Diabetes Flashcards
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
T/F: DM is most commonly diagnosed in middle-aged and older dogs
True
What is type 1 DM? Who is this more common in?
Failure of pancreatic beta cells
Dogs
What is type 2 DM? Who is this more common in?
Insulin resistance with beta cell burnout
Cats
What are the most common clinical signs of DM in dogs?
PU/PD
Polyphagia
Weight loss
What are causes of insulin resistance?
Obesity/diet
Chronic hyperglycemia
Endocrinopathy
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
T/F: animals with diabetes are more prone to UTI and pyelonephritis
True
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
How does hyperadrenocortisim complicate diabetes treatments?
Increased cortisol -> increase glucose -> insulin dosage??
What is acromegaly?
Rare functional pituitary tumor -> excess growth hormone
-> thickened facial bone
What is the pathogenesis from an insulin deficient to a diabetic ketoacidosis ?
Insulin deficiency
-> increased lipolysis and hepatic ketogenesis —> hyperkoneimia —> metabolic acidosis
Hyperglycemia and hyperketonemia cause a osmotic diuresis, what signs of diabetes are due to this effect?
PU/PD
Dehydration
Hypovolemia
Hypotension
Systemically, DM can have what effects?
Neuropathy UTI/pyelonephritis Hypertension Pulmonary Ocular -cataract or retinopathy
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
T/F: routine BP measurements are recommended for all DM cats
True
What pulmonary lesions are associated with DM?
Congestion and edema
Pneumonia (general immunosuppression)
Smooth muscle hypertrophy
Fibrosis
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
