Approach to Small Animal Patient with Suspected Diabetes Mellitus

Question 1

Define Diabetes Mellitus

Answer 1

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

Question 2

Outline pathogenesis of diabetes in dogs

Answer 2

1. Resistance to insulin
2. Insulin production increased
3. Islet cell exhaustion / destruction
4. Insulin production reduced relative to requirement
5. Diabetes Mellitus

Question 3

What organ releases insulin

Answer 3

Pancreas

Question 4

Outline pathogenesis of diabetes in cats

Answer 4

1. Islet cell pathology (e.g. Amyloidosis)/ Peripheral resistance to insulin
2. Islet cell destruction/ Islet cell insufficiency
3. Insulin production reduced relative to requirement
4. Diabetes Mellitus

Question 5

Type 1 vs type 2

Answer 5

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.

Question 6

Signalment of diabetes

Answer 6

Commoner in older animals
females more likely
terriers more likely

Question 7

What dog breed is predisposed to diabetes

Answer 7

Samoyed and Terries

Question 8

Clinical History of diabetes

Answer 8

Polyuria, polydipsia
Weight loss
Polyphagia
Exercise intolerance/lethargy
Blindness (dogs)
Severe HL weakness (cats)
Recent oestrus

Question 9

Clinical signs of diabetes

Answer 9

BAR
Thin
Cataracts
Neuropathies

Question 10

What results should you see in urinalysis of a diabetic patient

Answer 10

Glucosuria and Ketone bodies (Ketosis)

Question 11

What results should you see in Serum biochemistry
of a diabetic patient

Answer 11

Increased Glucose, Cholesterol and Liver enzymes

Question 12

Treatment of diabetes in dogs

Answer 12

Caninsulin injection

Question 13

Treatment of diabetes in cats

Answer 13

Insulin injections
Oral Hypoglycaemics

Question 14

State some oral hypoglycaemics

Answer 14

SGLT2 inhibitors (velagliflozin, bexagliflozin)

Question 15

What do SGLT2 inhibitors, or sodium-glucose cotransporter 2 inhibitors do?

Answer 15

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.

Question 16

Two requirements for effective diabetes management

Answer 16

Owner compliance and Veterinary support

Question 17

Which cats should NOT be selected for SGLT2i?

Answer 17

DKA (Diabetic Ketoacidosis) , pancreatitis, liver disease, significant kidney disease, Blood ketones >2.5 mmol/L, Urine ketones positive

Question 18

Why cant i use sglt2 in patients with DKA

Answer 18

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.

Question 19

What percentage of energy requirement in diabetes mellitus in Obese, Thin and normal animal

Answer 19

Obese animals: 70% of calculated requirement for target weight
Thin animals: 100% requirement for optimal weight
Normal animals: 100% of calculated requirement

Question 20

How many percent of metabolisable energy from complex carbohydrates of a diabetic canine patient

Answer 20

50-55

Question 21

How many percent of metabolisable energy from fat should a diabetic canine patient consume

Answer 21

Restricted (<20% ME)

Question 22

How many percent of metabolisable energy from protein should a diabetic canine patient consume

Answer 22

Moderate (14-30% ME)

Question 23

Should there be simple sugars in a diet for a diabetic canine patient

Answer 23

No simple sugars

Question 24

Should there be simple sugars and complex CHO in a diet for a diabetic feline patient

Answer 24

no simple and reduced complex CHOs

Question 25

Things to tell owners about diabetes mellitus in dogs and cats

Answer 25

Injections are not like normal insulin production
Very basic approach
More attention to diet and exercise
Keep dog healthy so that insulin can work

Question 26

Stabilisation of diabetes in canine (Method 1)

Answer 26

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)

Question 27

Stabilisation of diabetes in canine and feline (Method 2)

Answer 27

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.

Question 28

My diabetic pet isn’t eating If otherwise bright and happy…

Answer 28

Decrease insulin by 50%
If eats in next 2 hours can give remainder

Question 29

Diabetes and surgery

Answer 29

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

Question 30

Why can cats have hyperglycaemia

Answer 30

Stress induced