Cats: Insulin Dosing Pens And More

Authors Thompson A, Lathan P, Fleeman L Accepted for publication 19 February 2015 Checked for plagiarism Yes Peer reviewer comments 3 1School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia; 2College of Veterinary Medicine Mississippi State University, Starkville, MS, USA; 3Animal Diabetes Australia, Melbourne, VIC, Australia Abstract: Insulin therapy is still the primary therapy for all diabetic dogs and cats. Several insulin options are available for each species, including veterinary registered products and human insulin preparations. The insulin chosen depends on the individual patient's requirements. Intermediate-acting insulin is usually the first choice for dogs, and longer-acting insulin is the first choice for cats. Once the insulin type is chosen, the best method of insulin administration should be considered. Traditionally, insulin vials and syringes have been used, but insulin pen devices have recently entered the veterinary market. Pens have different handling requirements when compared with standard insulin vials including: storage out of the refrigerator for some insulin preparations once pen cartridges are in use; priming of the pen to ensure a full dose of insulin is administered; and holding the pen device in place for several seconds during the injection. Many different types of pen devices are available, with features such as half-unit dosing, large dials for visually impaired people, and memory that can display the last time and dose of insulin administered. Insulin pens come in both reusable and disposable options. Pens have several benefits over syringes, including improved dose accuracy, especially for low insulin doses. Keywords: diabetes, mellitus, canine, feline, NPH, glargine, porcine lente Introduction Insulin the Continue reading >>

Research Updates: Giving Glargine Insulin To Newly Diagnosed Diabetic Cats May Increase The Likelihood Of Remission

Research Updates: Giving Glargine Insulin To Newly Diagnosed Diabetic Cats May Increase The Likelihood Of Remission

Diabetic remission, defined as reversion from a hyperglycemic to normoglycemic state in a diabetic patient after discontinuing insulin therapy, has been reported in cats that first present with uncomplicated diabetes mellitus or for treatment of diabetic ketoacidosis. Authors of previous studies have suggested that the success of glycemic control or the type of insulin being administered may affect the remission rate. This study's goal was to determine and compare the likelihood of remission in cats with newly diagnosed diabetes mellitus when treated with glargine insulin, protamine zinc insulin (PZI), or Lente insulin given subcutaneously twice a day. In this nonrandomized, prospective study, 24 cats in which diabetes mellitus had been diagnosed within the preceding 24 hours were enrolled. Initial assessment included performing a physical examination, serum chemistry profile, urinalysis, and urine bacterial culture. Each cat's fructosamine concentration was also determined. All cats with serious concurrent diseases were excluded from the study. Enrolled patients included 21 cats with adequate food consumption and a lack of systemic signs that allowed immediate administration of one of the three subcutaneous insulins and three cats that required treatment with intravenous fluids and regular insulin before subcutaneous insulin administration could be started. Cats were distributed into the three insulin treatment groups with an attempt made to evenly match groups based on breed (Burmese vs. non-Burmese) and whether or not the cats had previously been given corticosteroids. The initial dose of subcutaneous insulin was between 0.25 and 0.5 IU/kg, as determined by the serum glucose concentration (< 360 mg/dl [< 20 mmol/L] vs. > 360 mg/dl, respectively). All cats were fed an Continue reading >>

Do You Have A Dosing Protocol For Glargine For Cats And Can Standard Process Feline Whole Body Support Lower The Glucose?

Do You Have A Dosing Protocol For Glargine For Cats And Can Standard Process Feline Whole Body Support Lower The Glucose?

« Back to Previous Page ▲ 0 ▼ ♥ 0 My question has to do with feline diabetes. My 7 year old male probably got diabetes from being overweight. At one point he was 22 pounds and now is down to 17 pounds. Getting him regulated continues to be a problem. He was diagnosed in December of 2015 and is on his third type of insulin now, Lantus (glargine), which has the most flat curves. I have kept a detailed glucose log for him, indicating dates, times, glucometer readings, insulin units given, and what food he was given, and type it into a Word table weekly from the written notebook which I email to my vets. I do a 12 hour curves on him every weekend. He goes to 3 different vets, a holistic one, a traditional one, and a university veterinary hospital for an internal medicine specialist. I’ve had to do a lot of research myself on feline diabetes and found the German protocol was the only one that actually lists a dosing protocol for Lantus. A dosing protocol for glargine is what I need, but none of my vets will agree to the German one or give me a US one. Lantus drug sheets from the pharmacy do not go into dosing at all, and only talk about humans taking it. I didn’t agree with the internal medicine intern or resident who suggested prescription dry food. All the articles I read say feed only canned food, no dry, which is what I’ve been doing. The traditional vet is the one prescribing and dosing the glargine, and one day his glucose went very low and I had to feed him extra food and not give him any insulin and then he seems to go into smogoyi effect. After reading the German protocol, I believe the traditional vet had him going up too fast, about a unit per week, which might be OK for Prozinc, but not for Lantus. The German protocol would only recommend going up by Continue reading >>

Insulin For Cats

Insulin For Cats

Most diabetic cats will require insulin therapy as part of their treatment. Diet is also an important cornerstone of treatment for feline diabetes mellitus, and a few diabetic cats can be managed with diet alone, but the majority will require insulin. There are a variety of types of insulin available. Some are designed for human use but can be useful in pets, while others have been developed specifically for animal use. The natural insulins produced by cat and dog pancreatic cells have slightly different structures than the natural insulin produced by human pancreatic cells. Insulin types made for human use match the natural human insulin, and may not always be as effective in pets. With any insulin, the goal of treatment is to safely reduce or eliminate the symptoms of diabetes (weight loss with excessive thirst, urination and appetite). There is no ‘best’ insulin for all cats, but some are preferable to others. Many veterinary internal medicine specialists recommend glargine (Lantus®, made by Sanofi Aventis) as a first-line choice. Lantus® is a recombinant human insulin which is usually very effective in cats. In combination with an appropriate diet (canned cat food with less than 7% carbohydrates), glargine has the best chance of inducing a remission, meaning that the cat will no longer require insulin. Lantus® is typically dosed at 1 or 2 units twice daily (BID). In some cats it can be used once daily. Once daily administration is not as likely to induce remission—and won’t control the blood sugar very tightly—but is an option for families or cats who can’t do twice daily injections. The glargine product information for human use recommends replacing the vial every 28 days, but if kept refrigerated, the insulin is effective for cats for at least three Continue reading >>

Regulating Feline Diabetes With Lantus: Glargine Insulin For Cats

Regulating Feline Diabetes With Lantus: Glargine Insulin For Cats

Glargine insulin, or Lantus, is an increasingly popular method for managing diabetes in felines. Diabetes mellitus, known commonly as type II or sugar diabetes, is a serious disease affecting a growing number of cats. It can develop when the pancreas stops producing enough insulin, the hormone responsible for controlling the amount of blood sugar in the body. The resulting high glucose levels can lead to complications like damaged kidneys, muscles and nerves. Without treatment, diabetic felines are also susceptible to organ failure and death. Lantus injections may help regulate the disease by lowering blood sugar levels in diabetic cats. Learning more about how this product works, including precautions and guidelines for its use, can help cat owners select the right treatment method for their diabetic pet. How Does Lantus Work? Lantus (sometimes misspelled "Lantis") is a synthetic or analog insulin manufactured by Sanofi-Aventis. Like other kinds of injectable insulin, it provides the body with the hormones necessary to help lower the amount of glucose in the bloodstream. Lantus releases insulin slowly in the body, which helps minimize the number of injections required to maintain healthy glucose levels. Its long-lasting effects have helped make it an increasingly preferred method for managing feline diabetes, since cats metabolize insulin around twice as fast as people. Lantus typically remains active in cats for around 12 hours per dose, which may require owners to administer the medicine twice a day. Owners should always consult with a veterinarian regarding specific dosage recommendations and instructions. Although the product is not FDA-approved for feline use, it may be available by prescription from a veterinarian. Unlike some older insulin products, the active i Continue reading >>

Insulin Glargine

Insulin Glargine

Why has my veterinarian prescribed this medicine? Insulin glargine is a long-acting insulin used in cats with diabetes mellitus to help regulate blood sugar. How do I give this medication? "An overdose could seriously harm your cat." This medication is injected under the skin (subcutaneously) usually twice a day. Read the label carefully. Allow the medication to come to room temperature before injecting. This medication does not need shaking or swirling. Ensure your veterinarian has demonstrated the proper technique for withdrawing the insulin and proper injection technique. Do not dilute or mix glargine insulin with diluents or other medications. Measure the dose with reasonable care. Double-check the dose in the syringe. An overdose could seriously harm your cat. The dose is generally only a few units of insulin and the gradations on a syringe are tiny. Try to give this medication at about the same time each day. Do not give the pet more insulin than directed and do not give more often than directed. Try not to miss giving any doses. It is a good idea to keep two vials of insulin on hand, just in case one is broken or you run out over a weekend or holiday. Be aware of your pet's normal behavior. This will help determine when something is wrong. If your pet is not acting normal, suspect low blood sugar (hypoglycemia). You may wish to carry packets of honey, packets of sugar or a small bottle of corn syrup for emergency administration when leaving home with your pet. What do I do if I miss giving a dose? Give the dose as soon as possible. If it is almost time for the next dose, skip the missed dose, and continue with the regular schedule. NEVER give the cat two doses at once. How do I store this medicine? Keep this medicine out of reach of children. Store the insulin in Continue reading >>

Using Glargine In Diabetic Cats

Using Glargine In Diabetic Cats

Rhett Marshall BVSc MACVSc The Cat Clinic 189 Creek Road, Mt Gravatt, 4122 Basic information Glargine must not be diluted or mixed with anything because the prolonged action is dependent on its pH Glargine has a shelf-life of 4 weeks after opening and kept at room temperature. Refrigeration prolongs its shelf-life and allows opened vials to be used for up to 6 months. The manufacturer however recommends discarding opened vials after 4 weeks When performing a blood glucose curve, samples probably only need to be taken every 4hrs over 12 hr in many cats (ie. 0h [before morning insulin], 4h, 8h and 12h after morning insulin) Dose changes should be made based on pre-insulin glucose concentration, nadir (lowest) glucose concentration, daily water drunk, and urine glucose concentration. Better glycaemic control is achieved with twice daily dosing rather than once daily More accurate dosing may be achieved using 0.3ml U-100 insulin syringes Indications for starting glargine All newly diagnosed diabetic cats (to increase chance of remission) Poorly controlled or unstable diabetic cats (glargine’s long duration of action is likely to benefit these cats) When SID dosing is desired or demanded (glycaemic control and remission rates are higher if glargine is dosed BID) Ketoacidosis – replaces regular insulin and can be used IM or IV When corticosteroid administration is required in cats at high risk of developing clinical signs of diabetes or cats in remission. For initial insulin dose, BG > 20mmol/L à start with 0.5U/kg ideal body weight twice daily (BID) BG < 20mmol/L à start with 0.25U/kg ideal body weight BID Blood glucose should be sampled every 3-4hrs for several days, either at home or in hospital. Dose reductions can be made (based on the blood glucose parameters in T Continue reading >>

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