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RUSVM SAM 1 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the DDX for hypoglycemia ??

A

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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2
Q

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

A

True

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3
Q

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

A

Failure of pancreatic beta cells

Dogs

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4
Q

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

A

Insulin resistance with beta cell burnout

Cats

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5
Q

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

A

PU/PD
Polyphagia
Weight loss

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6
Q

What are causes of insulin resistance?

A

Obesity/diet
Chronic hyperglycemia
Endocrinopathy

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7
Q

How does diabetic remission occur in cats?

A

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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8
Q

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

A

True

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9
Q

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

A

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

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10
Q

How does hyperadrenocortisim complicate diabetes treatments?

A

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

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11
Q

What is acromegaly?

A

Rare functional pituitary tumor -> excess growth hormone

-> thickened facial bone

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12
Q

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

A

Insulin deficiency

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

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13
Q

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

A

PU/PD

Dehydration
Hypovolemia
Hypotension

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14
Q

Systemically, DM can have what effects?

A 
Neuropathy 
UTI/pyelonephritis 
Hypertension 
Pulmonary 
Ocular -cataract or retinopathy
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15
Q

Why do we see a neuropathy in DM cats?

A

Dropped hock /plantigrate posture

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

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16
Q

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

A

True

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17
Q

What pulmonary lesions are associated with DM?

A

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

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18
Q

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

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

Healthy diabetic

19
Q

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

Dehydration 
Weakness 
Mentally dull 
Vomiting 
Anorexia 
Collapse 
Ketone breath
A

Sick diabetic

20
Q

What are your initial diagnostics for DM?

A

Blood glucose -hyperglycemia

Urine dipstick -glucosuria

21
Q

What laboratory abnormalities will you see in DKA?

A 
Hyperglycemia 
Glucosuria, ketonuria 
Metabolic acidosis 
Hyponatremia 
Hypochoremia 
Hypokalemia 
Hypophsphatemia 
Hypomagnesemia
22
Q

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

A

Intermediate

Onset 30min
Duration 6-12hrs

23
Q

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

A

Long

Onset 1-2hr
Duration 8-24hrs

24
Q

What insulin is FDA approved for vet use?

A

Vetsulin (lente)

25
Q

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

A

True

26
Q

What type of insulin forms micro precipitates to delay absorption?

A

Glargine (Lantus)

27
Q

How is insulin therapy started?

A

1/4-1/2 unit/kg body weight BID

Low dose if obese

28
Q

What type of diets are best for diabetic cats?

A

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

29
Q

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

A

Stimulate insulin release from pancreas -> increase peripheral glucose uptake

Decrease hepatic glucose production and GI uptake

Acarbose w insulin
Metformin

30
Q

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

A

False

-usually require inulin therapy as well

31
Q

Methods of long term DM monitoring?

A

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

32
Q

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

A

Weakness, seizures, collapse

Ptyalism

33
Q

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

A

One daily initially

Once or twice weekly long-term

34
Q

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

A

Call and make an appointment

35
Q

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

A

Give 1/2 of normal insulin dose and monitor insulin tests

Call if remains neg

36
Q

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

A

Continue current therapy

37
Q

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

A

Make appointment -> physical exam and insulin adjustment

38
Q

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

A

2-3weeks

Ideal for assessing glycemic control with monthly insulin adjustments

39
Q

Fructosamine can be falsely lowered in cats with??

A

Marked hypoproteinemia -> dependent on blood glucose and serum protein

Hyperthyroidism

40
Q

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

A

6-9wks

41
Q

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

A

False

Not appropriate for animals undergoing regular insulin changes

Used for follow up of a consistently, well controlled cat on stable insulin dose

42
Q

Glycosylated hemoglobin can be falsely lowered with??

A

Anemia

43
Q

When should you be ding blood glucose curves?

A

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

44
Q

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

A

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

RUSVM SAM 1 (26 decks)

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