Endocrine Pancreatic Disorders 2 Flashcards
Why does diabetic ketoacidosis occour?
- Insulin abscence -> high glucose but not accesible
- lipolysis occours
- ketone formationas a byproduct -> acidosis (pH shift)
- damages cells
CLinical signs of ketoacidosis?
- vomiting
- inapetance
- coma
- death
What is the difference between bovine and canine/feline ketosis?
- there is no hyperglycaemia in cows > bovine ketosis - combination of intense adipose mobilisation and high glucose demand - EARLY LACTATIOn - intense gluconeogenesis - serum NEFA -> ketone synthesis in the liver > clinicopathologic characterization - ^ serum NEFA and ketone bodies - LOW glucose - NO concurrent acidaemia (unknown why)
Principles of DM Tx
- correcting underlying causes
- oral hyperglycamics
- insulin
- daily dose and frequency
- amount and type of food
- insulin and meal times
Cascade of events -> DM in the cat
- genetics
- environmental (v excercise, ^ abdo fat)
- ^ insulin production to maintain normal glucose
> impaired glucose tolerance (glucose will stay longer higher after a meal, but fasting glucose normal)
> pancreatic failure (d/t genetics and acquired factors [lipid] and [glucose] ) - possible to REVERSE pancreatic failure -> REMISSION§
How does [glucose] affect pancreas?
- hyperglycaemia DAMAGES the pancreas
- hurry up and start tx! (not necessarily aggressive tx, just quick)
- might be reversible in some cases
What 3 things are you aiming for when tx the underlying casues of DM?
- decrease demand for insulin
- increase senstivity for insulin
- increase insulin availability
Initial tx for female entire BITCH
Neuter immediately [CF COMMON KNOWLEDGE]
- entire-ness will inhibit ability to stabilise
Are oral hypoglycaemics used in animals?
- no evidence cf. in humans
> only potential one - Sulphonylureas
- red bull for B cells so only useful for CATS (dogs have no B cells left)
- only used as last resort if refusing insulin injections
- Dogs must have insulin
Most appropriate tx for dogs and cats
INSULIN!
- let B cells rest
How can insulin and feeding be timed correctly in the DOG?
> meal
- 10-30mins until post-prandial hyperglycaemia
insulin
- 2 hours +
SO ALWAYS GIVE INSULIN FIRST [CF. COMMON KNOWLEDGE]
- feed 30-90mins later
- only if a reliable eater (can give 25% food at time of injection to test appetite)
How can insulin and feeding be timed correctly in the CAT?
- feed at the same time (post prandial hyperglycaemia not as reliable)
Which insulin preparations are available
> LIC - Caninsulin/Vetsulin (has been only LIC one) - New one will be lic soon ProZinc PZI > Cascade - human lente - porcine lente 40IU/ml - bovine lente - bovine + human rec PZI - insulin glargine - determir - degludec
What characteristics of insulin are important?
- peak activity time
- duration of action
> NOT necessarily trasnferable from data sheets/BSAVA formulary d/t individual variation
Most cats adn dogs can be regulated with how many injections per day?
BID
- very difficult to control with SID
- even newer insulins dont have a long enough duration of action (hypoglycaemia and associated signs seen)
WHat is the problem with most insulin types in cats?
> do not last long enough
- shorter duration 8-20hours, some 3hrs
- administer 12hourly
Which insulins are best for cats and dogs?
> cats - PZI q12hours -lente, glargine or detemir q12hrs - meals coordinated (some cats do better grazing) > dog - lente (caninsulin) q12hrs - detemir q12hrs
What must be remembered when injecting animals?
Rotate site (can go anywhere) - or fibrosis will affect uptake
How can DM be monitored?
- water consumption, clinical signs, BW > glucose curves (BG q2hrs for 12hours) - do NOT use single spot test to increase dose (nadir will change day to day) - dont be too mathematical looking at curves!! - stress will impact also > fructosamine - no more often than 3weeks - bad for detail (hypo's missed)
How is feeding managed for DM?
- 60-80kcal/kg
- 1700kcal/m^2
> moderate fat content
> low carbohydrate for feline diabetics good evidence ^ remission rate
> no specific diet for dogs - just PALATABLE so that it is eaten reliably (even if this means giving crappy food!)
> concurrent dz
How have cats evoluation affected their optimum diet choice?
- high protein hunting diet
- low carb
Summary Tx of canine DM
- BID lente insulin
- 2 meals roughly 12 hrs
- possible dietary manipulation
- monitoring
Summary Tx of feline DM
- BID insulin (PZI, lente, glargine)
- Meals individdualised - grazing may be better (insulin?)
- Dietary manipulation (low carb)
- Rigorous monitoring?
> owner and goal dependant
> owner committed/keen for remission? - home ear prick available
