3. Dosage Forms and Insulin

Question 1

What is a dose

Answer 1

specific amount calculated for a specific anima
ex 50mg

Question 2

What is a dosage/

Answer 2

the mass of drug needed per unit weight of the animal (10mg/kg)
refers to any animal

Question 3

What is a dosage form/

Answer 3

physical form of the drug - tablet, liquid, suspension, ointment

Question 4

What are capsules?

Answer 4

powdered drugs placed in a gelatin capsule
opening capsules or dividing capsules is considered EDLU

Question 5

What is a sustained-release drug form?

Answer 5

tablets or capsules with a special exterior coating that decreases the rate of dissolution
disrupting the coating is considered ELDU

Question 6

What is a suspension dosage form?

Answer 6

particles of drug in a liquid; shake before EACH use
never give suspensions by IV route

Question 7

What is the ointment and creams dosage form?

Answer 7

includes drugs with lots of systemic side effects or those that do not have good oral absorption

Question 8

What are some of the diff types of dosage forms/

Answer 8

tablet, capsule/gel-gaps, sustained-release, suspension, ointments, creams, past, injectables, depots/implants

Question 9

What is a dosing regimen?

Answer 9

refers to complete information needed
specific amount of drug; number and frequency of administration over a certain amount of time - mass of drug (most commonly expressed as mg), route of dosing, frequency (aka dose interval), duration
ex. metacam 0.1 mg/kg PO q24h x 5d

Question 10

What is diabetes mellitus?

Answer 10

can occur in cats OR dogs, lack of insulin
insulins main func is to move glucose out of the blood and into the tissue cells where it can be used for energy
if there is a lack of insulin, glucose accumulates in the blood and urine and tissue cells are starving for energy (therefore despite eating lots, the animal is losing weight and is essentially starving - therefore if owner is unwilling/unable to treat, it is inhumane to not euthanize
DM is either not being produced or body does not recognize the insulin

Question 11

What are the two types of diabetes mellitus and what are they/

Answer 11

Type 1: insulin dependent diabetes mellitus - pancrease does not prod insulin bc beta-islet cells that normally prod insulin are destroyed by the immune system; autoimmune dz. more common in dogs
Type 2: NON insulin dependent diabetes mellitus - insulin is prod, but body does not recognize it; related to obesity. more common in cats

Question 12

What are some symptoms of diabetes mellitus?

Answer 12

High blood glucose - it spills over into the urine; sweet urine great for bacterial growth so inc risk of UTI. Glucose osmotically draws water into urine = PU/PD. sugar accumulates in lens of eyes (diabetic cataracts = diabetic glaucoma in dogs)
Results of being in starvation mode - fat + muscle metabolized by ketosis, the by-produc is ketones (aka acids) that cause acidosis. Diabetic ketoacidosis (DKA) can be fatal
neurons can only metabolize glucose = neurological deficiencies (hind end weakness, abnormal behaviour, tremors

Question 13

What are some presenting signs of diabetes mellitus in patients?

Answer 13

weight loss (in spite of ravenous appetite)
dehydrated
PU/PD
plantigrade stance in cats

Question 14

How do we treat diabetes mellitus?

Answer 14

1. insulin
2. weight loss if obese (esp in cats w/ type 2 diabetes)
3. dec carbs in diet; inc protein (better digested in diabetics) and soluble fibre (slows down sugar release)
4. treating bact UTI - antibiotics
5. Treating cataracts/glaucoma (dogs)
6. oral hypoglycemia agents (newer, less commonly used)

Question 15

What are some important facts about treating diabetic animals/

Answer 15

Feeding schedule MUST be consistent (same amount every day)
match the glucose-lowering effects of insulin w/ the glucose-raising effects of the meal, usually a low fiber, low-calorie diet (to slow gut transit time and maintain a stable glucose lvl throughout the day AND keep the pet from becoming overweight/encourage healthy weight loss

Question 16

What do we need to be aware about when giving insulin/

Answer 16

feed and give insulin at the same time
insulin is a protein and needs to be refrigerated and handled gently - invert 2-3times to mix and to prevent denaturation of protein (exception is caninsulin, which should be shaken at first use)
keep routine as much as possible to avoid stress hyperglycemia
know the signs of hypoglycemia (ataxia, coma, lethargy, seizures)
teach owner how to handle, store and administer insulin

Question 17

What are the different types of insulin?

Answer 17

short/rapid-acting insulin
intermediate-acting insulin and
long-acting insulin

Question 18

What makes a short/rapid acting insulin?

Answer 18

molecule is small and rapidly absorbed after SQ injection
onset: 0.5-1.5hrs after injections
Peak action: 2-4 hrs

Question 19

What makes an intermediate-acting insulin

Answer 19

Moecule is bigger, leading to slower absorption
Onset: 1.5-3 hrs
peak action 2-11hrs

Question 20

What makes a long-acting insulin?

Answer 20

molecule is modified by either attaching another molecule, or changing its pH, to allow for a much slower absorption
onset: 1-3 hrs
peak action: 4-26 hrs

Question 21

What insulin is commonly used in cats?

Answer 21

prozinc and glargin (lantus). combined w/ a low carb, high protein diet
remission rates of 65% or higher have been reported with this combo of diabetic diet and insulin
watch for signs of remission (decrease PU/PD, inc body weight, less ravenous appetite) so that hypoglycemia doesn’t occur
serum fructosamine may more useful than a glucose curve (stress hyperglycemia make BG readings unreliable); alternately, clients can be taught to do BG curves at home to reduce stress of being in clinic

Question 22

What insulin is commonly used in dogs?

Answer 22

caninsulin, prozinc also used in dogs
often need higher doses than in cats
remission much less common than in cats
diabetic cataracts much more common in dogs than cats

Question 23

What are glucose curves?

Answer 23

serial blood glucose measurements every 1-2hrs
determines effectiveness of insulin and can help determine/adjust dose
must give 1-2 weeks after starting insulin, or after any dose adjustments, before your perform a curve

Question 24

when do we typically take glucose curves?

Answer 24

usually done from immediately b4 morning dose of insulin until evening dose of insulin

Question 25

Why is it difficult to perform a glucose curve in clinic?

Answer 25

because of stress hyperglycemia
teach owners and send glucometer home, fructosamine, continuous glucose monitoring (CGM) freestyle libre2

Question 26

How do we continuously monitor glucose?

Answer 26

a sensor with a flexible cath is inserted into skin
measures interstitial glucose lvls - lags behind blood glucose by ~10 minutes
measurements are transmitted to owners smart phone via an app
kept in place by a skin adhesive and a t-shirt to prevent self-removal
lasts up to 2 weeks
easy for owners to use

Question 27

How do we dispense and store insulin?

Answer 27

1. dispensing insulin - caninsulin available in 3ml and 10ml vials, send home 3ml for sm dogs and 10ml for lg dogs = 1 mo supply, prozinc available in 10ml vial - longer shelf life
2. Storage - in fridge UNOPENED until exp date, after open, in fridge to about 4-6wks, prozinc longer - good until exp whether open or not
3. dispense appropriate syringes w/ insulin

Question 28

What type of insulin syringes are there?

Answer 28

caninsulin/prozinc reqs a U40 syringe - 1ml is divided into 40 unites, each of those units = 1 unit of insulin
Glargine req a U100 syringe 1 divide by 100
Syringes NOT interchangeable - important to communicate with client

Question 29

How do we dose insulin?

Answer 29

dosed by weight in units of insulin/kg
some dosing takes into account the severity of hyperglycemia at the time of diagnosis
ex. for initial dose - dog starting on caninsulin: dose is 0.5-1 unit/kg q24hr
Cats on glargine: 0.25-0.5 unit/kg q12hr, not to exceed 2 units ber cat BID to start
Dosages are a starting point, adjusted up/down based on glucose lvls
vet will give you dose and are the ones who adjust dose, NOT client

Question 30

How do we give insulin/

Answer 30

1. insulin must be kept in the fridge once opened. check exp dates and specific handling instructions on insert for each brand you dispense
2. to mix, invert vial completely 2-3 times (ensure bubble goes completely to the top each time)
3. inject SQ. alt injection sites as scar tissue forms over time will dec absorption
4. most insulin is prescribed q12h. Give 15 min after eating, if they don’t eat, skip that dose

Question 31

What is hypoglycemia?

Answer 31

Insulin causes blood sugar to drop, if anim no eat > becomes hypoglycemic
acute hypoglycemia is worse than hyperglycemia, can be fatal
Signs: weakness/disorientation/restlessness, tremors/shivering, seizures, loss of consciousness

Question 32

Why do we warn owners not to give insulin if they pets have not eaten? What happens if they DO still give it?

Answer 32

If they have hypoglycemia because of giving an insulin dose when they haven’t eaten, or in an accidental dose, they should rub sugar or syrup on the gums
err of the side of caution and treat for hypoglycemia
cats in remission are at risk of hypoglycemia if their insulin is not stopped

Question 33

What are oral hypoglycemic agents?

Answer 33

Human drugs
Action: work by stimulating pancreatic beta cells to secrete insulin; therefore some pancreatic function is needed
ex. glipizide
limited success in anims so seldom used
relatively high potential for s/e

Question 34

What is senvelgo?

Answer 34

An oral hypoglycemic agent
action: inhibits a glucose transporter in the kidneys that is responsible for reabsorbing glucose, resulting in lower serum glucose lvls
use restricted to cats only, newly diagnosed, type 2 diabetic, not on insulin currently and has never been on insulin