Endocrinology: Diabetes Mellitus Clicker Questions Flashcards
Insulin with the longest duration of effect is:
A. Crystalline Insulin
B. Human recombinant insulin/Vetsulin-Lente
C. Protamine Zinc (PZI) - Ultralente
D. Glargine
D. Glargine
Duration of action is inversely related to potency.
A. Crystalline Insulin is given to IV to DKA patients. Highly potent but only acts for about 30 minutes.
B. Human recombinant insulin/ Vetsulin-Lente has an intermediate duration. Used most commonly to manage diabetic dogs.
Both C. Protamine Zinc (PZI) - Ultralente and D. Glargine are considered long acting insulin formulations. Both are administered twice daily to cats. There is no difference in their ability to induce remission, but Glargine is slightly longer acting.
The insulin and dosing schedule of choice in a dog is:
A. Lente-like Vetsulin insulin BID
B. Lente insulin SID
C. PZI SID
D. Glargine SID
A. Lente-like Vetsulin Insulin BID
The insulin and dosing schedule of choice in a cat associated with 80% induction of remission is:
A. Vetsulin Lente BID
B. PZI SID
C. Glargine BID
D. Glipizides
E. Alpha glucosidase inhibitors
C. Glargine BID
In a cat, you do NOT want to use an intermediate-acting insulin. You want to use a long-acting insulin.
Oral glipizides are not helpful because, although they do have Type II diabetes at the time of diagnosis, they usually have so much amyloid deposition in their pancreas that they are not secreting sufficient insulin as a consequence of glucose toxicity.
They are insulin dependent so you need to use a long-acting formulation., so either PZI or Glargine but you need to dose it TWICE daily.
The ideal range of [BG] of a diabetic dog on insulin therapy is:
A. 75-120 mg/dL
B. 100-250 mg/dL
C. 200-350 mg/dL
B. 100-250 mg/dL
The normal range for a diabetic patient on insulin is NOT the same as the reference range given by the laboratory for normal dogs.
Different than in humans where euglycemia is the ideal range.
You perform a Blood Glucose Curve in your clinic. Your patient’s PU/PD and polyphagia has resolved after starting 0.25 IU/kg for one week. The nadir occurs at 5 hours and is 72mg/dL. The blood glucose remains below 250mg/dL for 10 hours. What do you recommend?
A. The dose should remain unchanged
B. The dose should be increased by 5% so it’s effect lasts 10-12 hours.
C. The dose should be reduced by 5% and repeat BG curve in 5 days
C. The dose should be reduced by 5% and repeat blood glucose curve in 5 days.
The nadir happens after 5 hours which is pretty good, but at 72 mg/dl, it is too low. You want the nadir to be above 90mg/dl. Therefore, the dose is too high, so we need to reduce the dose by 5%. You do not even have to look at the rest. The dose is too high.
A cat is in the hospital for a blood glucose curve. The nadir is < 80mg/dl. The most likely cause is:
A. Insulin over dosage
B. Lack of food intake
C. Strenuous exercise
D. Overlap of insulin effect - duration is too long
E. All of the above
E. All of the above
Patient should eat at home with owner giving insulin before admission into the hospital so at least we know that problem did not happen.
Exercise can contribute to poor overall blood glucose. If the owner is doing a blood glucose curve at home, ask about patient activity level.
Insulin may not be very potent but is very long acting (more than 14 hours) so that it overlaps and has a cummulative effect. so the subsequent nadir, which usually happens earlier in the morning is going to be very low.
A dog has a [BG] > 300mg/dL several hours each day (within four hours of dosing), fructosamine > 500umol/L, persistent clinical signs with a [blood glucose] nadir of 70 mg/dl (2 hours post injection). What is the problem?
A. Under dosing insulin
B. Somogyi Effect
C. Duration of action is too short
D. Insulin resistance
B. Somogyi effect
Typically, his blood glucose value remains above reference value which is 250 mg/dl for most of the day.
Fructosamine is a retrospective of the patient’s blood glucose for the the two week, and is very increased. This is consistent with poor diabetic control.
The nadir usually happens 4 to 6 hours after dosing, but in this dog, the nadir occurs at 2 hours and drops to 70 mg/dl.
A dog treated with Vetsulin has a nadir of 110 mg/dL at 4 hours post insulin. The blood glucose remains within 100 - 250 mg/dl for 9 hours each day. The dog is still PU/PD. What do you recommend?
A. Increase the dose by 5%
B. Increase the dose by 10%
C. Change to a long-acting insulin BID
D. Change to a shorter-acting insulin TID
C. Change to a long-acting insulin BID
OR
D. Change to a short acting insulin TID
The most important dietary component in a diabetic cat is:
A. High protein > 45% ME
B. Low fat < 30% ME
C. High carbohydrates > 30% ME
D. High insoluble fiber > 40% ME
A. High protein > 45% ME
What is the least likely reason for a real or apparent insulin resistance?
A. Incorrect storage or administration
B. hypothyroidism or hyperthyroidism
C. Cushing’s/Acromegaly
D. Renal failure
E. Hypertrophic Cardiomyopathy
F. Infections
G. Obesity
H. Diet
I. Drug-like gestagens and steroids
J. Anti-insulin antibodies
J. Anti-insulin antibodies Extremely unlikely
