Diabetes mellitus and Insulin (Endocrine)

Question 1

Lower insulin concentrations

Answer 1

Insulin dependent cells can’t utilize blood glucose
Insulin independent cells can utilize blood glucose (neurons)

Question 2

Diabetes Mellitus: Type 1

Answer 2

Dogs, B cell destruction
Progressive complete insulin insufficiency
Caused by pancreatic destruction and hereditary

Question 3

Diabetes Mellitus: Type 2

Answer 3

Cats, obesity (60%)
Insulin resistance, dysfunctional B cells, ↑ hepatic gluconeogenesis
Pancreatic neoplasia and hyperadrenocorticism (10-20%)

Question 4

Diabetes Mellitus CS

Answer 4

PU/PD
Polyphagia
WL

Question 5

DX of Diabetes Mellitus

Answer 5

Difficult
Persistent fasting hyperglycemia (>200 mg/dL)
Glycosuria, ketonuria

Question 6

Diabetes Mellitus dietary therapy

Answer 6

↑ or insoluble fiber can delay GI glucose absorption
High protein/ low carbs
Commercial diets (hills and purina)

Question 7

Diabetes Mellitus drug therapy (insulin)

Answer 7

Maintains blood glucose concentrations, eliminate CS of diabetes
Short acting IV

Question 8

Challenges to drug therapy

Answer 8

Integration with meals, exercise, owner need and lifestyle
1-2 large doses instead to respond to glucose concentrations

Question 9

Insulin preps

Answer 9

Grouped by time of onset and duration of action
Affects antigenicity
Cattle and swine traditional
Bacterial produced recombinant products (more potent in cats)

Question 10

Intermediate insulin lente

Answer 10

Insulin and high concentrations of zinc (10x greater than reg insulin)
Vetsulin (only insulin approved for dogs)

Question 11

Insulin, zinc and protamine

Answer 11

Long acting insulin
Poorly soluble after SQ injection (slow onset, long duration of action)

Question 12

Designer recombinant insulins

Answer 12

Long acting insulin
Amino acid structure of protein altered to change PK profile

Question 13

Glargine

Answer 13

Long acting insulin in cats
Structure changes cause a constant systemic absorption
Rapid onset

Question 14

Detemir

Answer 14

Long acting insulin
Peak effect more predictable than glargine
Longer duration of action

Question 15

Hypoglycemia

Answer 15

Complication of insulin therapy
CS: neurologic (disorientation, weakness, seizure, blindness)

Question 16

What causes hypoglycemia

Answer 16

Insulin overdose
Failure to eat
Vomiting
↑ exercise

Question 17

Treating hypoglycemia

Answer 17

Feeding normal meal (mild)
Feeding/ rubbing on mm sugar/ syrup (moderate)
Slow IV 50% dextrose with CRI 5% dextrose until patient fed (severe)

Question 18

Insulin resistance

Answer 18

Marked hyperglycemia throughout the day despite insulin doses

Question 19

Diabetic Ketoacidosis (DKA)

Answer 19

Catabolic disorder
Relative or absolute insulin deficiency
Development: ↑ secretion of stress hormones (cortisol, progest. and GH)

Question 20

DKA CS

Answer 20

Dehydration and prerenal azotemia
V/D (complicate acid-base and electrolyte disorders)
Weakness, ataxia and seizures

Question 21

Bloodwork for DKA

Answer 21

Severe acidosis
Blood glucose >300 mg/dL
Hypokalemia, hypophosphatemia, hypomagnesemia
Ketonuria

Question 22

Aggressive DKA treatment

Answer 22

Restore water and electrolyte (IVFT)
Correct acidosis (bicarbonate)
Insulin supplementation (begin low)
Carb substrate
Isotonic, Na containing fluids

Question 23

Effects of IVFT

Answer 23

Enhances renal blood flow, promote urinary excretion, ↓ effects of stress hormones

Question 24

Pancreatic exocrine insufficiency

Answer 24

Poor digestion
↓ trypsin, amylases, lipases
Enzyme replacement