Endocrinology - Diabetes Mellitus Flashcards
What are the four presentations of diabetes mellitus?
Stable and uncomplicated canine, stable and uncomplicated feline, stable and ketotic, and diabetic ketoacidotic
What history is typically associated with a stable and uncomplicated canine diabetic?
A history of excessive drinking and urination, always hungry but losing weight
What will you find on PE in a stable, uncomplicated canine diabetic?
They may be relatively normal and cataracts are common
How do cataracts develop?
The lens is freely permeable to glucose and is metabolized to sorbitol via aldose reductace. These are potent hydrophilic agents that cause the lens fibers to swell and rupture
What will you find on the minimum database in a stable, uncomplicated canine diabetic?
Unremarkable CBC, hyperglycemia, mild elevation of liver enzymes (ALP > ALT), hypercholesterolemia, and hypertriglyceridemia
What will you find on urinalysis in a stable, uncomplicated canine diabetic?
Glucosuria and variable USG
Why do 24% of diabetic dogs have bacterial UTIs with no evidence of pyuria?
Glucose may be a substrate for bacteria. Since the immune system is compromized due to the diabetic state, it allows for the bacteria to proliferate
Stable and uncomplicated canine diabetics are ______ dependent.
insulin - they are ‘type 1’ diabetics
In order to treat stable and uncomplicated canine diabetics, we must provide exogenous sources. What are the exogenous insulin types that can be given to dogs?
NPH, Lente, PZI, and long-acting analogs
True or False: Normoglycemia is our goal of therapy in stable, uncomplicated canine diabetics.
FALSE
What are the goals of therapy in a stable, uncomplicated canine diabetic?
Eliminate the clinical signs of diabetes mellitus and reduce the risk of complications
What complications are associated with stable, uncomplicated canine diabetics?
ketoacidosis, infection, and neuropathy
What should be your insulin of choice when initiating treatment in a stable, uncomplicated canine diabetic?
NPH or Lente
What is the intial insulin dosage in the stable, uncomplicated canine diabetic?
0.25-0.5 units/kg subcutaneously every 12 hours
When should a recheck occur after diagnosis of stable and uncomplicated diabetes in the dog?
In about 1-2 weeks - want to recheck clinical signs, BG curve, and urine
What client education is important when their dog has been newly diagnosed with diabetes mellitus?
Teach them insulin handling and storage, practice injections, inform them of the signs of hypoglycemia, and make sure they know the animal has to eat prior to giving insulin
A majority of feline diabetics are of what ‘type’?
Type 2 diabetes - there is a relative insulin deficiency
What is an important risk factor for feline diabetes?
obesity
What condition is more problematic in the feline diabetic versus the canine diabetic?
stress hyperglycemia - it affects diagnosis and monitoring
What complication is more common in the feline diabetic?
diabetic neuropathy
Is dietary management more important in the canine or feline diabetic?
the feline
What are the goals of therapy in a diabetic feline?
Eliminate clinical signs, reduce risk of complications, and promote diabetic remission if possible
What are the first choices of exogenous insulin in the stable feline diabetic?
PZI or glargine
What is the initial insulin dosage in the stable feline diabetic?
1 Unit/cat SC BID
Aside from insulin therapy, what is important in initial therapy of the stable feline diabetic?
Implement dietary management
What oral hypoglycemic dug is an option for feline diabetics?
Glipizide - only successful in 1/3 of cats
When is the use of Glipizide indicated in feline diabetic patients?
When the owners are unwilling or unable to give insulin
What is the ideal diet for a feline diabetic?
high protein, low-carbohydrate diets
What is different between cats and dogs about insulin administration and feeding?
Meal feeding at the time of insulin administration is not essential in the cat
What is diabetic remission in cats?
When the cat is able to maintian normoglycemia without insulin
If diabetic remission is going to occur, when does it typically occur?
within the first 3 months of treatment
Remission is not a cure. What lifelong therapy is recommended in feline diabetic patients?
weight and dietary management
What is diabetic ketosis/ketoacidosis?
A state of insulin deficiency and diabetogenic hormone excess
What is the pathophysiology of diabetic ketosis/ketoacidosis?
In states of cellular glucose deficiency, ketone bodies can be used as an energy source. As ketone bodies increase in the vascular space, then exceed the renal threshold. This results in osmotic diruesis and other pathologic consequences
What does glucagon do?
Promotes hepatic glycogenolysis and glyconeogenesis. It also increases lipolysis and release of FFA into the circulation
How is ketosis diagnosed?
Using urine dipsticks and blood/serum beta-hydroxybutyrate
Why can you not diagnose ketosis with urine dipsticks alone?
Because they do not measure beta-hydroxybutyrate
How will a stable ketotic diabetic present clinically?
There will be ketones in the urine. The patient will still be eating and drinking, maintaining hydration, and there will be no vomiting or other signs
______ plus ________ = diabetic ketoacidosis.
ketosis, metabolic acidosis
DKA patients are _____ animals and they warrant immediate ______.
sick, care
True or False: DKA is life-threatening if it is not corrected.
TRUE
What are some precipitating causes of DKA?
concurrent disease, diestrus, insulin withdrawal, and fasting/dehydration
What concurrent diseases can precipitate DKA?
Pancreatitis, UTI/pyelonephritis, hyperadrenocorticism, pneumonia, neoplasia, renal disease, and hepatic disease
What is the signalment for DKA?
Middle-aged to older dogs and cats, no sex predilection
What historical signs are associated with DKA?
PU/PD/PP and weight loss
What acute clinical signs are associated with DKA?
Anorexia +/- adipsia, vomiting/diarrhea, dehydration, and weakness/depression
What will you find on a PE in a patient with DKA?
dehydration, muscle wasting, variable BCS, poor hair coat, weakness/depression, cataracts (dogs), and peripheral neuropathy (cats)
What diagnostics should be done for a patient with DKA?
CBC, Chemistry, UA, venous blood gas, and diagnostic imaging
What findings are consistent with DKA?
Hyperglycemia, glucosuria, ketonuria, acidosis, and be clinically ill
What are the treatment orders for DKA (in order)?
- Restore intravascular volume
- Correct dehydration
- Correct electrolyte disturbances
- Correct acid-base imbalance
- Reduce blood glucose concentration with insulin
- Eliminate ketones
- Address underlying diseases
