Diabetes Flashcards by Corinne Perra

What is the DDX for hypoglycemia ??

Did you leave the blood in the tube too long, Karin?

Insulinoma 
Extrapancreatic neoplasia 
Sepsis 
Infection 
Neonatal/toy-breed hypoglycemia 
Prolonged starvation 
Hepatic insufficiency 
Hypoadrenocorticism 
Renal failure 
Panhypopituitarism 
Iatrogenic 
Toxin 
Severe polycemia

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T/F: DM is most commonly diagnosed in middle-aged and older dogs

True

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What is type 1 DM? Who is this more common in?

Failure of pancreatic beta cells

Dogs

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What is type 2 DM? Who is this more common in?

Insulin resistance with beta cell burnout

Cats

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What are the most common clinical signs of DM in dogs?

PU/PD
Polyphagia
Weight loss

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What are causes of insulin resistance?

Obesity/diet
Chronic hyperglycemia
Endocrinopathy

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How does diabetic remission occur in cats?

Can occur isn 20-40% of cats if treated adequately

Glucose toxicity is removed from the Bcelsl
Reduces the peripheral insulin resistance developed by chronic hyperglycemia

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T/F: animals with diabetes are more prone to UTI and pyelonephritis

True

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How does a concurrent UTI (or other infectous disease) complicate treatment for diabetes?

Infection -> increased cortisol -> increase glucose -> dosage of insulin is not enough to manage hyperglycemia

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How does hyperadrenocortisim complicate diabetes treatments?

Increased cortisol -> increase glucose -> insulin dosage??

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What is acromegaly?

Rare functional pituitary tumor -> excess growth hormone

-> thickened facial bone

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What is the pathogenesis from an insulin deficient to a diabetic ketoacidosis ?

Insulin deficiency

-> increased lipolysis and hepatic ketogenesis —> hyperkoneimia —> metabolic acidosis

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Hyperglycemia and hyperketonemia cause a osmotic diuresis, what signs of diabetes are due to this effect?

PU/PD

Dehydration
Hypovolemia
Hypotension

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Systemically, DM can have what effects?

Neuropathy 
UTI/pyelonephritis 
Hypertension 
Pulmonary 
Ocular -cataract or retinopathy

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Why do we see a neuropathy in DM cats?

Dropped hock /plantigrate posture

Glucose binds proteins -> nerve structural abnormality leading to myelin defect, axonal degeneration, and sorbitol accumulation

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T/F: routine BP measurements are recommended for all DM cats

True

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What pulmonary lesions are associated with DM?

Congestion and edema
Pneumonia (general immunosuppression)
Smooth muscle hypertrophy
Fibrosis

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Are the following clinical signs of a ‘sick’ or ‘healthy’ diabetic?

Pu/PD
Weight loss 
Polyphagia 
Dry, flaky skin 
Plantigrade stance

Healthy diabetic

Are the following clinical signs of a ‘sick’ or ‘healthy’ diabetic?

Dehydration 
Weakness 
Mentally dull 
Vomiting 
Anorexia 
Collapse 
Ketone breath

Sick diabetic

What are your initial diagnostics for DM?

Blood glucose -hyperglycemia

Urine dipstick -glucosuria

What laboratory abnormalities will you see in DKA?

Hyperglycemia 
Glucosuria, ketonuria 
Metabolic acidosis 
Hyponatremia 
Hypochoremia 
Hypokalemia 
Hypophsphatemia 
Hypomagnesemia

In NPH and lente are short, intermediate, or long acting insulin?

Intermediate

Onset 30min
Duration 6-12hrs

PZI and ultralente are short, long, or intermediate acting insulin?

Long

Onset 1-2hr
Duration 8-24hrs

What insulin is FDA approved for vet use?

Vetsulin (lente)

T/F: lente insulin and PZI vet bot thane a U-40 formulation and are usually dosed BID

True

What type of insulin forms micro precipitates to delay absorption?

Glargine (Lantus)

How is insulin therapy started?

1/4-1/2 unit/kg body weight BID Low dose if obese

What type of diets are best for diabetic cats?

Low CHO/Low fiber/high protein -> more likely to revert to non-insulin dependent state

What is the MOA of oral hypoglycemic agents and what are two of these agents?

Stimulate insulin release from pancreas -> increase peripheral glucose uptake Decrease hepatic glucose production and GI uptake Acarbose w insulin Metformin

T/F: metformin is a good stand alone therapy for cats with detectable concentrations of inulin at the time of treatment

False | -usually require inulin therapy as well

Methods of long term DM monitoring?

Clinical signs/body weight Fructosamine/Glycosylated Hb Regular diagnostics Blood glucose curves

What are signs of hypoglycemia that you should inform your clients of for home monitoring?

Weakness, seizures, collapse | Ptyalism

How many time should clients check urine for glucose and ketones?

One daily initially | Once or twice weekly long-term

At home urine results.. ketones (+). What should the client do?

Call and make an appointment

At home urine results.. glucose (-). What should the client do?

Give 1/2 of normal insulin dose and monitor insulin tests Call if remains neg

At home urine results.. glucose (minorly +). What should the client do?

Continue current therapy

At home urine results.. glucose (high +). What should the client do?

Make appointment -> physical exam and insulin adjustment

A fructosamine measurement allows assessment of glucose level over how long?

2-3weeks Ideal for assessing glycemic control with monthly insulin adjustments

Fructosamine can be falsely lowered in cats with??

Marked hypoproteinemia -> dependent on blood glucose and serum protein Hyperthyroidism

Glycosylated hemoglobin is used to measure glucose levels over how long?

6-9wks

T/F: glycosylated hemoglobin can be used to monitor animals glucose levels over long periods of time if they are undergoing regular insulin changes

False Not appropriate for animals undergoing regular insulin changes Used for follow up of a consistently, well controlled cat on stable insulin dose

Glycosylated hemoglobin can be falsely lowered with??

Anemia

When should you be ding blood glucose curves?

Persistent clinical signs with increasing doses of insulin - dose above 1unit/kg with no resolution of clinical signs - insulin resistance (dose >2unit/kg) Evidence of hypoglycemic events

What should you do if you significantly increase insulin doss without resolution of hyperglycemia?

Rule out technical errors - watch insulin give injection - correct product and syringe - appropriate storage and mixing Re-asses diet -type, treat, and volume Try another insulin type Complicating conditions