Diabetes (Marin) Flashcards
define diabetes mellitus
relative or absolute lack of insulin OR lack of insulin function/response
why is there hyperglycemia and polyphagia in diabetes
because the liver is like omg we are starving, none of my tissues are using glucose, and it starts breaking down glycogen into glucose
polyphagia because the hunger signal isn’t turned off
describe the difference between type 1 and type 2 DM?
type 1: autoantibodies against the beta cells in the pancreas, this is what dogs get
type 2: insulin resistance and dysfunctional beta cells, this is what cats get, usually associated with obesity
what causes DM type 1?
arent sure, we think immune mediated destruction of the pancreas
can sometimes be secondary causes like pancreatitis and cushings
what causes DM type 2?
secondary to prolonged insulin resistance. the cause is mulfactorial including: obesity, chronic pancreatitis, genetics, etc
overweight cats are ____ more likely to get DM
4-6x
with DM type 2, increased insulin resistance is caused by:
downregulation of receptors, impaired insulin binding, post receptor defect, being overweight
with DM type 2, decreased insulin secretion is caused by
beta cell damage from glucose toxicity, inflammatorty infiltration, oxidative damage, amyloid depositis
stress in cats can cause glucose to rise above
16 mmol/L (sometimes as high as 33)
true ore false, I just sharted my pants
😳
true or false: stressed cats can have glucosuria
truuuuuu BUT their fructosamine would be normal
who gets cataracts with DM?
doggy soggy
who gets diabetic neuropathy
cats
a dog or cat comes to you with: PUPD, weight loss, and polyphagia. Besdies DM, what other things are on your ddx?
CKD, hyperthyroidism, cushings, hypothyroidism, addisons, acromegaly, neoplasia
list causes other than DM that can cause hyperglycemia
cushings, steroid use, pheochromocytoma, diestrus, acromegaly
list causes other than DM that can cause glucosuria
fanconi syndrome, renal tubular damage, steroid use, strip test error, pigmenturia, AKI
what chemistry changes are consistent with DM?
hyperglycemia, hypercholesterolemia, hypertriglyceridemia, elevated ALP»»ALT in dogs
what UA results are consistent with diabetes
isosthenuria, glucosuria, SOMETIMES evidence of UTIs (often silent and lack an active sediment)
what is the frustosamine test in cats
basically an average of blood sugar over the past 2-3 weeks. It is usually normal in stress cats and elevated in DM
if the cat has hyperthyroidism it can be lowered due to increased GFR
why do DM animals have silent UTIs?
because of medullary washout
general management of diabetes involves
insulin 2x a day forever
diet management/diet change
what are the 3 most commonly used insulins?
Caninsulin (Lente)
ProZinc (PZI)
Lantus (glargine)
dogs need what kind of insulin
intermediate acting, Q12 hrs
caninsulin often used (serge said not to memorize the dose)
needs to be in fridge, roll it dont shake it ya nasty
cats need what kind of insulin
longer acting insulin, Q12 hrs
Glargine: 1U per cat BID if less than 4kg, if more than 4kg then it’s 1.5-2 U BID
who can go into diabetic remission
cats beech
protamine zinc insulin is approved for
cats, it’s similar to caninsulin but it’s better!! caninsulin is NOT long acting enough in cats
should you give Glipizide to a cat
NOOOOO its a med given to humans in a prediabetic state to stimulate insulin secretion but it does nothing in cats
what is Bexacat
a tablet used in cats (newly approved) to increase urine glucose excretion, meant for early DM with pancreatic reserves still left
what is the proper way to manage a diabetic dog’s diet?
Q12 feedings with insulin administration, NO TREATS! nothing that can cause high blood sugar! Nothing in between those 2 feedings!
can do a high fibre diet to regulate blood sugar, or an adult diet works too, there are diabetic diets too
be careful with thin dogs: high fiber is not ideal for skinny dogs
what is the proper way to manage a diabetic cat’s diet?
we want a high protein, lower carb and fat diet–>higher gluconeogenesis from amino acids
timing of feedings is less important than in dogs. Q12 is ideal but not every cat can handle this
can consider canned/wet food to help decrease energy intake (moisture increases food volume and hydration). these diets are high in protein but also high in fats so be cautious
what part of diabetic control is frequently overlooked
weight management!!
you’ve just diagnosed a cat or a dog with diabetes and youre starting them on insulin therapy. when should you recheck them?
1 week: blood glucose curve/continuous glucose monitoring
3 weeks: clinical signs
8 weeks: clinical signs
12 weeks: BGC/CGM, CBC/chem/UA
then every 3-6 months
is fructosamine an approrpiate way to monitor dog and cat DM?
it’s not adequate for fine tuning and early stages of diabetic control. you need a glucose curve or continuous glucose monitoring
consistently high urine glucose readings coupled with uncontrolled clinical signs indicates…
that insulin dose is not working
are single BG measurements effective?
NOOOOOOOOOOOOOOOOOOO
doing a blood glucose curve is especially important during…
early on during the regulation phase of DM
on a BGC, ideally the highest BG concentration, just before insulin is given, is
less than 15 mmol/L
on a BGC, the nadir is…
the lowest BG concentration, ideally between 5-7.8 mmol/L
all glucose curves must be interpreted in the context of
clinical signs!!!! how does the patient look???
the most important part of a glucose curve is
the nadir
true or false: you should change the type of insulin before adjusting the dose
FALSE you should stay on the same insulin and change the dose
if the nadir is acceptable but the patient still has DM signs, why would this be?
it’s likely that the blood glucose is beyond renal threshold and you need to reevaluate: diet, treats, weight, exercise, other medical conditions
can you give smaller insulin doses in between the big Q12 ones?
NOOOOOOOOO
to determine if you need to adjust the insulin dose based on a glucose curve, you should look at the nadir, and if the nadir is less than 5 you should…..
if the nadir is more than 10 you should…
decrease the insulin dose, in cats by 0.5 units, and in dogs, by 25%
increase the dose by same amount as above, but consider it could also be the following things: stress, somogyi effect, overlapping dosages, concurrent illness
if the nadir is between 5 and 9, you should
do nothing! your dose is likely appropriate
to determine the dose of insulin, look at the ____
nadir
how much insulin is too much for dogs and cats?
dogs: more than 2.2 U/kg
cats: more than 1.5 U/kg
what happens if your patient is still not controlled but you’ve maxed out the insulin dose?
consider other diseases that would interfere like cushings, hypo or hyperthyroid, CKD, etc
what are the 2 ways to perform a glucose curve?
option 1: feed them, give insulin at a normal time, note the time, then they come in to the vet and you pull the first sample, then get a sample every 2 hours.
option 2: feed them in hospital, give insulin in hospital, and immediately get the same. some cats wont eat in hospital which is why this one is sketchy.
ideally you want 12 hrs of info but 8-10 is lots
how are blood samples usually collected for glucose curve monitoring?
usually ear prick or paw pad
rub the area to warm it up, clip the area, if using the ear, go near the marginal vein
this is a cat that comes in for a recheck after you prescribed him with Glargine. This is 1 week on insulin. the cat has had no change in ANY clinical signs. interpretation?
the NADIR is too high and since no clinical improvement, increase insulin dose by 0.5 Q12
Max is still having clinical signs. Interpretation?
nadir is around 11, which is too high but not insanely high either.
try to reduce treats and change the diet before increasing the dose by 25%
Tessa is doing great, eating a little less tho.
nadir is around 3 which is too low!
decrease the dose by 25%
Evil the cat, a 3 month diabetic cat, she’s PUPD. What is going on here??????
this is the Somogyi effect. the cat is in diabetic remission and doesn’t need insulin anymore
the glucose gets so low due to too much insulin, and the body rebounds and this causes insulin resistance and the BG to spike, mainly due to counter regulatory hormones.
note: fructosamine test would miss this because it’s an average and the average here would be high!
Stella is doing well at home, no clinical signs! interpretation?
the nadir is around 7 which is good! some cat curves will “just look like this” and this is ok! The cat is doing well clinically and the nadir is good! no changes are required
what happened here?
insulin dose was missed
what is a freestyle libre?
a continuous glucose monitor that measures interstitial glucose (not blood glucose) every 15 minutes for 10-14 days
a free style libre is a way to get a lot of information about glucose trends in diabetic animals. What is one thing you should remember about interpreting curves from these?
interstitial glucose levels will be a little lower than blood glucose
how often do cats go into diabetic remission
about 1/4 of cats can go into remission 4-6 weeks after starting insulin therapy and changes to the diet
diabetic remission is defined as
period of 4 weeks of not needing insulin, it is NOT a cure! the beta cells can “rebound” a bit
what is glucolipidotoxicity?
beta cell death and exhaustion, and dysfunction of incretin hormones
what is the best way to get a cat to acheive DM remission?
be aggressive in your treatment! tightly control the blood glucose levels, do weight loss management and special diets, control any concurrent diseases
much more likely to acheive for cats caught early
a cat named Dingle is a diabetic patient and comes to see you for a check up. He has been diabetic for a few months now. At his previous visit you increased his insulin dose by 0.5 U BID because his nadir was too high and he still had clinical signs. The owner says he is now not interested in food and seems really lethargic. what is likely happening here?
hypoglycemia from too high an insulin dose
if you do a blood glucose curve and you notice a curve that looks like a Somogyi, what should you do?
reduce the dose by 25-50% and repeat the glucose curve in 1 week
