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Clinical Endocrine, Metabolic and Dermatology > Diabetes Mellitus in Dogs and Cats > Flashcards

Diabetes Mellitus in Dogs and Cats Flashcards

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1
Q

How can Diabetes mellitus be defined in animal medicine?

A

A group of disorders characterized by:
- Hyperglycemia
- Glucosuria
Either due to impaired insulin secretion from the endocrine pancreas, or peripheral insulin resistance

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2
Q

What are the types of DM in humans?

A

Type I
Type II
Other: Gestational

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3
Q

What is Type I diabetes mellitus in humans?

A
  • Cell-mediated autoimmune destruction of the beta cells of the endocrine pancreas, leading to a loss of insulin production
  • Strong genetic susceptibility but there must be a triggering environmental effect
  • Requires Insulin Therapy for Tx
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4
Q

What are the possible Diabetogenic and the Protective factors associated with Type I diabetes in humans?

A

Diabetogenic: Vit D deficiency, certain viruses, cows milk during early stages of development

Protective: Vit D, certain pathogens (e.g. parasites), and Breast milk

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5
Q

What is Type II diabetes mellitus in humans?

A
  • Impaired insulin secretion due to peripheral insulin resistance
  • Strong genetic predisposition
  • May not require insulin therapy initially
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6
Q

What is the most prevalent type of diabetes in DOGS?

A

Type 1/1.5
- Specifically the LADA (Latent Autoimmune Diabetes of Adults)

note: autoantibodies, breed and genetics play a part

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7
Q

What are the similarities between Canine and Human Type I DM?

A
  • Insulin deficiency
  • Genetic predisposition: Samoyed, Terries, Min Schnauzer, Min Poodle, Collie
  • Evidence of autoimmunity: but this is not very strong
  • Seasonality of diagnosis: more commonly diagnosed in fall/winter months
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8
Q

What are some other causes of DM in dogs?

A

Impaired Insulin Secretion:

  • Congenital (beta cell aplasia)
  • Pancreatitis (seen in 30 - 40% of DM cases)

Peripheral Insulin Resistance:

  • Metoestrus (GH induced insulin resistance)
  • Other endocrine disorders: hyperadrenocorticism
  • Drugs: Glucocorticoids + Progestagens
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9
Q

Sooooo, how do we classify canine DM?

A

Can be classfied based on the Potential Causes:

Congenital Insulin Deficiency: familial, diagnosed at a young age and Retrievers, Cairns and Keeshounds are predisposed

Autoimmune Destruction: Samoyed, terriers are predisposed

Pancreatitis: usually seen in older animals with relapsing signs. Rottweilers and Min Schanuzaers are predisposed due to their idiopathic hyperlipidemia

Metoestrus: Entire females. Elkhounds, terriers and collies are predisposed

Other Endocrine Diseases: Hyperadrenocorticism (Glucocorticoids) and Acromegaly (Progestagens)

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10
Q

How is DM classified in CATS?

A
  • Type I: rare
  • Type II: 80% of cases
  • Other: Acromegaly/ pancreatic disease: 20% of cases
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11
Q

What are the similarities between Human and Feline Type II DM?

A
  • Insulin resistance/ impaired secretion
  • Genetic predisposition in certain breeds: Burmese, Burmese X, Norwegian Forest
  • Older age (10 - 15 years old)
  • Obesity is a big risk factor
  • Physical inactivity
  • Increased amylin/ amyloid deposition in the pancreas
  • Remission is possible
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12
Q

What are the differences between Human and Feline Type II DM?

A
  • Cats are more prone to glucose toxicity, which initially is a reversible suppression of insulin, however, can quickly lead to an irreversible loss of beta cells and permanent reliance on supplemental insulin
  • -> Glucose toxicity is defined as a decreased secretion of insulin by pancreatic β cells following a prolonged hyperglycemia
  • Cats are more prone to ketosis, which is not that much of a concern in humans
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13
Q

How does Acromegaly cause DM in cats?

A

Acromegaly in cats is a consequence of the development of a GH-producing pituitary tumour. GH is an insulin antagonist

In order to diagnose feline acromegaly, you must measure Feline IGF-1

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14
Q

What is the renal threshold for Glucose in dogs?

A

12 - 15 mmol/L

Above this and the kidneys are unable to reuptake all glucose, and therefore spillover occurs into the urine

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15
Q

What are the clinical signs associated with uncomplicated DM in dogs?

A
  • PU/PD
  • Polyphagia
  • Weight loss
  • Exercise Intolerance
  • Recurrent cystitis
  • Hepatomegaly
  • +/- Ketotic breath
  • Cataracts
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16
Q

How can DM be diagnosed in dogs?

A
  • Hematology: no change or stress leucogram
  • Biochem: elevated cholesterol, triglycerides, ALP, ALT and Glucose
  • Urinalysis: Glucosuria +/- ketonuria, UTI
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17
Q

What is the Treatment for DM in dogs?

A

1) Insulin administration
2) Dietary changes
3) Exercise Modification

+/- Ab’s for UTI

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18
Q

What Insulin preparations are available for DM in humans?

A

Short-acting: semilente
Intermediate-acting: NPH or lente
Long-acting: Promatine Zinc Insulin (PZI), Ultralente, Glargine, Detemir
Ultra-long acting: Degludec

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19
Q

How are insulin preparations classified?

A
  • Duration of action: short vs intermediate vs long vs ultralong
  • Species of origin
  • Concentration
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20
Q

What Insulin preparations are available for DM in animal species?

A
  • First Choice: Porcine lente (e.g. Caninsulin)
  • Second Choice: Recombinant Human PZI (e.g. ProZinc)
  • Other Insulin Analogues if there are problems associated with the above (e.g. Glargine, Levemir, Lantus)
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21
Q

What diet changes need to be made in diabetic patients?

A
  • Low in simple sugars
  • High fibre
  • High protein
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22
Q

What exercise changes need to be made in diabetic patients?

A
  • Consistent from day to day if possible, avoid no walks, and then 12km hikes on the weekend
  • Exercise prior to the animals next injection of insulin
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23
Q

What are the Stabalization Protocols for Lente and PZI insulin preparations (in both dogs and cats)?

A

Lente (caninsulin): equal dosing BID, feed twice a day at injection times. Ad lib feeding is ideal though

If the Owner can only dose SID, then PZI (ProZinc) should be used: feed one meal at the time of injection, then feed again 6-12 hours later. Or ad lib
Note: PZI is actually the recommended insulin preparation for cats, it can be given SID, however remission will not occur with only SID, it needs to be BID

24
Q

What is the Starting Dose for Insulin in dogs and cats?

A

Depends on the degree of hyperglycemia!
In dogs a good place to start is 0.5 IU/kg or less

In cats, a good place to start is 0.25 IU/kg
Caution: in cats a MAX of 2 IU per injection

25
Q

How is a Maintenance/ Stabilizing Dose of Insulin done at home?

A

1) The following morning after Starting Dose is administered at the vet, urine glucose should be measured. If it is negative, this indicates the stabilizing dose can be lower than what was given as a Starting dose
2) Blood glucose is done once every 3 days at the vet, and timed for 4-6 hours post injection in the morning
3) Stabilization period takes 3+ weeks
4) Stabilization dose is reached when the same dose has been used for 3 consecutive measurements/ vet visits
5) Animal must then be monitored once every week for 3 weeks, then every 1-3 months

note: this stabilization period is long and requires owner compliance
Caution: cat owners need to be aware that remission is possible and they need to look out for signs of hypoglycemia

26
Q

How is a Maintenance/ Stabilizing Dose of Insulin done in hospital?

A

1) Daily blood glucose
- Low (<3.5 mmol/L) - decrease insulin dose
- Normal (3.5 - 8.0 mmol/L) stay the same
- High (>8.0 mmol/L) - increase dose
Adjust insulin dose on a daily basis

2) Stabilization period 10 - 14 days
3) Stabilization dose is reached when the same dose has been used for 3 consecutive measurements
4) Animal must then be monitored once every week for 3 weeks, then every 1-3 months
note: rapid stabilization and no owner intervention needed

27
Q

When dose adjustments need to be made to an insulin dose, by how much should the dose be adjusted by?

A 
~ 10% adjustment
So, in:
- Small dogs: 1-2 IU
- Medium dogs: 2-4 IU
- Large dogs: 4-6 IU

25 - 30% adjustment if the animal is hypoglycemic!

28
Q

How should diabetic animals be monitored?

A
  • Owners opinion of control and quality of life
  • Animals weight
  • Blood glucose
  • Serum fructosamine concentration: high levels indicate high glycation and thus high glucose levels
29
Q

When are clinical signs of DM usually seen when associated with Metestrus in the dog?

A

Clinical signs are seen 3-5 weeks after estrus- correlating with peak progesterone levels and therefore GH concentrations

30
Q

Why is cataracts a concern in diabetic animals? What causes the cataracts to form?

A
  • Related to high blood glucose and accumulation of sorbitol and fructose
  • This attracts water into the lens, swelling and rupture of lens fibres and results in blindness
31
Q

Why is hypoglycemia a concern in diabetic animals? What might cause it?

A
  • Excessive insulin dose: too high a dose or accidentally injected twice by 2 different family members
  • Too little food/ not eating
  • Excessive exercise
  • Can be spontaneous too
32
Q

What are the signs associated with hypoglycemia that Owners should be on the look-out for?

A
  • Hunger
  • Weakness
  • Lethargy
  • Confusion
  • Ataxia
  • Twitching
  • Convulsions
  • Coma
33
Q

What is the at-home treatment for hypoglycemia?

A
  • corn syrup or maple syrup rubbed on the gums of the animal

Ensure no xylitol is in the product

34
Q

What are the complications associated with uncontrolled diabetes in DOGS?

A
  • Cataracts: though this is almost inevitable to happen even in controlled diabetes!
  • Hypoglycemia
  • UTI’s
  • Pancreatitis
  • Others: Diabetic neuropathy, Diabetic nephropathy and Systemic hypertension
35
Q

What is the renal threshold for Glucose in cats?

A

14 - 16 mmol/L

Above this and the kidneys are unable to reuptake all glucose, and therefore spillover occurs into the urine

36
Q

What are the clinical signs associated with uncomplicated DM in cats?

A
  • PU/PD
  • Polyphagia
  • Weight loss
  • Hepatomegaly
  • Poor haircoat
  • Plantigrade stance: representing a peripheral neuropathy
37
Q

How can DM be diagnosed in cats?

A
  • Hematology: stress leucogram
  • Biochem: elevated cholesterol, ALP, ALT (not as marked as in dogs) and Glucose
  • Urinalysis: Glucosuria +/- ketonuria, UTI

Caution: it is common in stressed cats to develop hyperglycemia and subsequent glucosuria

Therefore definitive diagnosis requires one of the following:

1) hyperglycemia + glucosuria + ketonuria
2) persistent hyperglycemia + glucosuria: measured at home
3) hyperglycemia + glucosuria + elevated fructosamine

38
Q

What are the treatment aims of diabetes in cats?

How do they differ from the dog, and why?

A
  • Maximize the chance of recovery/ remission
  • Reduce hyperglycemia to prevent glucose toxicity: by doing this we will hopefully maximize beta-cell preservation and address any clinical signs
  • Reduce stimulus for endogenous insulin secretion by decreasing any insulin resistance: this will then decrease amylin toxicity/ amyloid deposition and prevents beta-cell exhaustion

They differ from dogs because cats have a chance of going into remission and recovering fully

39
Q

What is the Tx for DM in cats?

A

1) Insulin administration: porcine lente or human PZI (same as dogs)
2) dietary modification: low in CHO, high protein diet +/- high fibre if the cat is overweight
(wet is preferred over dry)

3) Exercise if possible
4) Treat other illnesses/ complications

40
Q

What are the complications associated with uncontrolled diabetes in CATS?

A
  • UTI’s
  • Peripheral neuropathy: platigrade stance = poor prognostic indicator
  • Don’t tend to get diabetic cataracts, unlike in dogs
41
Q

What are the chances of achieving remission in cats?

A
  • Variable results: anywhere from 0% - 100%

- More likely to be closer to 50%

42
Q

When is remission most likely to occur in cats?

A

3 - 4 months, but can take longer

43
Q

What influences the chance of remission in the cat?

A
  • Insulin
  • Diet
  • Target blood glucose concentration/ monitoring protocols
  • Individual factors of the cat e.g. genetics, obesity
  • Presence of acromegaly: acromegaly can be the cause of DM in 20-30% of cats. If the cat has acromegaly, the cat will NOT achieve remission unless the pituitary tumour is removed
44
Q

What are the predictors of remission in cats?

A

1) Fructosamine levels: the lower the fructosamine level, the greater the chance of remission!
2) Neuropathy: suggests remission won’t occur = plantigrade stance is a poor prognostic indicator
3) Age: remission increases as the cat ages, although this is counter-intuitive, it suggests that older cats are better adapted at dealing with the DM than younger ones

45
Q

Once a cat achieves remission, what are the chances of relapsing?

A

25 - 30%
- most of these relapse cases have impaired glucose tolerance

  • Only 1/4 of cats that relapse will achieve a second remission
46
Q

Is remission possible in dogs?

A

Yes, but it is very rare

47
Q

What is considered to be successful treatment/ maintenance of a Diabetic dog or cat?

A
  • Adequate control of clinical signs
  • Majority of the day the glucose level is within the reference range but this is not always true
  • Control of fructosamine concentrations
  • Hypoglycemia does NOT occur
  • This does NOT mean normal glucose blood concentrations 24/7, it is alright to have peaks of mild hyperglycemia throughout the day
48
Q

What signs are associated with an unstable diabetic dog?

A
  • Worsening or poor control of clinical signs
  • Inappropriately high levels of blood glucose
  • An increasing fructosamine concentration
  • A high insulin dose ( >2 IU/kg/injection) required
  • Development of ketoacidosis or hypoglycemia
49
Q

Once the animal is reaching 1.5 - 2 IU/kg/injection you need to investigate into reasons why the insulin is not taking effect as well, what are some factors/ reasons?

A

1) Insulin factors: expiry date, heated, frozen, diluted, excessive dose, inappropriate syringe size (40 iu/ml or 100 iu/ml), poor absorption in the same injection spot (scar tissue = less absorbable), poor absorption from fat
2) Diet and exercise factors: diet changes or treats, or inconsistent exercise
3) Owner factors: insulin handling, insulin storage, injection technique, compliance, people forget to give, or end up double dosing
4) Individual animal factors: some intermediate-acting insulins end up having a shorter duration in animals, some animals are picky eaters
5) Undiagnosed concurrent diseases: obesity/ emaciation, hyperadrenocorticism or stress, metestrus, thyroid, acromegaly, pancreatitis

50
Q

If an animal does NOT eat its meal, what dose of insulin should be given?

A

Only half the regular dose

51
Q

Can a human glucometer be used for animal patients?

A

Yes, but must be aware that they typically read lower than the actual glucose concentration (sometimes as much of a difference of 2-3 mmol/L)

Ideally a vet designed one will give a more accurate reading AND require less blood in order to give a reading

52
Q

What is the Somogyi Overswing?

A

An insulin dose that is too high may bring about the Somogyi effect or ‘rebound hyperglycemia’. This is produced because blood glucose concentrations fall too rapidly. It is a life-saving response

53
Q

If the Somogyi Overswing is noticed, what must be done to control?

A

1) Decrease insulin dose by 25-30%
2) Reassess in 3 days
3) Consider switching to twice daily insulin doses, instead of one
4) Adjust dose
5) Restabilize insulin requirement

54
Q

In an animal that has been diagnosed with insulin resistance, it is possible that it has concurrent diseases, what are these likely to be in the dog and cat?

A

Cat: obesity, hyperthyroidism, IBD, Pancreatitis, Acromegaly

Dog: Obesity, UTI, skin disease, Hyperadrenocorticism, Acute Pancreatitis, Neoplasia, Hypothyroidism

55
Q

If no concurrent disease is obvious in an animal with insulin reistance, what should be considered?

A
  • Insulin antibodies: switch to a different species of insulin
  • Poor absorption: switch type of insulin and injection site
  • Prolonged Somogyi: decrease dose and reassess

Clinical Endocrine, Metabolic and Dermatology (17 decks)

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