Endocrinology - Diabetes Management

Question 1

When should diabetic monitoring occur?

Answer 1

1-2 weeks after diagnosis and implementation of insulin
1-2 weeks after insulin changes
Every 3-6 months in stable diabetics
Whenever the owner observes clinical signs

Question 2

What diagnostics should be done for diabetic monitoring?

Answer 2

Urinalysis and glucose monitoring +/- full blood work

Question 3

How is a blood glucose curve done?

Answer 3

BG is recorded every 2 hours after insulin administration ideally for 12 hours

Question 4

What are the parameters of the blood glucose curve?

Answer 4

Pre-insulin BG, Nadir, duration of insulin effect, highest BG, and average BG

Question 5

What is important to remember when interpreting the blood glucose curve?

Answer 5

Must interpret the curve in light of other clinical parameters before making decisions regarding insulin administration

Question 6

When is a glucose curve indicated?

Answer 6

1-2 weeks after any change in insulin dose or formulation, any patient with poor control of clinical signs, and routine monitoring in any patient every 3-6 months

Question 7

What are the pitfalls to the glucose curve?

Answer 7

Day-to-day variability, effect of stress hyperglycemia, expense, and potential to miss hypoglycemia

Question 8

What does fructosamine measurement reflect?

Answer 8

The mean BG for the past 2 weeks

Question 9

What is the use of fructosamine measurement?

Answer 9

It eliminates confounding effect of stress hyperglycemia

Question 10

What are the limitations of fructosamine measurement?

Answer 10

Can be normal in recent-onset DM and reduced in cases of hypoproteinemia and hyperthyroidism

Question 11

A good control of fructosamine is associated with a low/high number.

Answer 11

low number

Question 12

The presence of high fructosamine supports poor glycemic control but does not help do what?

Answer 12

identify the underlying problem

Question 13

What are the benefits to home monitoring?

Answer 13

Stress hyperglycemia is not as common, glucose curves are time consuming and expensive, and frequent glucose curves required following diagnosis

Question 14

What is the freestyle libre?

Answer 14

A disposable 14-day flash glucose monitoring system that can be used to monitor glucose as often as every minute

Question 15

What are the reasons for poor glycemic control (clinical signs are not resolving)?

Answer 15

Poor owner compliance, insulin underdose, insulin resistance, insulin-induced hypoglycemia, and problems with insulin metabolism/duration of effect

Question 16

How do you ‘diagnose’ poor owner compliance?

Answer 16

History, observe how they administer insulin, and take blood glucose (from their administration and yours)

Question 17

What may be the cause of an insulin underdose?

Answer 17

The initial dose when starting insulin therapy is too low for most and/or they may have increased sensitivity to insulin after starting treatment

Question 18

Most diabetis will have glycemic control with __unit/kg insulin BID or lower.

Answer 18

1 - occasionally up to 1.5 U/kg

Question 19

What generally is the cause of insulin resistance?

Answer 19

There is a concurrent disease process that impairs insulin activity

Question 20

What common diseases can lead to insulin resistance?

Answer 20

Obesity, infection, acromegaly (cats), hyperadrenocorticism (dogs), pancreatitis, and neoplasia

Question 21

Insulin resistance can be a source of sudden loss of ______ control, or can be a precipitating cause of ____ (especially in _____).

Answer 21

Glycemic, diabetes, cats

Question 22

When should you be suspicious of insulin resistance?

Answer 22

When doses exceeding 1-1.5 units/kg are needed for glycemic control and other problems such as owner compliance is ruled out

Question 23

What is the approach to determine insulin resistance?

Answer 23

fulll blood work, search for infection:urine culture, imaging, +/- advanced endocrine diagnostics

Question 24

What is the somogyi effect?

Answer 24

It is when insulin induces hyperglycemia

Question 25

What is the etiology of the somogyi effect?

Answer 25

Hypoglycemia brought on by an insulin overdose causes the stimulation of diabetogenic hormones which then increases BG levels and results in rebound hyperglycemia

Question 26

The somogyi effect can induce insulin resistance for how long?

Answer 26

Up to 72 hours

Question 27

What clinical signs are associated with the somogyi efect?

Answer 27

Clinical signs of hyperglycemia dominate and glucosuria is common

Question 28

What is required to document the somogyi effect and what will you see?

Answer 28

BG curve is required to document - you will see hypoglycemia or a rapid drop in BG followed by profound hyperglycemia

Question 29

What is inadequate insulin duration due to?

Answer 29

Rapid metabolism of insulin - the duration is less than 8-10 hours

Question 30

What does inadquate insulin duration result in?

Answer 30

Persistence of clinical signs and insulin overdose/somogyi

Question 31

How is inadiquate insulin duration diagnosed?

Answer 31

glucose curve

Question 32

What is the ‘solution’ of inadequate insulin duration?

Answer 32

Increase the frequency of administration or change to a longer- acting insulin