CC: Diabetes Mellitus

Question 1

What is Diabetes Mellitus? Type 1 and Type 2?

Answer 1

Glucose in the urine

Type 1: Insulin deficient - aka juvenile diabetes
Type 2: Insulin resistant

Question 2

What is Diabetes Insipidus? Central and Nephrogenic?

Answer 2

Pee a lot and no glucose in the urine

Central: Not producing enough ADH
Nephrogenic: Resistant to ADH

Question 3

What enzymes are up-regulated by insulin in the glycolytic pathway?

Answer 3

Step 1: Glucokinase
Step 3: PFK
Step 9: Pyruvate Kinase

Question 4

Why does diabetes mellitus result in hyperglycemia?

Answer 4

Cells are not taking up glucose from the bloodstream.
Inhibition of glycolysis
Increased hepatic output of glucose (increased gluconeogenesis)

Glucagon has gone UP UP UP.

Question 5

What were Fluffy’s lab results?

Answer 5

Hyperglycemia
Elevated Alkaline Phosphatase (liver and bone)
Elevated Alanine Aminotransferase (liver and muscle)
Elevated cholesterol (lipemia)
Elevated triglycerides (lipemia)
Decreased potassium and chloride (electrolyte abnormalities)
Metabolic Acidosis
Glycosuria (glucose in urine)
Ketonuria (ketones in urine)

Question 6

What is Fluffy’s Diagnosis?

Answer 6

Diabetic Ketoacidosis

Question 7

Describe typical diabetes in DOGS.

Answer 7

Females Type 1

Mini-poos and Dachsunds are super pre-disposed.

Question 8

Describe typical diabetes in CATS.

Answer 8

Males Type 2

Question 9

Fasting vs. Diabetes: Fasting

Answer 9

Fatty acids are mobilized as well
plasma FFA and Ketones stimulate insulin release
Insulin will limit FA delivery to liver

Question 10

Fasting vs. Diabetes: Diabetes

Answer 10

Insulin is low and Glucagon is high:
HSL is activated and running full throttle –> FAs released
Hepatic Glucose output increased –> hyperglycemia

Insulin is not properly regulating

Question 11

Fasting vs. Diabetes: Diabetic Ketoacidosis

Answer 11

Epinephrine is elevated along with everything else from diabetes
Dogs are also fasting so fat mobilization is increased
Increased Plasma FAs
Increased CPT-1 activity (brings in fatty acids for beta-oxidation –> lots of acetyl CoA –> Ketone formation)
Ketogenesis is exaggerated

Question 12

What is the vicious cycle inherent in Diabetes Ketoacidosis?

Answer 12

Osmotic Diuresis: hyperketonemia and hyperglycemia constantly dehydrate the animal

Question 13

What is the number one goal for treatment of Diabetic Ketoacidosis?

Answer 13

Treat the KETONES!! and Rehydrate – always rehydrate

Question 14

What are the goals of treatment of Diabetic Ketoacidosis?

Answer 14

1. Halt Ketogenesis/Rehydrate
2. Increase Ketone body utilization
3. Decrease gluconeogenesis
4. Promote glucose utilization
5. Decrease proteolysis

Question 15

How did they treat Fluffy’s diabetic ketoacidosis?

Answer 15

1 unit of insulin every hour for the first three hours until hyperglycemia subsided
dextrose 5% iv (glucose and rehydration)
monitored blood glucose and administered insulin appropriately over the course of several hours

Question 16

What was the resolution of Fluffy’s case?

Answer 16

Rapid resolution of DKA = Hyperadrenocorticism (Cushing’s)
Cushing’s caused severe insulin resistance (opposes action of insulin) and at the same time stimulated the shit out of gluconeogenesis
Treatment of Cushing’s resolved alopecia