Diabetes Mellitus pt 2 Flashcards
how do we interpret DM lab results in context?
§Interpret laboratory findings in conjunction with history, PE findings
§ Priority to clinical signs
§ If clinical signs have resolved, but blood glucose curve recheck shows hyperglycemia…
> Interpret the numbers with context
diabetic remission in cats
- when possible
- how common
Cats with remaining beta cell function:
Resolve hyperglycemia = Beta cell recovery
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Studies report 15-100% of diabetic cats achieving remission
> Treated with insulin and appropriate diet
Diabetic Remission in Cats
- What cats will go into remission?
§ Excellent glycemic control early in treatment (within 6 months)
§ Intensive monitoring (home curves)
§ No insulin-antagonizing drugs/conditions
§ Use of long-acting insulin & low carbohydrate diet
Recognizing Diabetic Remission
- signs to look for
§ Blood glucose within normal to low range on recheck curves
§ Clinical signs of hypoglycemia often not present
§ Urine always negative for glucosuria
> Owner can check at home
Managing Diabetic Remission
Gradually reduce insulin dose
- Recheck curves 1-2 weeks after each decrease
- helpful to measure pre-insulin glucose
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Continue to monitor cat at home
- remission may only be temporary
Canine Insulin Therapy
- recommended insulin types
- staring doses
§ Intermediate-acting insulins recommended in dogs
Insulins:
- Porcine lente
- NPH
- Determir
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Starting doses:
§ 0.25 – 0.5U/kg q12 hours starting dose for Caninsulin, NPH
§ 0.1 U/kg for detemir
long term insulin therapy for canine average dose for regulated dogs? when would we consider insulin resistance?
Eventually, average dose for regulated dogs 0.5U/kg q12h
* Range 0.2-1 U/kg q12h
* When >1.5 U/kg per dose, consider insulin resistance
ideal diets for diabetic dogs
§ No one specific dietary approach
§ Obesity-induced insulin resistance impacts treatment response
> Use weight-loss approach in obese patients
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* Non-obese DM dogs can do well on most diets
* One study of stable diabetic dogs
> Similar results in glycemic control for high versus moderate fibre diet
> Dogs with high post-prandial glucose could benefit from increased fibre
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Type & quantity of carbohydrate can have an impact
- “Low glycemic index” desirable
- Combination of soluble, insoluble, and fermentable fibres
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Fat content matters
- Many DM dogs have lipid derangements (hyperlipidemia)
- High fat contraindicated if pancreatitis risk
- Some thin dogs will need a higher fat content to regain weight
importance of exercise for diabetic dog, timing
- Helps promote weight loss, ideal body condition
- Lowers glucose via increased blood flow and overall improvement in insulin/glucose metabolism
- Consistency (time & amount)
- Ideally not around the peak insulin effect time
<> - Intermittent strenuous exercise could require dose decrease
Troubleshooting the Diabetic Pet
§Suboptimal insulin response
§Rule out:
§ Technical problems with insulin, injections
§ Inappropriate treatments
§ Causes of insulin resistance
examples of insulin or technical problems that could lead to suboptimal insulin response
§ Wrong syringe (U-40 versus U-100)
§ Expired insulin:
> Has appearance of insulin changed?
§ Client using proper injection technique?
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§ Some pets develop inflammation at injection site
§ Recommend alternating sites
insulin vial stability, and handling requirements
- Most insulin vials have listed stability of 4-6 weeks
- In veterinary practice, vials often acceptable for 3-6 months
> Refrigerate to increase length of stability
> Owner to monitor insulin appearance for changes - Handling requirements different between insulin types
> Vigorous shaking Caninsulin vial, gentle rolling for others
Somogyi Effect - what is it, when to suspect it
happens when a low blood sugar (hypoglycemia) episode overnight leads to high blood sugar (hyperglycemia) in the morning due to a surge of hormones
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Occurs when insulin results in hypoglycemia
§ Body responds by rapidly secreting counter-regulatory hormones
§ Signs of hypoglycemia are not often apparent
§ Results in hyperglycemia, can persist for up to 72 h
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§ Often results from rapid dose increases with insufficient monitoring
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Suspect when:
§ Persisting hyperglycemia in face of escalating insulin dose
§ Cyclic insulin response (e.g., 1 good day followed by a few days of poor response)
what is considered a short insulin duration? when do we often see it, and what should we do?
§ Detected via BG curve: nadir appropriate, duration <10 hours
> Clinical signs of DM persist
§ Less of a problem in cats with Glargine, PZI
§ Dogs on NPH, Lente insulins
> Consider Detemir
Insulin Resistance - what we will see, definition, possible mechanisms
§ Normal dose of insulin leads to low biological response
§ Defined as persistent hyperglycemia despite >1.5 U/kg per dose
§ Insulin is inhibited pre-receptor, at receptor, or post-receptor
> Clinical effects will appear similar
