Diabetic Ketoacidosis

Question 1

what are the signs of prolonged lack of insulin in dogs and cats

Question 2

what factors predispose a patient to developing DKA?

Answer 2

Poorly managed diabetes or well managed diabetes with a co morbidity that may lead to dysregulation or insulin resistance. In addition it may be from a new disease (neoplasia, cushings, hyperthyroidism) or a consequence of having DM itself (UTI!! or pancreatitis)

Question 3

Insulin facilitates movement of glucose __ cells with some cells being more/less reliant on this

Answer 3

Insulin facilitates movement of glucose into cells with some cells being more/less reliant on this

Question 4

describe potassium and phosphorus’s relationship with insulin

Answer 4

Potassium and phosphorus won’t move into the cells/muscles without insulin so when you give insulin it drives them both out of the blood resulting in a decrease on bloodwork

Question 5

Type 1 diabetes

Answer 5

lack of insulin production by beta cells

Question 6

Type 2 diabetes

Answer 6

resistance to the effects of insulin

Question 7

T/F: the liver is dependent on glucose

Answer 7

T, it can’t use ketones

Question 8

describe ketosis physiology

Answer 8

without insulin fatty acids will be converted to ketone bodies then acetyl-coa that enters the krebs cycle

Question 9

In ketogenic diet ketones are __ while in diabetic ketoacidosis ketones are __

Answer 9

In ketogenic diet ketones are low while in diabetic ketoacidosis ketones are high

Question 10

ketones can be used by __ organs and are __

Answer 10

ketones can be used by most organs and are acids

Question 11

T/F: it’s common for diabetic patients to have some ketones but it doesn’t mean they have ketoacidosis

Answer 11

T

Question 12

The goal of DM treatment is to __ while the goal of Diabetic ketoacidosis treatment is to __

Answer 12

The goal of DM treatment is to regulate blood glucose while the goal of Diabetic ketoacidosis treatment is to get rid of ketones so no longer acidemic

Question 13

T/F: a UTI that is only detactable by urine culture is enough to dysregulate a cat with diabetes mellitus sending it into diabetic ketoacidosis

Answer 13

T

Question 14

briefly outline the approach to a diabetic ketoacidosis patient

Answer 14

1. Stabilize with replacement fluids and add potassium supplementation
2. Monitor BG Q1-2 hrs
3. Insulin therapy once stable (w/in 1-4 hours) with CRI, IM, IV or SQ if doing long acting
4. Monitor glucose and when it falls below 200 start supplementing with dextrose BUT continue giving insulin
5. Check potassium within 4 hours of starting insulin therapy and keep rechecking ketones + acid/base q 4 hours
6. if not too bad then correcting may take a day but more severe cases can take 2-5 days

Question 15

why does giving insulin help decrease ketones in the body helping correct diabetic ketoacidosis?

Answer 15

When insulin is high the body utilizes glucose instead of fat for energy which produces less ketones while if insulin is low there will be more utilization of ketones predisposing to an acidosis if uncontrolled

Question 16

describe the difference between the keto diet and diabetic ketoacidosis

Answer 16

In the keto diet the person has normally functionally insulin that stays at a low level as a result of eating a low carb diet that starts to utilize fat as energy. This is still regulated by insulin just at lower levels. However, in diabetic ketoacidosis there is a severe lack of insulin since the patients are diabetic. This means in a dysregulated patient the ketones will be produced excessively in the absence of insulin causing the blood to go acidotic.