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Small Animal Medicine > Diabetes, Pt. 3 > Flashcards

Diabetes, Pt. 3 Flashcards

1
Q

What is the time of onset on a glucose curve? Nadir? Duration of effect? Glucose differential?

A

amount of time until apparent effect

lowest glucose value, ideally midway in dosing interval

how long the insulin lasts - amount of time the BG is in the ideal range when the nadir is acceptable

difference between highest and lowest glucose values, preferrable < 100

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2
Q

What is the ideal glucose range in a diabetic patient’s glucose curve? What in the main goal of therapy?

A
  • DOGS: 80-200 mg/dL for 24 hours
  • CATS: 80-300 mg/dL for 24 hours

eliminate clinical signs

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3
Q

What is the ideal nadir? When should it occur?

A

80-150 mg/dL

approximately halfway through dosing interval - time of nadir indicated peak insulin action

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4
Q

How should insulin dosages be altered if the nadir is too high or low? If it occurs too soon or late?

A

TOO HIGH = increase dose of insulin by 10-25%
TOO LOW = decrease dose of insulin by 10-25%

TOO SOON = change to a longer acting insulin
TOO LATE = change to a shorter duration

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5
Q

What is happening in this glucose curve?

A

nadir occurred too soon - change to longer acting insulin

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6
Q

What is happening in this glucose curve?

A

no response to insulin

  • increase dose
  • insulin resistance!
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7
Q

What is happening in this glucose curve?

A

nadir is too low and too soon

  • likely rebound hyperglycemia
  • decrease dose first
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8
Q

What is the Somogyi effect? What should be done when this is seen?

A

rebound hyperglycemia in response to severe hypoglycemia, due to the low levels of glucose causing catecholamine release —> glycosuria, severe hyperglycemia on spot BG measurements

decrease insulin by 25% and repeat the curve in a week

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9
Q

Unregulated diabetic:

A
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10
Q

When is insulin resistance expected?

A
  • very difficult to regulate a patient on what should be adequate levels of insulin
  • > 1.5 U/kg in dog or cat to get BG <300 mg/dL
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11
Q

What are some causes of insulin resistance?

A
  • administration of drugs that antagonize insulin - corticosteroids commonly found in eye and ear meds
  • heat cycle, diestrus, pregnancy
  • bacterial infection - UTI, dental disease
  • hypothyroidism
  • hyperadrenocorticism
  • acromegaly
  • hyperthyroidism
  • chronic pancreatitis
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12
Q

How can it be determined if it is truly insulin resistance or owners not giving insulin properly?

A
  • observe owners’ administration
  • discuss insulin handling and storage
  • check for proper syringe
  • check expiration dates
  • double-check type of insulin and dose
  • switch to non-diluted
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13
Q

What are the most common causes of hypoglycemia in response to insulin therapy?

A
  • incorrect use of syringe
  • concentrated insulin
  • overlap of insulin action (long-acting)
  • anorexia, vomiting
  • maldigestion, malabsorption
  • transient diabetes
  • insulin dose too high
  • aging, remission
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14
Q

What are common signs of hypoglycemia caused by insulin administration?

A
  • behavioral changes
  • ataxia
  • depression
  • ptyalism
  • weakness, seizures
  • stupor, coma
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15
Q

What are 3 potential long-term complications of hypoglycemia?

A
  1. cerebral edema
  2. temporary blindness
  3. behavior change
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16
Q

How long might a patient need to be on a dextrose drip after ecoming hypoglycemic on insulin therapy?

A

up to 3 days

17
Q

After hypoglycemia, when should insulin be reinitiated?

A

when BG is in the diabetic range at a 50% reduced dosage

18
Q

What are some signs of complicated diabetes?

A
  • PU/PD
  • lethargy, weakness
  • inappetence
  • vomiting, diarrhea
  • emaciation
  • dehydration, shock
  • acetone odor on breath (DKA)
  • neurologic abnormalities
19
Q

What should be looked for in a patient that is no longer regulated on insulin therapy and has become sick? What should always be done in this case?

A
  • pancreatitis
  • UTIs
  • renal disease
  • metabolic disease
  • Cushing’s
  • hypothyroidism
  • ketosis
  • obesity
  • acromegaly
    (a diabetic dog should always be hungry!)

urine culture

20
Q

What is hyperosmolar hyperglycemic state?

A

relative lack of insulin where hyperlgycemia causes osmotic diuresis and decreased fluid intake —> hyperglycemia + hypernatremia = hyperosmolarity

  • most common in the peripheral tissues of cats with Type 2 diabetes
21
Q

What is diabetic ketoacidosis?

A

insulin deficiency allows for the production of ketones from impaired fatty acid metabolism and their buildup in adipose tissue

22
Q

What biochemical triad is present in diabetic ketoacidosis?

A
  1. hyperglycemia
  2. ketonemia/ketonuria
  3. metabolic acidosis

cane have ketosis without ketoacidosis = ketones present, but not at high enough concentration to cause acidosis

23
Q

When is diabetic ketoacidosis most common? What causes this? What clinical signs are associated?

A

dogs and cats previously diagnosed with BM

inadequate insulin and concurrent infection, inflammation, or insulin resistant disorders

  • dehydration
  • depression, weakness
  • tachypnea
  • vomiting, abdominal pain
  • acetone odor on breath
  • slow and deep breathing
24
Q

What are the 5 steps to the pathophysiology of DKA?

A
  1. glucose in unable to go into cells to be used as a fuel source = perceived starvation
  2. liver makes a huge amount of glucose and when cells cannot use it, the body starts using adipose tissue for energy (fat —> ketones)
  3. initial formation of ketone bodies are a protective mechanism against cellular starvation, but organs need insulin to use it
  4. utilization of ketones decreases, allowing for their accumulation
  5. increased amounts cause metbolic acidosis
25
Q

How does DKA cause dehydration and hypovolemia? Nauseous signs? What electrolyte abnormalities are seen?

A

ketonuria and osmotic diuresis from glucosuria

ketonemia and hyperglycemia stimulate CTZ

hypernatremia, low K

26
Q

What are the 4 most common signs of DKA?

A
  1. dehydration
  2. shock
  3. scidosis
  4. hyperosmolarity
27
Q

What concurrent disease processes are most common in dogs and cats with DKA? Why?

A
  • DOGS: acute pancreatitis, UTIs, hyperadrenocorticism
  • CATS: hepatic lipidosis, CKD, acute pantreatitis, infections, neoplasia

increased stress hormones (glucagon, cortisol) counteract the effects of insulin = ketone prodcution

28
Q

What is the goal to treating DKA?

A
  • correct fluid deficits, acid-base balance, electrolyte imbalances
  • reduced blood glucose and ketonuria
  • being insulin therapy
  • treat concurrent disease
29
Q

What insulin is recommended for treating DKA? How does ketonemia and hyperglycemia affect this?

A

rapid acting - Regular —> lowers hyperglycemia and ketonemia —> once BG are lowered and maintained at 200-250 and clinical signs stop, longer acting ones can be used

with significant ketonemia, insulin must be given even if blood sugars are normalizing —> this means glucose needs to be added to fluids so that the insulin does not cause hypoglycemia - once ketones are normalized, glucose is weaned off

30
Q

What is euglycemic ketoacidosis? What is critical in these patients?

A

DKA that occurs despite normal blood glucose almost exclusively in patients on SGLT2 inhibitors

insulin administration despite normoglycemia —> administer dextrose to maintain normal values!

31
Q

What are common signs of diabetic hyperosmolar (nonketotic) syndrome?

A

DM symptoms and….

  • dehydration
  • lethargy
  • depression, comatose
    (most common in cats)
32
Q

What is seen on serum biochemistry in patients wtih diabetic hyperosmolar (nonketotic) syndrome? Why?

A
  • BG > 600
  • minimal to no ketones
  • serum osmolality > 350 mOsm/kg (glucose, sodium, BUN!)

relative lack of insulin + hyperglycemic osmotic diuresis + hypernatremia (lack of fluid intake) = hyperosmolarity

33
Q

How should the hypoosmolar state seen in diabetic hyperosmolar (nonketotic) syndrome be corrected? Why? How is insulin therapy altered?

A

slow correction with a balance of fluids, BG, and electrolytes by reduceing BG at 50 mg/dL/hr, or else cerebral edema occurs

delayed 4-6 hours until fluids have improved the condition by correcting dehydration and improving urine production, hyperglycemia, hyperosmolarity, and electrolytes

34
Q

What are the most common causes of death in diabetic patients?

A
  • hypoglycemia
  • euthanasia (exasperated owners by imperfect control) —> SGLT2 inhibitors will likely decrease this!
35
Q

What are some considerations for diabetics that need to undergo surgery?

A
  • ensure good glycemic control
  • not allowed food in the morning, give half a dose of insulin
  • schedule as first procedure
  • monitor frequently
  • 5% dextrose in fluids
  • can use Regular insulin until awake enough to eat

Small Animal Medicine (52 decks)

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