Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 1/2 > Digestion & Metabolism 2: Insulin, Glucose Curves & Diabetes > Flashcards

Digestion & Metabolism 2: Insulin, Glucose Curves & Diabetes Flashcards

1
Q

GENERALLY, what 5 things should we do for DIABETES treatment?

A
  1. INSULIN
  2. DIET
  3. EXERCISE
  4. ORAL HYPOGLYCEMICS
  5. Tx of CONCURRENT DZ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

insulin is secreted in a ____ fashion in WHAT 3 species?

describe them? (speed, magnitude & duration)

A

BIPHASIC
1. CATS
2. DOGS
3. HUMANS

describe?
1st PHASE
–> RAPID
–> HIGH MAGNITUDE
–> 5 MINUTES

2nd PHASE
–> SLOW
–> LOW MAGNITUDE
–> 1 HOUR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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?

A

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!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is BASAL-BOLUS INSULIN THERAPY? (2)

how OFTEN is the insulin given? (2 acceptable answers)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

insulin COMPARATIVE GENETICS?

A

is VERY WELL-CONSERVED between HUMAN, CAT & DOG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SHORT-ACTING INSULIN is given WHEN & WHY?

INTERMEDIATE INSULIN is meant to mimic ___ ____

A

SHORT-ACTING INSULIN = given RIGHT BEFORE A MEAL to MIMIC FIRST PHASE

INTERMEDIATE INSULIN = SECOND PHASE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

4 SUB-CATEGORIES of INSULIN?

A
  1. SHORT-ACTING
  2. INTERMEDIATE
  3. LONG
  4. ULTRA-LONG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

4 TYPES of SHORT-ACTING INSULIN?

which one is IDENTICAL to human insulin?

how are they NAMED? why does this process occur?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

LISPRO/ASPART insulin…

what SUB-CATEGORY of insulin is this?

LISPRO ONSET/DURATION?

ASPART ONSET/DURATION?

A

SUB-CATEGORY = SHORT-ACTING

LISPRO…
onset = 5-15 MINUTES
duration = 30-60 MINUTES

ASPART…
onset = 30-60 MINUTES
duration = 8-10 HOURS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

REGULAR INSULIN…

sub-category?

used MAINLY for animals with WHAT DISEASE?

3 routes of ADMINISTRATION?

A

SHORT-ACTING insulin

used MAINLY for DKA

3 routes?
1. IV
2. IM
3. SC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

in DOGS with DKA, which ROUTE & TYPE (names) of INSULIN works best? (3)

what’s the SUB-CATEGORY?

BUT, we can still use ___ ___

A
  1. ROUTE = IV
  2. LISPRO
  3. ASPART

SHORT-ACTING insulin

BUT, we can still use REGULAR INSULIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what SUB-CATEGORY & NAME of insulin was reported to DECREASE POST-PRANDIAL HYPERGLYCEMIA?

A

SHORT-ACTING INSULIN, LISPRO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

all SHORT-ACTING insulin products are at WHAT concentration? what does this term mean?

A

U-100

means 100 UNITS per mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HUMAN insulin DIFFERS from DOG insulin by ___ amino acid(s), and from CAT insulin by ___ amino acid(s)

A

1, 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

3 names of INTERMEDIATE-acting insulins?

A
  1. NPH
  2. LENTE
  3. rPZI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

NEUTRAL PROTAMINE HAGEDORN (NPH)…

sub-category of insulin?

produced by ___ ___ TECHNOLOGY using a ____-____ STRAIN of ___ ____

this is IDENTICAL to…

A

INTERMEDIATE insulin

produced by RECOMBINANT DNA TECHNOLOGY using a NON-PATHOGENIC STRAIN of E. COLI

IDENTICAL to HUMAN INSULIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the NUMBER ONE choice of INTERMEDIATE INSULIN for DOGS?

A

NPH (neutral protamine hagedorn)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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?

A

aka = VETSULIN, LENTE

sub-category = INTERMEDIATE

approved for DOGS & CATS

PRIOR to administration = SHAKE until HOMOGENOUS

given BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

RECOMBINANT PROTAMINE ZINC INSULIN (rPZI)

aka BRAND NAME?

identical to…

sub-category?

A

aka PROZINC

IDENTICAL to HUMAN INSULIN

sub-category = INTERMEDIATE insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

for all INTERMEDIATE-ACTING INSULINS, can start at ____ U/kg via ____ route ___ per day as a ____ & ____ ____DOSE

A

for all INTERMEDIATE-ACTING INSULINS, can start at 0.5 U/kg via SQ route TWICE per day as a SAFE & SAFE STARTING DOSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

all INTERMEDIATE-ACTING insulins are at WHAT concentration?

A

U-40 or 40 UNITS per mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  1. if you were to take a U-100 SYRINGE and give a U-40 PRODUCT, you will be UNDER/OVERDOSING the patient
  2. if you were to take a U-40 SYRINGE and give a U-100 PRODUCT, you will be UNDER/OVERDOSING the patient
A
  1. = UNDERDOSING
  2. = OVERDOSING
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

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?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

GLARGINE…

sub-category?

mimics ___ phase of INSULIN SECRETION

synthesized ___ based on ____ ____ ____

why can GLARGINE NOT be DILUED?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

why is GLARGINE LONG-ACTING?

A

LONG-ACTING because forms MICROPRECIPITATE at PHYSIOLOGIC pH & takes a LONG TIME TO BREAK DOWN

27
Q

TYPICAL starting dose (U/kg), route, & frequency of ADMINISTRATION for GLARGINE in ___?

A

CATS

0.5 U/kg administered SQ BID (can do 12-24 hours)

28
Q

why is GLARGINE considered PEAKLESS?

A

remains FLAT, just LONG, CHRONIC ACTING & NOT INCREASING

29
Q

what is the SMALLEST concentration of GLARGINE AVAILABLE?

A

U-100 or 100 UNITS per mL

30
Q

ULTRA-LONG acting insulin…

given HOW OFTEN?

how does the ULTRA-LONG mechanism work? (3)

A

given ONCE PER WEEK

mechanism?
1. INSULIN binds to its receptor & FUSES with FC

  1. FC region of IMMUNOGLOBULIN binds to FC receptor
  2. RECYCLING OF INSULIN FUSION MOLECULE INTRACELLULARLY causes EXTENDED DURATION OF ACTION
31
Q

what SUB-CATEGORY of insulin is BEST?

A

the one that WORKS BEST FOR A PARTICULAR ANIMAL! many work for dogs & cats

32
Q

ADEQUATE range of BLOOD GLUCOSE CONCENTRATION 9n mg/dL for…

DOGS?

CATS?

why is it HIGHER in ___?

A

DOGS = 100-250 mg/dL

CATS = 100-300 mg/dL

HIGHER in cats because HIGHER RENAL THRESHOLD

33
Q

for animals with diabetes, HOW OFTEN & WHEN should we feed/give insulin?

what does this help accomplish in the animal?

A

give at the SAME TIME EVERY DAY & TWICE DAILY

in animal, helps DECREASE POST-PRANDIAL BLOOD GLUCOSE FLUCTUATIONS

34
Q

for dogs with DIABETES, feed should be HIGH in ____ ____ and should help INCREASE ____ _____

FIXED ____ & RESTRICTED ____

A

INSOLUBLE FIBER, INSULIN SENSITIVITY

FIXED PROTEIN & RESTRICTED FAT

35
Q

for CATS with DIABETES, should have HIGH ____ and LOW ____ given ____ DAILY

need to have FIXED ___ ___

A

HIGH PROTEIN and LOW CARB given TWICE DAILY

need to have FIXED CALORIC INTAKE

36
Q

what does EXERCISE do to the body? (2)

A
  1. able to BRING IN MORE GLUT4 from BLOOD –> CELLS
  2. causes DECREASE IN BLOOD GLUCOSE
37
Q

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)

A

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

38
Q

EUGLYCEMIC KETOACIDOSIS..

can occur secondary to WHAT drug being given to CATS?

why?

lethality?

A

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

39
Q

if a dog is on LONG-TERM SGLT2 INHIBITORS, what should we be on the LOOKOUT FOR?

how can we MONITOR this?

A

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

40
Q

if we see KETONES in the urine…

A

EMERGENCY!

41
Q

if a dog VOMITS or DOES NOT EAT MEAL, how much insulin should we give?

then what should we do?

A

HALF THE DOSE OF INSULIN, but this is a ONE-TIME FIX!

then SEEK VETERINARY ADVICE

42
Q

what is the MOST COMMON clinical sign of DIABETES in CATS?

what OTHER 2 PE FINDINGS should we monitor in DIABETIC PATIENTS??

A

MOST COMMON in CATS = PU/PD

ALSO monitor…
1. POLYPHAGIA
2. BODY WEIGHT

43
Q

GLUCOSE CURVE…

= what is its purpose?

how is it performed for animals receiving INSULIN BID?

how is it performed for animals receiving INSULIN SID?

A

= 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

44
Q

SOMOGYI EFFECT….

= what is it?

what 4 HORMONES does it demonstrate the activity of?

A

= 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

45
Q

in a DOG OR CAT, the INSULIN dose should be INCREASED/DECREASED

A

should be INCREASED because BG ABOVE 350!

dogs = 100-200

cats = 100-300

46
Q

in a DOG OR CAT, the INSULIN dose should be INCREASED/DECREASED

A

should be DECREASED because BG BELOW 100!

dogs = 100-200

cats = 100-300

47
Q

CONTINUOUS GLUCOSE MONITOR SENSOR…

contains WHAT enzyme?

the LARGER the ___, the HIGHER the ____ ____

measures ____ ____ concentration

NO NEED FOR….

A

contains GLUCOSE OXIDASE

the LARGER the CURRENT, the HIGHER the GLUCOSE CONCENTRATION

measures INTERSTITIAL GLUCOSE CONCENTRATION

NO NEED FOR BLOOD SAMPLING

48
Q

when is INSULIN RESISTANCE suspected?

GIVE A SPECIFIC VALUE

A

when HYPERGLYCEMIA is present in the face of INSULIN THERAPY ABOVE 1.5 U/kg per INJECTION

49
Q

what is the MOST COMMON REASON for INSULIN RESISTANCE?

A

IMPROPER HANDLING OF INSULIN (not homogenous or REFRIGERATED)

50
Q

why can CONCURRENT SYSTEMIC DISEASES cause INSULIN RESISTANCE?

A

because could have CONSTANT SECRETION OF GCCs, which are COUNTER-REGULATORY HORMONES that CAUSE HYPERGLYCEMIA regardless of anything else

51
Q

CONCURRENT DISORDERS that might cause INSULIN RESISTANCE… (7)

A
  1. UTI = glucose in URINE can be good for BACTERIA
  2. HYPERADRENOCORTICISM
  3. HYPERTHYROIDISM
  4. HYPOTHYROIDISM
  5. ACUTE PANCREATITIS
  6. EPI
  7. ACROMEGALY
52
Q

GLYCOSYLATED HEMOGLOBIN…

= what is it made of?

what does it REFLECT? & why is it used?

A

= 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

53
Q

FRUCTOSAMINE

this is a more COMMON ____ ____ ___

= what is it made of?

REFLECTS… & why is it different from GLYCOSYLATED Hb?

A

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

54
Q

PROGNOSIS for cats with UNCOMPLICATED DIABETES…

A

usually GOOD & die of OLD AGE & OTHER CAUSES

55
Q

HYPERSOMATOTROPISM…

aka?

MAINLY affects what SPECIES? but can affect…

pathophys? & how it manifests in DOGS (1) vs CATS (2)?

A

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

56
Q

why are most patients with ACROMEGALY also DIABETIC?

A

because SECRETION OF GROWTH-HORMONE is COUNTER-REGULATORY & causes HYPERGLYCEMIA

57
Q

ACTIONS of GROWTH HORMONE… (5)

A
  1. STORES protein
  2. stimulates SYNTHESIS of SOLUBLE COLLAGEN
  3. stimulates PRODUCTION OF CARTILAGE (CHONDROGENESIS)
  4. INCREASES HEPATIC GLUCOSE PRODUCTION
  5. LYSES FAT to cause KETONE PRODUCTION
58
Q

GROWTH HORMONE has a ___ EFFECT ON ___ & ___

what does this mean?

A

DIABETOGENIC, CARBS, FAT

this means that it INCREASES the amount of CARBS & FAT in CIRCULATION by DECREASING THEIR STORAGE

59
Q

IGF-1…

secreted by…

catabolic/anabolic?

has a MAJOR ROLE in GROWTH OF ____ & ____

1 action?

acts SIMILARLY to…

A

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

60
Q

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?

A

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

61
Q

in CATS, how can we DEFINITIVELY DIAGNOSE ACROMEGALY?

A

need to see PITUITARY MASS on MRI or CT

62
Q

IGF-1 can be increased in WHAT 2 CONDITIONS?

A
  1. ACROMEGALY + DIABETES
  2. DIABETES ONLY
63
Q

TREATMENT for ACROMEGALY in…

CATS? (include duration)

DOGS? why?

A

CATS? = STEREOTACTIC RADIATION THERAPY (1-2 treatments) for 15-20 mins

DOGS? = OHE
–> many dogs have ACROMEGALY secondary to DIESTRUS

Year 1/2 (139 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions