DIABETES Flashcards
1
Q
MOST COMMON FORM OF DM IN DOGS AND CATS
A
- INSULIN DEPENDENT DM
- Requires daily insulin injections
- Decreased serum insulin concentration
2
Q
HOW TO MANAGE NON INSULIN DEPENDENT DM
A
- May be managed with diet and oral hypoglycemic agents
- Normal or increased serum insulin concentration
- 25-30% diabetic cats ?
3
Q
PATHOPHYSIOLOGY FOR DM
A
- Islet-specific amyloidosis
- Beta cell vacuolization
- Decreased numbers of beta cells
4
Q
POTENTIAL CAUSES FOR DM
A
- Obesity
- Chronic Pancreatitis
- Drugs (steroids)
- Concurrent illness
- Immune destruction?
- Genetics?
5
Q
SIGNALMENT FOR DM IN BOTH CATS AND DOGS
A
- Older animals
- Dogs: average of 7-9 yrs of age
- Cats: average of 9-11 yrs of age
- Dogs: females > males
- Cats: males > females
- Any breed or mixed breed
6
Q
2 TYPES OF PRESENTATION FOR DM
A
-
Non-ketotic (“healthy” or “happy” diabetic)
- Primary focus of today’s discussion
-
Diabetic ketoacidosis (“sick” or “unhappy” diabetic)
- Usually some concurrent illness (e.g. pancreatitis) causes counter-regulatory hormone release (e.g., increased epinephrine, cortisol, glucagon, growth hormone)
- Considered later in course
7
Q
HISTORY FOR DM
A
- PU / PD
- due to glucose which absorb more water
- Polyphagia
- they hav the sugar bt cant get it into the cell
- Obesity with recent weight loss
8
Q
PE FINDINGS FOR DM
A
- Often unremarkable
- May be obese
- +/-history of weight loss
- Hepatomegaly
- Cataracts (dogs)
- Diabetic neuropathy
- Cats –“unkempt” haircoat
9
Q
CBC AND CHEM PANEL FINDINGS FOR DM
A
-
CBC
- No significant abnormalities
-
Serum chemistry
- Hyperglycemia
- if u are nt hyperglycemic u are nt diabetic
- hyperglycemic is nt enough to say u hav diatedes like in dogs. it could be due to stress
- Increased ALT, ALP (fat accumulation in liver)
- Hypercholesterolemia
- Hyperglycemia
10
Q
Collective term for glycated proteins in blood
A
- Serum Fructosamine
- Results from irreversible, non-enzymatic binding of glucose to proteins
- Serves as a marker of mean blood glucose over the circulating lifespan of the proteins (1-3 weeks before sampling)
- Not affected by acute increases in blood glucose (i.e., stress)
11
Q
URINALYSIS FINDINGS FOR DM
A
- Glucosuria
- Ketonuria
- Proteinuria
- Bacteriuria with or without pyuria
12
Q
MECHANISMS FOR Transient DM in Cats
A
- Underlying pancreatic islet pathology (e.g. islet cell amyloid)
- Insulin antagonism
- Obesity
- Drugs (e.g. glucocorticoids, megestrol acetate)
- Hyperglycemia-induced beta cell dysfunction (“vicious cycle”)
- Occurs in 10-20% of diabetic cats
13
Q
GOALS OF THERAPY FOR DM
A
- Resolution of clinical signs (most important!!)
- PU/PD
- Polyphagia
- Weight loss
- Animal appears healthy and interactive with owner
- Animal has stable body weight
- Owner is happy
14
Q
TX FOR DM
A
Dietary therapy
Insulin therapy
Client education
15
Q
DISCUSS DIET TX FOR DM
A
- Promote weight loss if needed
- Diet characteristics
- Diet with complex carbohydrates, low in fat, high in fiber
- Soluble (gums, pectins) preferable to insoluble (lignin, cellulose) fiber
- Most commercial high fiber diets contain mainly insoluble fiber (still helpful)
- Adhere to regular feeding schedule (BID meals)
- Avoid between meal “snacks”
16
Q
DIET THEARAPY FOR DM CATS
A
- Recent studies support role for “low-carbohydrate, high-protein” diet for cats with diabetes mellitus
- Based on “strict” carnivorous nature of cats
- Better regulation in many cats
- Some cats may no longer require insulin
- Must consider role of “transient” diabetes in outcome
17
Q
TYPE OF INSULIN U SHOULD GIVE TO DOGS
A
PORCINE
HOG DOG
18
Q
TYPE OF INSULIN U SHOULD GIVE TO CATS
A
COW CAT
19
Q
WHICH TYPE OF INSULIN IS SHORT ACTING
A
REGULAR
FOLLOWED BY MPH
20
Q
THIS TWO TYPES OF INSLIN Contain protamine and zinc to delay insulin absorption from SQ site of injection
A
- NPH and PZI
- Lente insulins
- Depend on zinc content to delay insulin absorption from SQ site of injection
21
Q
- THIS DRUG
- HAS Long duration of action (up to 18 hrs in cats) can contribute to “carry over” effect
- nt used in dogs good for cats
A
- Glargine (Lantus®)
- May facilitate remission in cats if used with low carbohydrate diet*
- Minimal effectiveness in dogs (unreliable)
22
Q
Highly purified porcine insulin suspension GOOD FOR DOGS
A
- aninsulin
- Resembles Lente in composition
23
Q
INSULINS FOR DOGS
A
- Humulin N (NPH): 0.25 to 0.5 U/kg SQ q12h
- Vetsulin: 0.25 to 0.5 U/kg SQ q12h
24
Q
INSULIN TYPES FOR CAT
A
Beef/pork PZI: 0.25 to 0.5 U/kg SQ q12h or q24h
Glargine (Lantus): 0.25 to 0.5 U/kg SQ q 12h or 24h
25
COMPLICATIONS FOR DM
* Difficulty in regulation (dogs & cats)
* Insulin-induced hypoglycemia (Somogyi effect)
* Persistent clinical signs (PU, PD, weight loss)
* Cataracts (dogs)
* Peripheral neuropathy (cats)
* Pancreatitis (dogs & cats)
* Bacterial infections (dogs & cats)
* Ketoacidosis (dogs & cats)
* Hepatic lipidosis (dogs & cats)
* Hypertension (dogs)
26
PATHOPHYSIOLOGY FOR CATARACT
* Glycolysis oversaturated in lens and leads to glucose metabolism via polyol pathway
* Sorbitol and fructose not freely permeable and attract water into lens
* Older cats have very low aldose reductase (hence don’t get diabetic cataracts)
27
(Complications indicating poor control of dm
* Dog: cataracts
* Cat: peripheral neuropathy
28
When is a glucose curve done?
7 -14 days after starting insulin therapy
29
(lowest blood glucose achieved on glucose curve
Glucose nadir
Reflects dosageof insulin
30
\*Duration of insulin action (time in “target zone”) tells u what
Reflects typeof insulin
31
Time from injection to glucose nadir tells u wat
Reflects type of insulin
Onset of insulin action (time from injection until blood glucose begins to fall) also Reflects type of insulin
32
Problems Identified by BG Curve
* Somogyi effect
* Short duration of insulin action
* Insulin resistance
* Stress
33
explain the somogmi effect
* High dose of insulin administered
* Animal becomes hypoglycemic (not seen by owner)
* Counter-regulatory hormones released and cause hyperglycemia
* epinephrine, cortisol, glucagon, growth hormone
* Counter-regulatory hormones cause transient (24-72 hrs) insulin resistance potentially leading to erroneous conclusion that animal needs more insulin
34
when should u suspect somogmi effect
* Morning blood glucose \> 400-450 mg/dL
* Continued clinical signs: PU, PD, weight loss
* Symptoms of hypoglycemia (often unrecognized)
* Insulin dosage \> 2.2 U/kg (dog) or \> 5 U (cat)
* Wide fluctuations in glycemic control
35
when should u suspect somogmy effect
* Hypoglycemia (\< 65 mg/dL) and hyperglycemia (\> 300 mg/dL) in one 24-hour period after insulin administration
