Diabetes: Treatment and Monitoring

Question 1

What are the insulin choices that are most common in veterinary medicine?

Answer 1

• Vetsulin
• ProZinc

Question 2

What are the insulin choices available? (the ones he wants us to know)

Answer 2

• Vetsulin
• ProZinc
• Humulin/NPH
• Levemir/Detemir
• Lantus/Glargine

Question 3

the power of something to influence or make an impression

Answer 3

Potency

Question 4

Which is the insulin that you should never use?

Answer 4

NPH

Question 5

Between solution and suspension, which is more readily accessible ?

Answer 5

Solution

Question 6

Dogs are _______

Answer 6

hogs (porcine)

Question 7

Cats are ________

Answer 7

Cattle (bovine)

Question 8

U40 insulin has 40 units of insulin in every 1 ml and the U100 has 100 units. Therefore when converting from a U40 syringe to a U100 syringe you are required to multiply your U40 units by:

Answer 8

2.5

Question 9

• Human recombinant
  ▫U-100 formulation
• Dogs
  ▫If you have to…
  ▫0.25 U/kg B-TID
• Cats
  ▫If you are in dire
  straits… (bad decision)
  ▫1 unit per cat B-TID
• Very Affordable

Answer 9

NPH/Humulin

Question 10

• Porcine lente insulin
  ▫U-40 formulation
• DOGS
  ▫0.25 U/kg
  ▫BID, Rarely SID
• Cats
  ▫1 unit per cat (it’s like the lowest dose)
  ▫BID-TID
• Shake vigorously

Answer 10

Vetsulin

Question 11

• Human recombinant
  protamine-zinc insulin
  ▫U-40 formulation
• Dogs
  ▫0.25 U/kg
  – - Higher starting dose?
  ▫BID
  ▫Unpredictable nadir
• CATS
  ▫1 unit per cat
  ▫BID, Possibly SID
  ▫Licensed for cats!
  ▫(sometimes) Subclinical hypoglycemia

Answer 11

ProZinc

Question 12

a condition in which your blood sugar (glucose) level is lower than the standard range

Answer 12

Hypoglycemia

Question 13

• Human recombinant
  insulin
  ▫U-100 formulation
• Dogs
  ▫0.25 U/kg
  ▫BID
  ▫Inter-dog variability
  ▫Comparable clinical
  response
• CATS
  ▫1 unit per cat
  ▫BID, Possibly SID
  ▫Peakless? improve Remission rates

Answer 13

Glargine/Lantus

Question 14

• Human recombinant
  insulin analog
  ▫U-100 formulation
• DOGS
  ▫0.1 U/kg (Different dosing, more concentrated)
  ▫BID, Rarely SID
  ▫Best option?
• Cats
  ▫0.25 unit/kg
  ▫BID, Possibly SID
  ▫Subclinical
  hypoglycemia

Answer 14

Detemir/Levemir

Question 15

What are the ideal insulin choices for a cat?

Answer 15

ProZinc, Lantus

Question 16

What are the ideal insulin choices for a dog?

Answer 16

Vetsulin (0.25 U/kg), Levemir (0.1 U/kg)

Question 17

What is the most important thing in a “diet therapy - dog”?

Answer 17

CONSISTENCY

Question 18

Diet Therapy - Dog
4 Factors

Answer 18

1. Diet Composition
   ▫Increased fiber
   ▫>45% CHO, <30% protein
   and fat
2. Stable Diet
3. Calorie Intake and Obesity
4. Feeding Schedule
   ▫Consistent calorie content
   ▫Consistent timing of meals
   ▫BID Feeding

Question 19

Central theme in feline
diabetic diets is carbohydrate
restriction:

Answer 19

▫Inhibiting starch digestion
▫Inhibiting intestinal
glucose absorption (fiber)
▫Decreasing carbohydrate
content of the diet

Question 20

It is important to always start with a ________ dose, BID

Answer 20

low

Question 21

Recheck should be?

Answer 21

▫2-3 months to achieve control
- Recheck every 2-3 weeks during this period

Question 22

Dose will only move curve ________

Answer 22

up or down

Question 23

The goals of therapy:

Answer 23

▫resolve the clinical signs of diabetes
▫prevent any consequences of diabetes
▫avoid hypoglycemia

Question 24

a normal level of sugar in the blood

Answer 24

Euglycemia

Question 25

____________ is not a treatment goal

Answer 25

Euglycemia

Question 26

* May appear weak, ataxic, disoriented, etc. * Difficult to detect in cats * Can progress to seizures * Offer food, rub karo syrup on gums

Answer 26

Hypoglycemia

Question 27

_____________ does not always resolve or improve with treatment of diabetes

Answer 27

Neuropathy

Question 28

* Non-enzymatic glycation of serum proteins * Reflect glycemic control over past 2-3 weeks * Not affected by stress and food intake * Affected by half-life of serum proteins (hyperthyroid, hypothyroid, PLE, etc...)

Answer 28

Monitoring - Fructosamine

Question 29

is a compound that is formed when glucose combines with protein. This test measures the total amount of fructosamine (glycated protein) in the blood. Glucose molecules will permanently combine with proteins in the blood in a process called glycation

Answer 29

Fructosamine

Question 30

* If you do it, do it right! * Measure q 2hr for at least as long as the insulin should last (12-24h?) * To determine the nadir: Identify at least 2 points on the upswing * If you do it, interpret carefully!

Answer 30

Monitoring – BG Curves

Question 31

the lowest point

Answer 31

nadir

Question 32

Interpretation of BG curves: Always correlate results with____________ and ______________

Answer 32

clinical signs, fructosamine

Question 33

* Never change insulin dose based on dipstick results alone * Glycosuria is normal in a treated diabetic animal * Lack of glucosuria in the urine – dose decrease? * Mild ketonuria can be normal in non-sick animal

Answer 33

Monitoring – Urine Dipsticks

Question 34

▫Blood glucose curves ▫Spot BG ▫Urine dipsticks

Answer 34

Troubleshooting

Question 35

–- CBC/Chem/UA –- Fructosamine

Answer 35

Initial Visit ▫Diagnostics

Question 36

occurs when the concentration of sodium in your blood is abnormally low

Answer 36

Hyponatremia