Approach to Small Animal Patient with Suspected Diabetes Mellitus Flashcards
Define Diabetes Mellitus
Chronic medical condition characterized by elevated levels of blood glucose (blood sugar) due to either insufficient insulin production or the body’s ineffective use of insulin
Outline pathogenesis of diabetes in dogs
- Resistance to insulin
- Insulin production increased
- Islet cell exhaustion / destruction
- Insulin production reduced relative to requirement
- Diabetes Mellitus
What organ releases insulin
Pancreas
Outline pathogenesis of diabetes in cats
- Islet cell pathology (e.g. Amyloidosis)/ Peripheral resistance to insulin
- Islet cell destruction/ Islet cell insufficiency
- Insulin production reduced relative to requirement
- Diabetes Mellitus
Type 1 vs type 2
Type 1 diabetes is autoimmune-driven, leading to insulin deficiency. Type 2 diabetes involves insulin resistance and relative insulin deficiency, managed through lifestyle changes, medications, and sometimes insulin.
Signalment of diabetes
Commoner in older animals
females more likely
terriers more likely
What dog breed is predisposed to diabetes
Samoyed and Terries
Clinical History of diabetes
Polyuria, polydipsia
Weight loss
Polyphagia
Exercise intolerance/lethargy
Blindness (dogs)
Severe HL weakness (cats)
Recent oestrus
Clinical signs of diabetes
BAR
Thin
Cataracts
Neuropathies
What results should you see in urinalysis of a diabetic patient
Glucosuria and Ketone bodies (Ketosis)
What results should you see in Serum biochemistry
of a diabetic patient
Increased Glucose, Cholesterol and Liver enzymes
Treatment of diabetes in dogs
Caninsulin injection
Treatment of diabetes in cats
Insulin injections
Oral Hypoglycaemics
State some oral hypoglycaemics
SGLT2 inhibitors (velagliflozin, bexagliflozin)
What do SGLT2 inhibitors, or sodium-glucose cotransporter 2 inhibitors do?
Work by inhibiting a specific protein in the kidneys, SGLT2, which plays a key role in glucose reabsorption in the renal tubules. By inhibiting SGLT2, these medications promote the excretion of glucose in the urine, leading to lower blood glucose levels.
Two requirements for effective diabetes management
Owner compliance and Veterinary support
Which cats should NOT be selected for SGLT2i?
DKA (Diabetic Ketoacidosis) , pancreatitis, liver disease, significant kidney disease, Blood ketones >2.5 mmol/L, Urine ketones positive
Why cant i use sglt2 in patients with DKA
In DKA, there is a relative or absolute deficiency of insulin, leading to uncontrolled breakdown of fats and the production of ketones. SGLT2 inhibitors may exacerbate this process by promoting further ketone production through their mechanism of action. Their mechanism of action and potential for fluid and electrolyte imbalances make their use inappropriate in the context of DKA.
What percentage of energy requirement in diabetes mellitus in Obese, Thin and normal animal
Obese animals: 70% of calculated requirement for target weight
Thin animals: 100% requirement for optimal weight
Normal animals: 100% of calculated requirement
How many percent of metabolisable energy from complex carbohydrates of a diabetic canine patient
50-55
How many percent of metabolisable energy from fat should a diabetic canine patient consume
Restricted (<20% ME)
How many percent of metabolisable energy from protein should a diabetic canine patient consume
Moderate (14-30% ME)
Should there be simple sugars in a diet for a diabetic canine patient
No simple sugars
Should there be simple sugars and complex CHO in a diet for a diabetic feline patient
no simple and reduced complex CHOs
Things to tell owners about diabetes mellitus in dogs and cats
Injections are not like normal insulin production
Very basic approach
More attention to diet and exercise
Keep dog healthy so that insulin can work
Stabilisation of diabetes in canine (Method 1)
Insulin Administration:
Lente Insulin: Administer 0.3 internationa lunits (iu) per kilogram of body weight every 12 hours.
Twice-Daily Feeding:
Feed the dog twice daily.
Monitoring and Adjustment:
Wait 3 Days: Allow a 3-day period.
Morning Urine Test (over 5 Days):
No Glucose: Reduce insulin dose by 5%.
<1% Glucose: No change in insulin dose.
>2% Glucose: Increase insulin dose by 5%.
Repeat Adjustments: Continue adjusting the dose until stable or until reaching >2 iu/kg.
Check stability: Control of clinical signs and glucose in urine at least once every 5 days (but OK if a little every day)
Stabilisation of diabetes in canine and feline (Method 2)
Insulin Administration:
Lente Insulin (or PZI): Administer 0.3 international units (iu) per kilogram of body weight every 12 hours.
Twice-Daily Feeding:
Feed the cat twice daily.
Monitoring and Adjustment:
Wait 3 Days: Allow a 3-day period.
Blood Glucose Curve: Perform a blood glucose curve to assess glucose levels throughout the day.
Adjust Dose (+/-10%): After the curve, adjust the insulin dose by increasing it by 10%.
Wait 3 Days on New Dose: Allow another 3-day period on the adjusted dose.
Repeat Adjustments:
Continue adjusting the dose by repeating the process until stability is achieved.
Check Stability:
Confirm stability by checking blood glucose levels on 2 consecutive days.
My diabetic pet isn’t eating If otherwise bright and happy…
Decrease insulin by 50%
If eats in next 2 hours can give remainder
Diabetes and surgery
Stabilise diabetes
Day of surgery: 1/2 insulin dose: no food
Operate early in day
Dextrose infusion
Feed 1/2 normal food as soon as able
Monitor blood glucose
Why can cats have hyperglycaemia
Stress induced
