Diabetes Mellitus Flashcards
Type 1 DM is also referred to as?
Insulin Dependent (IDDM)
Type 2 DM is also referred to as?
Non-Insulin Dependent (NIDDM)
Cats get what type of DM most commonly?
90% approximately get Type II DM aka Non-Insulin Dependent (NIDDM)
How are most cases of feline DM (NIDDM) managed?
Exercise, weight loss, and oral hypoglycemics.
Dogs get what type of DM most commonly?
Type 1 aka Insulin Dependent (IDDM)
What are signs of DM?
PU/PD/PP, weight loss, weakness, exercise intolerance, recurrent UTIs, blindness, recent estrus, neuropathies (plantigrade stance in cats), dermatopathies, cataracts.
What are some differential diagnoses to PU/PD?
Renal failure, hyperthyroidism (cats), Cushing’s (dogs), Hepatic disease (esp. hepatic carcinoma), Pyogenic infections, Hypercalcemia (may be paraneoplastic).
How would you make a diagnosis of DM?
Persistent hyperglycemia after a 6 hour fast, liver enzymes may be elevated, cholesterol may be elevated, glucosuria, cystitis (WBCs, RBCs, and protein), ketones would indicate DKA. Fructosamine can be helpful in confirming that the patient has Diabetes but keep in mind if the patient has low albumin, this would not be a useful test.
Fructosamine can be a useful test to look at ____ _____ of glycemic control.
2 weeks
What type of insulin is the most potent?
Soluble or Regular insulin, used either IM, IV or SQ. Mainly used for the management of the DKA patient.
R= ?
Regular or short-acting insulin
Give me a type of regular insulin?
Humulin-R
With IV use of Humulin-R how fast is the onset of action? When is the peak of when it starts working? What is the duration of action?
Immediate/ 0.5-2 hours/ 1-4 hours
With IM/SQ use of Humulin-R how fast is the onset of action? When is the peak of when it starts working? What is the duration of action?
10-30 minutes/ 1-5 hours/ 3-10 hours
Since Humulin-R is so quick and potent acting, what can you do if the patient is becoming hypoglycemic?
Start a 2.5-5% Dextrose CRI.
What is another name for intermediate acting insulins?
Lente insulins
What are some examples of lente insulins?
NPH (Novolin/isophane), Humulin-N or Humulin-L, Vetsulin (Caninsulin)
What species do we typically use lente insulins in?
Dogs
What is an appropriate route of administration for lente insulins?
SQ
What is the onset of action for Vetsulin? When is the peak of when it starts working? What is the duration of action?
0.5-2 hours/ 2-10 hours/ 4-24 hours
What is another name for long acting insulins?
Ultra lente
What are some examples of ultra lente insulins?
Protamine Zinc (PZI, ProZinc), Glargine (Lantus), Detemir (Levemir)
What do protamine and zinc do to normal lente insulin?
They delay absorption and extend clinical effect.
What is an appropriate route of administration for ultra-lente insulin?
SQ
What is an appropriate onset of action for PZI? When is the peak of when it starts working? What is the duration of action?
1-4 hours/ 4-8 hours/ 6-28 hours
What species do we tend to use ultra lente insulins in?
Cats
What is the starting dose of insulin in dogs?
0.25-0.5 IU/kg BID (*Exception is Insulin Detemir you’d use 0.1-0.2 IU/kg BID)
What is the starting dose of insulin in cats?
1 IU/cat BID
100 IU syringes are equivalent to how many mL?
1 mL
10 IU using a 100 IU syringe is equivalent to how many mL?
0.1 mL
1 IU using a 100 IU syringe is equivalent to how many mL?
0.01 mL
What is the nadir?
Lowest glucose value of a BG curve. It is the value that is used to determine if you will keep the patient’s current regimen or change it.
If an adjustment is needed to the patient’s dosage regimen how soon would you want to re-check them?
7 days
If an adjustment is not needed for the patient’s dosage regimen how soon would you want to re-check them?
3-6 months.
What can owners do at home to monitor the patient?
They can monitor thirst and urination, the patient’s weight, appetite and demeanor. You can also send them home with urine dip sticks to have them check for glucose and ketones.
An owner calls and says their diabetic dog is not eating but is otherwise BAR, what should you advise?
Decrease the insulin dose by 50%. If the patient eats in the next 2 hours, give remainder.
On the contrary, if an owner calls and says their diabetic dog is not eating but ADR what should you advise?
Have them come in, patient may be in Diabetic Ketoacidosis (DKA), need to monitor every 4 hours.
What should you do for a Diabetic patient that is having surgery?
Normal evening schedule the night before (dinner and insulin as per usual), withhold breakfast the morning of but give 1/2 dose of insulin. Feed 1/2 normal food as soon as patient is awake and able to or give Dextrose infusion if needed.
In which species is it more important to feed a low carb diet?
Felines (Variety of options: Hill’s M/D, Purina DM, Royal Canin Calorie Control.) Hill’s W/D or R/D for dogs.
What carbohydrate has the best glycemic index?
Sorghum
What should the protein content be for cats with DM?
50-55% of their ME (metabolizable energy) should come from protein. (Care should be taken in regards to cats that also have renal disease.)
Beta cells contain ____.
Insulin
Alpha cells contain _____.
Glucagon
Delta cells contain ______.
Somatostatin
F cells contain _______ ______.
Pancreatic polypeptide
What are some differentials for HYPOglycemia?
Artifact (if you leave a sample sitting for too long), Unable to produce (liver failure/cirrhosis, PSS, severe malnutrition, toy breeds, Addison’s [Pituitary/GH deficiency], Glycogen storage diseases), Excessive consumption (sepsis, extreme exertion), Exogenous hypoglycemic agents (insulin overdose, glipizide overdose, etc), Endogenous hypoglycemic agents (xylitol toxicity, insulinoma, extrapancreatic neoplasms, islet cell hyperplasia.)
How much Dextrose would you give to a patient acutely hypoglycemic (ex: patient is seizing with almost no blood sugar.)?
1 mL/kg 50% Dextrose diluted 1:4
Therefore a 30 kg dog would get 30 mL 50% Dextrose diluted with 90 mL of sterile saline and administered rapidly IV. If you do not have IV access you may administer it orally or transmucosally.
How much Dextrose would you give a dog on maintenance for hypoglycemia?
Maintenance rate in a dog: 60 mL/kg/day
Maintenance rate in a cat: 40 mL/kg/day
Dextrose concentration: 2.5-5%
How would you acutely control hypoglycemia with “nutrition”?
Karo Syrup/Corn Syrup
How would you chronically control hypoglycemia with “nutrition”?
Small frequent meals with complex CHO’s, something easily digestible with moderate fat and protein content.
Long term treatment of hypoglycemia may involve use of what?
Prednisone (Increases gluconeogenesis, decreases glucose uptake into tissues, stimulates glucagon secretion) 0.5 mg/kg/day, can increase as needed.
Diazoxide (inhibits release of insulin) typically used if diet and Prednisone not working.
Which 2 species are prone to insulinomas?
Dogs and Ferrets
What is Glipizide?
Oral hypoglycemic agent (stimulates insulin secretion). Requires functional beta cells in order to work! Only works in 20-30% of cats because they get Type 2 DM.
What is Metformin (glucophage)?
Oral hypoglycemic agent (unknown mech. of action)
How would you treat a “sick” DKA patient?
Correct fluid/electrolyte/acid-base abnormalities.
Supplemental K+ ( +/- Ph)
IV CRI of insulin or intermittent IM injections
It is not urgent to get glucose down to normal.
How would you treat a “healthy” DKA patient?
Like a normal diabetic patient but with extra monitoring.
How would you treat a hyperosmolar nonketotic diabetic?
Treat like a DKA but the goal is to bring down glucose SLOWLY.
What is the Somogyi response?
A significant drop in blood glucose triggers a glucagon/epinephrine response leading to a significant BG upswing. The mistake practitioners make is that they catch the patient when there is an upswing thinking the patient needs more insulin and they keep dosing them higher and higher and then when the patient goes into their “lows” they eventually bottom out their blood glucose levels.
