Endocrinology - Diabetes Management Flashcards

1
Q

When should diabetic monitoring occur?

A

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

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2
Q

What diagnostics should be done for diabetic monitoring?

A

Urinalysis and glucose monitoring +/- full blood work

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3
Q

How is a blood glucose curve done?

A

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

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4
Q

What are the parameters of the blood glucose curve?

A

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

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5
Q

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

A

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

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6
Q

When is a glucose curve indicated?

A

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

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7
Q

What are the pitfalls to the glucose curve?

A

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

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8
Q

What does fructosamine measurement reflect?

A

The mean BG for the past 2 weeks

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9
Q

What is the use of fructosamine measurement?

A

It eliminates confounding effect of stress hyperglycemia

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10
Q

What are the limitations of fructosamine measurement?

A

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

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11
Q

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

A

low number

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12
Q

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

A

identify the underlying problem

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13
Q

What are the benefits to home monitoring?

A

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

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14
Q

What is the freestyle libre?

A

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

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15
Q

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

A

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

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16
Q

How do you ‘diagnose’ poor owner compliance?

A

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

17
Q

What may be the cause of an insulin underdose?

A

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

18
Q

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

A

1 - occasionally up to 1.5 U/kg

19
Q

What generally is the cause of insulin resistance?

A

There is a concurrent disease process that impairs insulin activity

20
Q

What common diseases can lead to insulin resistance?

A

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

21
Q

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

A

Glycemic, diabetes, cats

22
Q

When should you be suspicious of insulin resistance?

A

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

23
Q

What is the approach to determine insulin resistance?

A

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

24
Q

What is the somogyi effect?

A

It is when insulin induces hyperglycemia

25
Q

What is the etiology of the somogyi effect?

A

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

26
Q

The somogyi effect can induce insulin resistance for how long?

A

Up to 72 hours

27
Q

What clinical signs are associated with the somogyi efect?

A

Clinical signs of hyperglycemia dominate and glucosuria is common

28
Q

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

A

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

29
Q

What is inadequate insulin duration due to?

A

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

30
Q

What does inadquate insulin duration result in?

A

Persistence of clinical signs and insulin overdose/somogyi

31
Q

How is inadiquate insulin duration diagnosed?

A

glucose curve

32
Q

What is the ‘solution’ of inadequate insulin duration?

A

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