Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dog & Cat Medicine and Surgery > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What cells create insulin?

Side effects of no insulin

A

Beta cells in pancreas

  • Glucose cannot enter cells
  • Cell “starvation”
  • Hyperglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Type I: Insulin dependent diabetes mellitus (IDDM) is due to what?

What % of dogs have this type? cats?

A

Beta cell destruction

  • > Virtually ALL DOGS
  • > 30-‐50% of cats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Type II: Non‐insulin dependent diabetes mellitus (NIDDM)

A

Insulin resistance and/or beta cell dysfunction

  • > 50‐70% of cats; Note: The term “non‐insulin dependent” is misleading
  • We should instead be thinking of the pathophysiology
  • Likely have some residual beta cell function
  • Insulin resistance, impaired insulin secretion; - Keep in mind - most of these cats are treated with insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of DM

A

 Genetics  Immune-‐mediated;  Insulin-‐antagonizing drugs;  Progesterone, cortisol  Obesity;  Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dog DM Signalment

A

Dogs:;  4-‐14 years (7-‐9 y peak)  Female > male;  Breed predispositions;  Aust Terrier  Schnauzers  Beagles;  Samoyeds  Etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cat DM Signalment

A

 Cats:;  Usually >9 y (peak 10 y)  Male neutered;  No breed predispositions (?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Common features of DM

A

 Common:  PU/PD;  Weight loss;  If diabetic ketoacidosis, can have history and PE reflecting systemic illness; - UTIs (50% of dogs);  May be obese or low body condition;  ± dull hair coat;  ± hepatomegaly;  ± cataracts (dogs);  ± plantigrade stance (cats)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Other differentials for DM

A

 Cats  DM;  Hyperthyroidism  Renal insufficiency

 Dogs:  DM;  Hyperadrenocorticism  Renal insufficiency;

      Also consider:;  Urinary tract infections, hypercalcemia, liver disease, etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Initially document 3 things for diagnosing DM

A
  1. Consistent clinical signs
  2. Persistent fasting hyperglycaemia
  3. Glucosuria
    When BG approx. \> 12 mmol/L in dogs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Differentials for DM (Pathologic, Physiologic, Pharmacologic)

A
  1. Pathological  Diabetes mellitus  Pancreatitis;  Hyperadrenocorticism
  2. Physiological  Post-‐prandial ( < 2 hours)  Stress/excitement  Diestrus
  3. Pharmacological/ toxicity
       Dextrose-‐containing IV fluids

   Steroids

   Progesterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Things to rule out with DM

A

 Rule out stress hyperglycemia especially in cats;  Document glucosuria and/or elevated fructosamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Goals of initial DM diagnosis

A
  1. Identify persistent hyperglycemia & glycosuria
  2. Diagnose DM
  3. Identify any contributing causes of DM
  4. Concurrent problems that make glucose regulation difficult
  5. Complications that may be secondary to persistent hyperglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Recommended DM Diagnostics

A
  • CBC
  • Biochemical profile
  • Urinalysis
  • Urine culture & sensitivity
  • ± Fructosamine level
  • ± cPLI or fPLI (pancreatic lipase immunoreactivity)
  • ± Abdominal ultrasound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Common Clinicopathologic Findings for DM - CBC/Biochem

A
  • CBC usually unremarkable
  • Biochemistry profile
    • Hyperglycemia
    • incr ALP & ALT (especially in dogs)
      • Mild-moderate ( < 500 U/L)
      • Usually due to DM effects on liver (lipidosis, etc)
    • incr cholesterol, triglycerides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Common Clinicopathologic Findings - Urinalysis

A
  • Glucosuria (a.k.a. “glycosuria”)
  • ± Ketonuria
  • ± Proteinuria
  • ± Bacteriuria, RBCs, WBCs
  • UTI’s common
  • May have unremarkable urine sediment, no clinical signs
  • Urine culture / sensitivity recommended in all patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Goals of DM treatment

A
  1. Minimize/eliminate clinical signs
  2. Delay/prevent DM-associated complications
  3. Prevent hypoglycemia secondary to treatment
    • Want to control [glucose] within/close to normal range
    • Address hyperglycemia
    • Insulin or oral hypoglycemic agents (cats only)
    • Diet
    • Consistent exercise
    • Control concurrent diseases that can lead to insulin resistance
17
Q

Intermediate acting therapy for DM

A

NPH; Caninsulin; (Vetsulin in USA - not currently available)

18
Q

Longer acting therapy for DM

A

Glargine; Protamine zinc insulin (PZI) - currently available in USA, approval pending in Canada

19
Q

Cats vs dogs in insulin response

A

 Cats usually require a longer-‐acting insulin than dogs;  And have a more unpredictable response

20
Q

Insulin Treatment; - Concentrations; - Amount of therapy (x times a day); Typical doses; Method of dose

A

Note different concentrations;  U‐40 (Caninsulin) versus U‐100 (most other insulins);  Require different syringes;  Most patients will require twice daily therapy;  Typical starting doses for most insulins:;  0.25-‐0.5 U/kg of lean body weight twice daily ;  SQ injection over truncal region;  Alternate sides each injection

21
Q

NPH

A

 Human recombinant product ;  U‐100 product (100 U per mL) ;  Typical duration of activity:;  2‐8 h in cats (may be too short);  Usually < 12 hours in dogs

22
Q

Caninsulin; Length of duration

A

 Veterinary‐approved product (cats & dogs);  Combination of a short & intermediate acting insulin ; - 30% amorphous zinc (short-‐acting); - 70% crystalline zinc (long-‐acting);  Porcine product;  U-40 insulin (40 units per mL);  Typical duration of action: ; - 2-‐10 hours in cats; - Close to 12 hours in dogs

23
Q

Protamine Zinc Insulin

A

 Long-‐acting insulin;  Recombinant human PZI;  Approved for cats in US, approval pending in Canada;  U-‐40 product (40 U per mL);  Compounded PZI (bovine) not recommended;  Typical duration of action: ; - 4-‐14 hours in cats; - >12 hours in dogs (maybe too long acting?)

24
Q

Glargine

A

 Long-‐acting insulin, U-‐100 product;  Recombinant human insulin product;  Forms a “depot” when injected SQ;  Gives a “peakless” insulin release in humans (flat-‐; line glucose curve)  Not in cats;  Typical duration of action  8-‐18 hours in cats;  >12 hours in dogs

25
Q

3 goals for dietary therapy

A
  1. Correct obesity, maintain appropriate weight; 2. Minimize impact of meal on glucose fluctuations; 3. Two main meals coinciding with injections; - Ideal to offer snacks in between to promote more continuous glucose release rather than two large; spikes per day; - Some pets are grazers (ok)
26
Q

3 principles for dietary therapy in dogs

A
  1. High fiber diets (soluble fibers); - Slow GI glucose absorption; - Contraindicated in thin dogs; - No proven benefit of high fiber diets for diabetic dogs; 2. In general, avoid highly digestible diets ; - E.g., low residue, Gastro (absorbed easily, spike); 3. Moderate fat restriction (fat <30% ME) if: ; - Chronic pancreatitis; - Persistent hypertriglyceridemia
27
Q

Principles for dietary therapy in cats

A

(Cats are carnivores); 1. Carbohydrate-restricted diet preferred; 2. Canned diets have higher protein than kibble; 3. High protein / low carbohydrate diets;  Improve control of DM, improve rate of diabetic remission ;  Some canned over-‐the-‐counter diets that are low carb /high protein;  Preferred to have <7% carbohydrate per dry matter basis

28
Q

Treatment considerations in dogs & cats

A
  1. Control concurrent disease ;  Insulin resistance; 2. Avoid insulin-‐antagonizing drugs or states  Glucocorticoids;  OHE for intact females once stable; (progesterone);  Consistent exercise -> Increases glucose delivery to cells, insulin mobilization; 3. If there are some functional pancreatic beta cells remaining:;  Alternatives to insulin therapy;  Potential for cats to have diabetic remission; 4. No reliable indicators of which diabetic cats have residual beta cell activity
29
Q

When can you use non-insulin treatment

A

 Diabetic cats with remaining beta cell; function may respond to medical therapy:;  Oral “hypoglycemic agent” plus high protein diet;  Very mild cases may respond to high protein diet change alone; -> Selecting candidates: ;  Stable / no DKA;  Mild clinical signs;  Owner’s desires;  Must have a concurrent diet change

30
Q

Glipizide, glyburide

A

 Stimulate insulin secretion from pancreas  Need some functional pancreas remaining

31
Q

Chances of remission in cats, depends on?

A
  1. Cats with remaining beta cell function:;  Resolution of hyperglycemia may allow beta cells to recover function…; 2. Most common within first few weeks-months of treatment;  Depends on early, well regulated glucose control;  Few predictive factors for remission;  Higher remission rates in cats treated with insulin + high protein diet
32
Q

What do you do if remission is suspected?

A

 Gradual withdrawal of insulin;  Avoid rebound hyperglycemia that may induce; glucose toxicity of the recovering beta cells ;  Recommend high protein diet for life;  Some may never require treatment for DM again;  Others become insulin‐dependent within weeks to months

33
Q

Purpose of a Glucose Curve (w.r.t. DM)

A

Curves allow assessment of:;  Insulin efficacy;  Glucose nadir;  Peak insulin effect;  Duration of action;  Degree of fluctuation in BG; Used to evaluate a newly treated patient, recent dose change or if clinical signs are present

34
Q

Drawbacks to glucose curves (w.r.t. DM)

A

 Time‐consuming;  10-‐12 hour curve recommended;  Can be expensive;  Stress hyperglycemia (especially cats);  Natural day‐to‐day variation;  Poor repeatability, highly variable

35
Q

Tecnique to giving a Glucose Curve

A
  1. Breakfast & insulin as usual; 2. To clinic ASAP (if monitoring at home, can start just before breakfast/insulin); 3. Blood samples taken every 1‐2 hours through day; 4. Until next insulin injection; 5. Usually 10‐12 hours in duration; 6. Occasionally a 24‐hour curve recommended
36
Q

Glucometer readings that are acceptable

A
  • Usually underestimate BG by 10-‐15%; - Compared to reference laboratory; - Exception is AlphaTrak (veterinary glucometer - can slightly under or overestimate BG)
37
Q

Bottom part of the glucose curve where it is the lowest is called the

A

Nadir; (Ideal is 5-9 mmol/L)

38
Q

Desired Recheck Results (3 elements)

A
  1. Resolution of clinical signs;  PU/PD, weight loss, etc; 2. Blood glucose curves;  Obtain glucose nadir 5-‐9 mmol/L;  Maintain BG < 16 mmol/L throughout day;  < 13 mmol/L feasible in many cases ; 3. Avoid hypoglycemia;  Hypoglycemia activates counter‐regulatory hormones that may cause a subsequent rapid spike in glucose levels;  “Somoygi” effects

Dog & Cat Medicine and Surgery (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions