Canine Diabetes Mellitus

Question 1

What are the causes of canine DM?

Answer 1

Immune mediated b cell destruction
Secondary to chronic pancreatic disease
Diestrus diabetes
Drug-related

Question 2

Describe DM caused by immune mediated b cell destruction

Answer 2

Most common cause
Results in absolute insulin deficiency

Question 3

Describe DM caused by secondary to chronic pancreatic disease

Answer 3

About 1/3 of cases
Persistent inflammation of the exocrine pancreas damages the islets
Islet loss results in essentially zero insulin secretion

Question 4

Describe DM caused by diestrus

Answer 4

Also known as “canine acromegaly”
Progesterone in the diestrus phase triggers release of GH by mammary tissue
GH is a powerful antagonist to insulin
DM may be reversible if dog is spayed ASAP

Question 5

Describe DM caused by drugs

Answer 5

Cyclosporine damages beta cells and impacts insulin sensitivity

Question 6

Do dogs get obesity related DM?

Answer 6

No

Question 7

Does steroid administration cause DM in dogs?

Answer 7

No

Question 8

What breed of dog is notorious for diestrus diabetes?

Answer 8

Norwegian Elkhound

Question 9

What is a dogs renal glucose threshold?

Answer 9

160-200 mg/dl

Question 10

When do you see polyuria in DM patients?

Answer 10

When blood glucose is greater than the renal glucose threshold

Question 11

What is the hallmark clinical signs of canine DM?

Answer 11

Sudden pu/pd/pp with rapid weight loss

Question 12

What two diagnostics are needed to diagnose DM?

Answer 12

Glucosuria and hyperglycemia

Question 13

What is seen on urinalysis of DM patients?

Answer 13

Glucosuria
Might have ketonuria
Often concentrated despite severe pu/pd
Might have UTI

Question 14

What is seen on serum biochem of DM patients?

Answer 14

Hyperglycemia (usually over 300, rarely exceeding 600 mg/dl)
Hypercholesterolemia
Hypertriglyceridemia
Elevated ALP activity

Question 15

Do dogs get stress hyperglycemia?

Answer 15

No

Question 16

With hypercholesterolemia, hypertriglyceridemia, and elevated ALP, should you chase Cushings?

Answer 16

Not unless you have clinical signs

Question 17

What electrolyte abnormalities are common?

Answer 17

Hyponatremia

Question 18

What is notable about the CBC of DM patients?

Answer 18

Stress leukogram is expected
Anemia is not expected - suggests concurrent disease

Question 19

What does an elevated PLI suggest?

Answer 19

Pancreatitis

Question 20

What is the #1 goal of treatment?

Answer 20

A satisfied owner

Question 21

What are engineered insulins referred to as?

Answer 21

Insulin ______

Question 22

What are suitable first choice insulins for dogs?

Answer 22

Plan A = Lente
Plan B = Insulin Detemir
Plan C = NPH

Question 23

What is Regular insulin, its duration, and uses?

Answer 23

Human molecule
U100
Duration 4-6 hours
Used for DKA

Question 24

What is NPH, its duration, and uses?

Answer 24

Human molecule
U100
Duration 8-10 hours
Used in dogs BID

Question 25

What is Lente, its duration, and uses?

Answer 25

Porcine molecule U40 Duration 10-12 hours Used in dogs BID Two peak formulation Designed to blunt post-prandial rise Comes in a pen system

Question 26

What is PZI, its duration, and uses?

Answer 26

Human molecule U40 Duration 12 hours Used in cats BID or SID Dogs rarely do well on PZI

Question 27

What is Detemir, its duration, and uses?

Answer 27

Engineered U100 Duration 10-12 hours Potent - lower starting doses Used in big dogs

Question 28

What is Glargine, its duration, and uses?

Answer 28

Engineered U100 Duration >12 hours Routinely used in cats BID

Question 29

What is Glargine U-300, its duration, and uses?

Answer 29

Engineered U300 Duration >12 hours Slow release can be helpful in some patients

Question 30

What is the starting dose of Lente and NPH?

Answer 30

0.25 U/kg BID

Question 31

What is the starting dose of Insulin Detemir?

Answer 31

0.1 U/kg BID

Question 32

What is the issue with Insulin Detemir?

Answer 32

Hard to dose in small dogs

Question 33

Why should you not aim for optimal control in the 1st dose of insulin?

Answer 33

Stress of illness will antagonize insulin, relationship with insulin will change, insulin becomes more powerful after a few doses

Question 34

What should your initial approach be for the first dose of insulin?

Answer 34

Administer the first insulin dose and feed in the morning Measure BG every 2 hours for 8-12 hours If BG remains >150 mg/dl send home on this dose If BG goes <150 mg/dl, decrease the dose by 10-25% If possible, re-monitor response Repeat BGC in 1 week

Question 35

What should you feed DM dogs?

Answer 35

A complete and balanced diet low in simple sugars Equal sized meals twice daily at the time of each insulin injection Consistency is key

Question 36

What can help improve insulin efficacy after each meal?

Answer 36

A short 15-30 min walk

Question 37

When should you recheck the patient if not using a continuous interstitial monitor?

Answer 37

Every 1-2 weeks for the first month

Question 38

When should you recheck with a dosing change?

Answer 38

Within 2 weeks

Question 39

When should you recheck in the clinic if everything is going well?

Answer 39

Every 3 months

Question 40

Treat the ...

Answer 40

Patient, not the numbers

Question 41

How should you record a blood glucose curve?

Answer 41

Test BG every 2 hours until next dose of insulin Repeat BG within 1 hour if any glucose value is <100 mg/dl

Question 42

What is the nadir target for DM dogs?

Answer 42

100-150 mg/dl Ok to get close to 80 mg/dl in stable patient

Question 43

When should you adjust the dose?

Answer 43

If nadir is: <100 mg/dl decrease insulin by 25% >150 mg/dl increase insulin by 10% 100-150 and average glucose is <250 mg/dl = no change 100-150 and average glucose is >250 mg/dl nadir is <6 hours after insulin = change to longer acting insulin nadir is >10 hours after insulin = change to shorter acting insulin

Question 44

How many doses can a client skip?

Answer 44

One