Canine Diabetes Mellitus Flashcards
What are the causes of canine DM?
Immune mediated b cell destruction
Secondary to chronic pancreatic disease
Diestrus diabetes
Drug-related
Describe DM caused by immune mediated b cell destruction
Most common cause
Results in absolute insulin deficiency
Describe DM caused by secondary to chronic pancreatic disease
About 1/3 of cases
Persistent inflammation of the exocrine pancreas damages the islets
Islet loss results in essentially zero insulin secretion
Describe DM caused by diestrus
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
Describe DM caused by drugs
Cyclosporine damages beta cells and impacts insulin sensitivity
Do dogs get obesity related DM?
No
Does steroid administration cause DM in dogs?
No
What breed of dog is notorious for diestrus diabetes?
Norwegian Elkhound
What is a dogs renal glucose threshold?
160-200 mg/dl
When do you see polyuria in DM patients?
When blood glucose is greater than the renal glucose threshold
What is the hallmark clinical signs of canine DM?
Sudden pu/pd/pp with rapid weight loss
What two diagnostics are needed to diagnose DM?
Glucosuria and hyperglycemia
What is seen on urinalysis of DM patients?
Glucosuria
Might have ketonuria
Often concentrated despite severe pu/pd
Might have UTI
What is seen on serum biochem of DM patients?
Hyperglycemia (usually over 300, rarely exceeding 600 mg/dl)
Hypercholesterolemia
Hypertriglyceridemia
Elevated ALP activity
Do dogs get stress hyperglycemia?
No
With hypercholesterolemia, hypertriglyceridemia, and elevated ALP, should you chase Cushings?
Not unless you have clinical signs
What electrolyte abnormalities are common?
Hyponatremia
What is notable about the CBC of DM patients?
Stress leukogram is expected
Anemia is not expected - suggests concurrent disease
What does an elevated PLI suggest?
Pancreatitis
What is the #1 goal of treatment?
A satisfied owner
What are engineered insulins referred to as?
Insulin ______
What are suitable first choice insulins for dogs?
Plan A = Lente
Plan B = Insulin Detemir
Plan C = NPH
What is Regular insulin, its duration, and uses?
Human molecule
U100
Duration 4-6 hours
Used for DKA
What is NPH, its duration, and uses?
Human molecule
U100
Duration 8-10 hours
Used in dogs BID
What is Lente, its duration, and uses?
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
What is PZI, its duration, and uses?
Human molecule
U40
Duration 12 hours
Used in cats BID or SID
Dogs rarely do well on PZI
What is Detemir, its duration, and uses?
Engineered
U100
Duration 10-12 hours
Potent - lower starting doses
Used in big dogs
What is Glargine, its duration, and uses?
Engineered
U100
Duration >12 hours
Routinely used in cats BID
What is Glargine U-300, its duration, and uses?
Engineered
U300
Duration >12 hours
Slow release can be helpful in some patients
What is the starting dose of Lente and NPH?
0.25 U/kg BID
What is the starting dose of Insulin Detemir?
0.1 U/kg BID
What is the issue with Insulin Detemir?
Hard to dose in small dogs
Why should you not aim for optimal control in the 1st dose of insulin?
Stress of illness will antagonize insulin, relationship with insulin will change, insulin becomes more powerful after a few doses
What should your initial approach be for the first dose of insulin?
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
What should you feed DM dogs?
A complete and balanced diet low in simple sugars
Equal sized meals twice daily at the time of each insulin injection
Consistency is key
What can help improve insulin efficacy after each meal?
A short 15-30 min walk
When should you recheck the patient if not using a continuous interstitial monitor?
Every 1-2 weeks for the first month
When should you recheck with a dosing change?
Within 2 weeks
When should you recheck in the clinic if everything is going well?
Every 3 months
Treat the …
Patient, not the numbers
How should you record a blood glucose curve?
Test BG every 2 hours until next dose of insulin
Repeat BG within 1 hour if any glucose value is <100 mg/dl
What is the nadir target for DM dogs?
100-150 mg/dl
Ok to get close to 80 mg/dl in stable patient
When should you adjust the dose?
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
How many doses can a client skip?
One
