Diabetes Flashcards
What is bolus vs. basal insulin secretion
Bolus insulin are spikes of insulin that occur post- prandially (after food) to prevent glucose spikes from food
Basal insulin secretion is the continuous low dose insulin that is secreted to inhibit lipolysis and gluconeogenesis
When we give insulin therapy what type of insulin secretion does it mimic
Bolus secretion
How would you explain the mechanism of canine diabetes to an owner?
It is an absolute deficiency in insulin causing a lack of production/permanent loss of insulin making ability. This is a result of beta cell destruction so this will be a life-long insulin-dependent diabetes. It is irreversible and like “type-1” in people
How would you explain feline diabetes mellitus to a client
Feline diabetes is insulin resistance due to beta cell exhaustion leading to eventual destruction. There are risk factors like obesity, high carbohydrate diets, concurrent diseases, certain drugs and in general sometimes this diabetes can be reversible. Compared to “type-2” in people
What is beta cell exhaustion and dysfunction?
Beta cell exhaustion is from chronic hyperglycemia which causes an increase in insulin that results in the cells being overworked. At this point diabetic remission is possible
Beta cell dysfunction is when the beta cells are about to die because of glucose toxicity and there is islet amyloid distribution and oxidative damage causing further destruction. This is the last step where remission is possible. Once there is cell death it is irreversible
what species can have diabetic remission
cats
what is diabetic remission
reversing the insulin resistance and beta cell exhaustion before beta cell failure and loss. This is accomplished through weight loss and a change in diet
What are the common clinical signs associated with diabetes
PU/PD, polyphagia, and weight loss
often a history of recurrent UTIs and other infections
cranial organomegally and dry haircoat too
often older than 8 years old
What are unique signs of diabetes in dogs compared to cats
often more female dogs and male cats are diagnosed, and over 50% of cats are overweight
dogs often get cataracts
cats often get a neuropathy that causes dropped hocks
What would you expect to see in the bloodwork/biochemistry of a diabetic animal
Mature neutrophilia, hyperglycemia, hyperlipidemia- hypercholesterolemia and hypertriglyceridemia, ALP» ALT
Low USG (<1.020), glucosuria, proteinuria, maybe ketones and sediment and should do a culture because probably UTI
What is stress hyperglycemia
A phenomenon in cats where they will have transient hyperglycemia and glucosuria because of stress and it can look like the animal has diabetes!
How could you rule out if a cat is diabetic or is hyperglycemic because of stress hyperglycemia
You can use a glycated serum protein like fructosamine to measure the average blood glucose concentration over a week or so or you can get the owner to to BGs at home when they aren’t stressed
What are four goals of diabetes treatment
resolution of clinical signs
maintain an ideal body weight
relative glycemic control
minimize diabetic complications (hypoglycemia, DKA)
How do dietary therapies differ between dogs and cats for diabetes
Dogs you want a low carb, high fiber diet, but unfortunately they aren’t very palatable. However, more important for dog to just eat something because no matter what you won’t be able to reverse the diabetes
In cats you want a low carb, high protein diet and this is more important because you may be able to achieve remission, but you still will need insulin therapy even with a diet change at first
What are the best insulins for newly diabetic dogs
vetsulin, NPH (Humulin-N or Novolin-N)
what are the best insulins for starting in a newly diabetic cat
ProZinc or Glargine (Lantus, Semglee, Basaglar)
What is the starting dose of Vetsulin in dogs or cats
dogs- 0.5 U/kg q12
Cats- 1-2 units q12
calculate dose and round down
What is the starting dose of NPH for dogs
dogs- 0.25-0.5 U/kg q 12
cats- don’t use!
what is the starting dose for ProZinc in cats
1-2 U/cat q12
what is the starting dose for glargine for cats
1-2 U/cat q12
What are some important things about insulin handling
Refrigeration is ideal but not essential (will help it last longer), Insulin should never be frozen, exposed to direct sunlight, or used if clumped/precipitated
Should replace vial every 1-3 months
never shake insulin, roll it in palms gently except vetsulin
How should an owner administer insulin (timing)
for dogs give a full dose if whole meal eaten, and a half dose if ate less than 50% of food or fasted. If you have to give two consecutive half doses, call DVM!
for cats give the dose if eating and drinking during the day
try to give insulin in a 2 hour window 7 days a week with consistency and in a similar body location
How should you monitor a well behaved dog with diabetes
Clinical signs!! (especially changes in weight) and maybe spot BG checks (home monitoring for Freestyle libre) or a glucose curve
How can you monitor diabetes in a fractious animal
clinical signs! fructosamine or free style libre maybe
Is urinary glucose monitoring helpful for monitoring diabetes
not helpful because even controlled diabetics will have glucosuria good for screening for ketones or diabetic remission in cats
How helpful are insulin spot-checks
insulin response varies day to day so the timing for the BG highs and lows isn’t very consistent and shouldn’t determine therapy changes
how do you preform a glucose curve
get a BG before feeding for the day then feed and give insulin, keep checking BGs every 2 hours for 8-12 hours (or cats every 3-4 hours). Avoid handling excessively
What are the five criteria to identify on a glucose curve
- was there a response to insulin, if no then you’re done
- what is the nadir (lowest reading), ideally 80-120/ around 100
- How long did it take to nadir?
- What is the BG range during the curve period (ideally around 100-250 mg/dL)
- What is the insulin’s duration of action (ideally around 12 hours)
What does a glucose curve look like if there is insulin under-dosing
a high BG with minimal nadir
What is “insulin resistance” defined as in terms of a diabetic getting insulin medication and not responding to it
> /= 1.5-2 U/kg BID and not getting good control of blood glucose/ minimal response
