Digestion & Metabolism 2: Insulin, Glucose Curves & Diabetes Flashcards
GENERALLY, what 5 things should we do for DIABETES treatment?
- INSULIN
- DIET
- EXERCISE
- ORAL HYPOGLYCEMICS
- Tx of CONCURRENT DZ
insulin is secreted in a ____ fashion in WHAT 3 species?
describe them? (speed, magnitude & duration)
BIPHASIC
1. CATS
2. DOGS
3. HUMANS
describe?
1st PHASE
–> RAPID
–> HIGH MAGNITUDE
–> 5 MINUTES
2nd PHASE
–> SLOW
–> LOW MAGNITUDE
–> 1 HOUR
explain WHY there’s a BIPHASIC secretion of INSULIN?
describe the phases based on why their TIMING is the way that it is
1st PHASE?
2nd PHASE?
in 1st PHASE…
1. has “READY-TO-RELEASE” POOL of GRANULES sitting NEAR CELL MEMBRANE
2. QUICKLY release INSULIN, but NOT MANY OF THEM –> only lasts 5 minutes!
in 2nd PHASE…
1. GRANULES with INSULIN are FARTHER AWAY, so takes longer
2. also MORE OF THEM –> lasts 1 hour!
what is BASAL-BOLUS INSULIN THERAPY? (2)
how OFTEN is the insulin given? (2 acceptable answers)
what is this?
1. give RAPID INSULIN RIGHT BEFORE a MEAL to MIMIC FIRST PHASE
2. then, give LONGER-ACTING INSULIN to MIMIC SECOND PHASE
how OFTEN = ONCE or TWICE a day
insulin COMPARATIVE GENETICS?
is VERY WELL-CONSERVED between HUMAN, CAT & DOG
SHORT-ACTING INSULIN is given WHEN & WHY?
INTERMEDIATE INSULIN is meant to mimic ___ ____
SHORT-ACTING INSULIN = given RIGHT BEFORE A MEAL to MIMIC FIRST PHASE
INTERMEDIATE INSULIN = SECOND PHASE
4 SUB-CATEGORIES of INSULIN?
- SHORT-ACTING
- INTERMEDIATE
- LONG
- ULTRA-LONG
4 TYPES of SHORT-ACTING INSULIN?
which one is IDENTICAL to human insulin?
how are they NAMED? why does this process occur?
4 types?
1. REGULAR INSULIN = identical to HUMAN
2. LISPRO INSULIN
3. ASPART INSULIN
4. GLULISINE INSULIN
named after AMINO ACID SUBSTITUTIONS that allow them to be SHORTER ACTING than REGULAR INSULIN
LISPRO/ASPART insulin…
what SUB-CATEGORY of insulin is this?
LISPRO ONSET/DURATION?
ASPART ONSET/DURATION?
SUB-CATEGORY = SHORT-ACTING
LISPRO…
onset = 5-15 MINUTES
duration = 30-60 MINUTES
ASPART…
onset = 30-60 MINUTES
duration = 8-10 HOURS
REGULAR INSULIN…
sub-category?
used MAINLY for animals with WHAT DISEASE?
3 routes of ADMINISTRATION?
SHORT-ACTING insulin
used MAINLY for DKA
3 routes?
1. IV
2. IM
3. SC
in DOGS with DKA, which ROUTE & TYPE (names) of INSULIN works best? (3)
what’s the SUB-CATEGORY?
BUT, we can still use ___ ___
- ROUTE = IV
- LISPRO
- ASPART
SHORT-ACTING insulin
BUT, we can still use REGULAR INSULIN
what SUB-CATEGORY & NAME of insulin was reported to DECREASE POST-PRANDIAL HYPERGLYCEMIA?
SHORT-ACTING INSULIN, LISPRO
all SHORT-ACTING insulin products are at WHAT concentration? what does this term mean?
U-100
means 100 UNITS per mL
HUMAN insulin DIFFERS from DOG insulin by ___ amino acid(s), and from CAT insulin by ___ amino acid(s)
1, 4
3 names of INTERMEDIATE-acting insulins?
- NPH
- LENTE
- rPZI
NEUTRAL PROTAMINE HAGEDORN (NPH)…
sub-category of insulin?
produced by ___ ___ TECHNOLOGY using a ____-____ STRAIN of ___ ____
this is IDENTICAL to…
INTERMEDIATE insulin
produced by RECOMBINANT DNA TECHNOLOGY using a NON-PATHOGENIC STRAIN of E. COLI
IDENTICAL to HUMAN INSULIN
what is the NUMBER ONE choice of INTERMEDIATE INSULIN for DOGS?
NPH (neutral protamine hagedorn)
PORCINE INSULIN…
aka WHAT 2 names?
sub-category?
FDA approved for WHAT 2 species?
what do we need to do PRIOR to administration?
given HOW often?
aka = VETSULIN, LENTE
sub-category = INTERMEDIATE
approved for DOGS & CATS
PRIOR to administration = SHAKE until HOMOGENOUS
given BID
RECOMBINANT PROTAMINE ZINC INSULIN (rPZI)
aka BRAND NAME?
identical to…
sub-category?
aka PROZINC
IDENTICAL to HUMAN INSULIN
sub-category = INTERMEDIATE insulin
for all INTERMEDIATE-ACTING INSULINS, can start at ____ U/kg via ____ route ___ per day as a ____ & ____ ____DOSE
for all INTERMEDIATE-ACTING INSULINS, can start at 0.5 U/kg via SQ route TWICE per day as a SAFE & SAFE STARTING DOSE
all INTERMEDIATE-ACTING insulins are at WHAT concentration?
U-40 or 40 UNITS per mL
INSULIN SYRINGES are DIALED PER ____ & are MATCHED to the _____ of ____ you give
you’ll need a LARGER VOLUME of INSULIN for U-40/U-100
INSULIN SYRINGES are DIALED PER UNIT & are MATCHED to the CONCENTRATION of INSULIN you give
you’ll need a LARGER VOLUME of INSULIN for U-40
- if you were to take a U-100 SYRINGE and give a U-40 PRODUCT, you will be UNDER/OVERDOSING the patient
- if you were to take a U-40 SYRINGE and give a U-100 PRODUCT, you will be UNDER/OVERDOSING the patient
- = UNDERDOSING
- = OVERDOSING
2 LONG-ACTING insulins?
which one has MANY SIDE EFFECTS & NOT RECOMMENDED?
which one is STANDARD OF CARE for CATS?
which one has an ALTERNATIVE FORM? what is the NAME of the alternative form?
2 types?
1. GLARGINE
2. DEGLUDEC
which one has MANY SIDE EFFECTS & NOT RECOMMENDED? = DEGLUDEC
which one is STANDARD OF CARE for CATS? = GLARGINE
which one has an ALTERNATIVE FORM? what is the NAME of the alternative form?
–> GLARGINE = TOUJEO
GLARGINE…
sub-category?
mimics ___ phase of INSULIN SECRETION
synthesized ___ based on ____ ____ ____
why can GLARGINE NOT be DILUED?
LONG-ACTING insulin
mimics SECOND phase of INSULIN SECRETION
synthesized GENETICALLY based on AMINO ACID SUBSTITUTIONS
GLARGINE cannot be DILUTED because it is INJECTED INTO A SOLUTION WITH pH OF 4
why is GLARGINE LONG-ACTING?
LONG-ACTING because forms MICROPRECIPITATE at PHYSIOLOGIC pH & takes a LONG TIME TO BREAK DOWN
TYPICAL starting dose (U/kg), route, & frequency of ADMINISTRATION for GLARGINE in ___?
CATS
0.5 U/kg administered SQ BID (can do 12-24 hours)
why is GLARGINE considered PEAKLESS?
remains FLAT, just LONG, CHRONIC ACTING & NOT INCREASING
what is the SMALLEST concentration of GLARGINE AVAILABLE?
U-100 or 100 UNITS per mL
ULTRA-LONG acting insulin…
given HOW OFTEN?
how does the ULTRA-LONG mechanism work? (3)
given ONCE PER WEEK
mechanism?
1. INSULIN binds to its receptor & FUSES with FC
- FC region of IMMUNOGLOBULIN binds to FC receptor
- RECYCLING OF INSULIN FUSION MOLECULE INTRACELLULARLY causes EXTENDED DURATION OF ACTION
what SUB-CATEGORY of insulin is BEST?
the one that WORKS BEST FOR A PARTICULAR ANIMAL! many work for dogs & cats
ADEQUATE range of BLOOD GLUCOSE CONCENTRATION 9n mg/dL for…
DOGS?
CATS?
why is it HIGHER in ___?
DOGS = 100-250 mg/dL
CATS = 100-300 mg/dL
HIGHER in cats because HIGHER RENAL THRESHOLD
for animals with diabetes, HOW OFTEN & WHEN should we feed/give insulin?
what does this help accomplish in the animal?
give at the SAME TIME EVERY DAY & TWICE DAILY
in animal, helps DECREASE POST-PRANDIAL BLOOD GLUCOSE FLUCTUATIONS
for dogs with DIABETES, feed should be HIGH in ____ ____ and should help INCREASE ____ _____
FIXED ____ & RESTRICTED ____
INSOLUBLE FIBER, INSULIN SENSITIVITY
FIXED PROTEIN & RESTRICTED FAT
for CATS with DIABETES, should have HIGH ____ and LOW ____ given ____ DAILY
need to have FIXED ___ ___
HIGH PROTEIN and LOW CARB given TWICE DAILY
need to have FIXED CALORIC INTAKE
what does EXERCISE do to the body? (2)
- able to BRING IN MORE GLUT4 from BLOOD –> CELLS
- causes DECREASE IN BLOOD GLUCOSE
if you give a DIABETIC cat EXCLUSIVELY SODIUM-GLUCOSE COTRANSPORT 2 INHIBITORS, this puts them at risk for WHAT?
THEREFORE, SGLT2 inhibitors are CONTRAINDICATED for CATS that… (2)
puts them at risk for DKA because IF LOSING GLUCOSE via URINE but NOT PUTTING IT BACK INTO CELLS, then they’ll BREAK DOWN FATS TO MAKE KETONES
SGLT2-inhibitors CONTRAINDICATED for cats that…
1. have EVER BEEN ON INSULIN
2. have SYSTEMIC ILLNESS
EUGLYCEMIC KETOACIDOSIS..
can occur secondary to WHAT drug being given to CATS?
why?
lethality?
secondary to SGLT2 INHIBITORS
why? = because even though GLUCOSE CONCENTRATION IS NORMAL, still KETOTIC/ACIDOTIC because GLUCOSE ISN’T BEING PUSHED BACK INTO CELLS & so we need KETONES
CAN BE FATAL
if a dog is on LONG-TERM SGLT2 INHIBITORS, what should we be on the LOOKOUT FOR?
how can we MONITOR this?
be on the lookout for KETONE PRODUCTION meaning that PATIENT IS NOT GETTING ENOUGH GLUCOSE INTO CELLS
can MONITOR via KETONE METER using a DROP OF BLOOD
if we see KETONES in the urine…
EMERGENCY!
if a dog VOMITS or DOES NOT EAT MEAL, how much insulin should we give?
then what should we do?
HALF THE DOSE OF INSULIN, but this is a ONE-TIME FIX!
then SEEK VETERINARY ADVICE
what is the MOST COMMON clinical sign of DIABETES in CATS?
what OTHER 2 PE FINDINGS should we monitor in DIABETIC PATIENTS??
MOST COMMON in CATS = PU/PD
ALSO monitor…
1. POLYPHAGIA
2. BODY WEIGHT
GLUCOSE CURVE…
= what is its purpose?
how is it performed for animals receiving INSULIN BID?
how is it performed for animals receiving INSULIN SID?
= helps determine PROPER DOSE OF INSULIN
performed BID? = BG measured EVERY 2 HOURS for AT LEAST 10 HOURS
performed SID? = G measured EVERY 2 HOURS for AT LEAST 20 HOURS
SOMOGYI EFFECT….
= what is it?
what 4 HORMONES does it demonstrate the activity of?
= occurs when we give OVERDOSE OF INSULIN/HYPOGLYCEMIA and COUNTER-REGULATORY HORMONES ACTIVATE to cause HYPERGLYCEMIA
4 hormones?
1. CATECHOLAMINES
2. GCCs
3. GLUCAGON
4. GROWTH HORMONE
in a DOG OR CAT, the INSULIN dose should be INCREASED/DECREASED
should be INCREASED because BG ABOVE 350!
dogs = 100-200
cats = 100-300
in a DOG OR CAT, the INSULIN dose should be INCREASED/DECREASED
should be DECREASED because BG BELOW 100!
dogs = 100-200
cats = 100-300
CONTINUOUS GLUCOSE MONITOR SENSOR…
contains WHAT enzyme?
the LARGER the ___, the HIGHER the ____ ____
measures ____ ____ concentration
NO NEED FOR….
contains GLUCOSE OXIDASE
the LARGER the CURRENT, the HIGHER the GLUCOSE CONCENTRATION
measures INTERSTITIAL GLUCOSE CONCENTRATION
NO NEED FOR BLOOD SAMPLING
when is INSULIN RESISTANCE suspected?
GIVE A SPECIFIC VALUE
when HYPERGLYCEMIA is present in the face of INSULIN THERAPY ABOVE 1.5 U/kg per INJECTION
what is the MOST COMMON REASON for INSULIN RESISTANCE?
IMPROPER HANDLING OF INSULIN (not homogenous or REFRIGERATED)
why can CONCURRENT SYSTEMIC DISEASES cause INSULIN RESISTANCE?
because could have CONSTANT SECRETION OF GCCs, which are COUNTER-REGULATORY HORMONES that CAUSE HYPERGLYCEMIA regardless of anything else
CONCURRENT DISORDERS that might cause INSULIN RESISTANCE… (7)
- UTI = glucose in URINE can be good for BACTERIA
- HYPERADRENOCORTICISM
- HYPERTHYROIDISM
- HYPOTHYROIDISM
- ACUTE PANCREATITIS
- EPI
- ACROMEGALY
GLYCOSYLATED HEMOGLOBIN…
= what is it made of?
what does it REFLECT? & why is it used?
= an IRREVERSIBLE, NONENZYMATIC INSULIN-DEPENDENT BOND of GLUCOSE to HEMOGLOBIN
reflects SERUM BLOOD GLUCOSE CONCENTRATIONS over the past 3-4 MONTHS; NOT used often, but MONITORING
FRUCTOSAMINE
this is a more COMMON ____ ____ ___
= what is it made of?
REFLECTS… & why is it different from GLYCOSYLATED Hb?
more COMMON GLUCOSE MONITORING TOOL
= NONENZYMATIC INSULIN-DEPENDENT BOND of GLUCOSE to VARIOUS SERUM PROTEINS (like ALBUMIN)
REFLECTS SERUM BLOOD GLUCOSE concentrations over the past 1-3 WEEKS because ALBUMIN HAS SHORTER HALF-LIFE
PROGNOSIS for cats with UNCOMPLICATED DIABETES…
usually GOOD & die of OLD AGE & OTHER CAUSES
HYPERSOMATOTROPISM…
aka?
MAINLY affects what SPECIES? but can affect…
pathophys? & how it manifests in DOGS (1) vs CATS (2)?
aka = ACROMEGALY
MAINLY affects CATS, but can affect DOGS
pathophys? = from EXCESS GROWTH HORMONE secretion from PITUITARY in ADULTHOOD
CATS = GH-secreting PITUITARY ADENOMA
DOGS = EXOGENOUS PROGESTERONE ADMINISTRATION or during DIESTRUS
why are most patients with ACROMEGALY also DIABETIC?
because SECRETION OF GROWTH-HORMONE is COUNTER-REGULATORY & causes HYPERGLYCEMIA
ACTIONS of GROWTH HORMONE… (5)
- STORES protein
- stimulates SYNTHESIS of SOLUBLE COLLAGEN
- stimulates PRODUCTION OF CARTILAGE (CHONDROGENESIS)
- INCREASES HEPATIC GLUCOSE PRODUCTION
- LYSES FAT to cause KETONE PRODUCTION
GROWTH HORMONE has a ___ EFFECT ON ___ & ___
what does this mean?
DIABETOGENIC, CARBS, FAT
this means that it INCREASES the amount of CARBS & FAT in CIRCULATION by DECREASING THEIR STORAGE
IGF-1…
secreted by…
catabolic/anabolic?
has a MAJOR ROLE in GROWTH OF ____ & ____
1 action?
acts SIMILARLY to…
secreted by GROWTH HORMONE
ANABOLIC
has a MAJOR ROLE in GROWTH OF SKELETON & CARTILAGE
1 action?
1. ANTILIPOLYTIC (PREVENTS FAT LYSIS)
acts SIMILARLY to INSULIN
what PROMOTES secretion of GH?
what INHIBITS secretion of GH?
what is PRODUCED by GH and acts as a NEGATIVE FEEDBACK? what ORGAN does it act on to do this?
PROMOTES = GHRH (hypothalamic growth hormone-releasing hormone)
INHIBITS = SOMATOSTATIN (hypothalamic growth hormone-inhibiting hormone)
IGF-1 MADE by GH and works in NEGATIVE FEEDBACK on PITUITARY to STIMULATE PRODUCTION OF SOMATOSTATIN
in CATS, how can we DEFINITIVELY DIAGNOSE ACROMEGALY?
need to see PITUITARY MASS on MRI or CT
IGF-1 can be increased in WHAT 2 CONDITIONS?
- ACROMEGALY + DIABETES
- DIABETES ONLY
TREATMENT for ACROMEGALY in…
CATS? (include duration)
DOGS? why?
CATS? = STEREOTACTIC RADIATION THERAPY (1-2 treatments) for 15-20 mins
DOGS? = OHE
–> many dogs have ACROMEGALY secondary to DIESTRUS
