Endocrine Pancreatic Disorders 2 Flashcards

1
Q

Why does diabetic ketoacidosis occour?

A
  • Insulin abscence -> high glucose but not accesible
  • lipolysis occours
  • ketone formationas a byproduct -> acidosis (pH shift)
  • damages cells
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2
Q

CLinical signs of ketoacidosis?

A
  • vomiting
  • inapetance
  • coma
  • death
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3
Q

What is the difference between bovine and canine/feline ketosis?

A
- 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)
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4
Q

Principles of DM Tx

A
  1. correcting underlying causes
  2. oral hyperglycamics
  3. insulin
  4. daily dose and frequency
  5. amount and type of food
  6. insulin and meal times
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5
Q

Cascade of events -> DM in the cat

A
  • 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§
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6
Q

How does [glucose] affect pancreas?

A
  • hyperglycaemia DAMAGES the pancreas
  • hurry up and start tx! (not necessarily aggressive tx, just quick)
  • might be reversible in some cases
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7
Q

What 3 things are you aiming for when tx the underlying casues of DM?

A
  • decrease demand for insulin
  • increase senstivity for insulin
  • increase insulin availability
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8
Q

Initial tx for female entire BITCH

A

Neuter immediately [CF COMMON KNOWLEDGE]

- entire-ness will inhibit ability to stabilise

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9
Q

Are oral hypoglycaemics used in animals?

A
  • 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
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10
Q

Most appropriate tx for dogs and cats

A

INSULIN!

- let B cells rest

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11
Q

How can insulin and feeding be timed correctly in the DOG?

A

> 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)

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12
Q

How can insulin and feeding be timed correctly in the CAT?

A
  • feed at the same time (post prandial hyperglycaemia not as reliable)
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13
Q

Which insulin preparations are available

A
> 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
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14
Q

What characteristics of insulin are important?

A
  • peak activity time
  • duration of action
    > NOT necessarily trasnferable from data sheets/BSAVA formulary d/t individual variation
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15
Q

Most cats adn dogs can be regulated with how many injections per day?

A

BID

  • very difficult to control with SID
  • even newer insulins dont have a long enough duration of action (hypoglycaemia and associated signs seen)
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16
Q

WHat is the problem with most insulin types in cats?

A

> do not last long enough

  • shorter duration 8-20hours, some 3hrs
  • administer 12hourly
17
Q

Which insulins are best for cats and dogs?

A
> cats
- PZI q12hours
-lente, glargine or detemir q12hrs 
- meals coordinated (some cats do better grazing)
> dog
- lente (caninsulin) q12hrs 
- detemir q12hrs
18
Q

What must be remembered when injecting animals?

A
Rotate site (can go anywhere) 
- or fibrosis will affect uptake
19
Q

How can DM be monitored?

A
- 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)
20
Q

How is feeding managed for DM?

A
  • 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
21
Q

How have cats evoluation affected their optimum diet choice?

A
  • high protein hunting diet

- low carb

22
Q

Summary Tx of canine DM

A
  • BID lente insulin
  • 2 meals roughly 12 hrs
  • possible dietary manipulation
  • monitoring
23
Q

Summary Tx of feline DM

A
  • 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