Exam 3 - Complicated Diabetic Patients Flashcards
what are some long term potential complications that need to be managed for diabetic patients?
DKA - both dogs & cats
UTIs - both dogs & cats
cataracts - dogs
peripheral neuropathy - cats
what defines a complicated/problematic diabetic patient?
uncontrolled clinical signs related to hyperglycemia - excessive thirst, urination, & hunger
episodes of hypoglycemia - sleepiness, confusion, blindness, & seizures
maintain a suitable body weight - weight loss despite treatment
long term complications aren’t managed - DKA, UTIs, cataracts, & peripheral neuropathy
patient is not meeting these goals
what is the most important goal of managing diabetic patients?
a happy owner is most important!!! patient’s life line
what 4 questions do you need to answer when approaching a complicated diabetic patient?
- did the insulin have ANY effect?
- nadir (lowest BG value)
- duration of the EFFECT of insulin
- average BG concentration
what are the main 3 reasons we have for why diabetic patients become complicated?
- insulin related
- client related
- patient related - very complicated diabetic patient!!!
what kind of patient presentation for a diabetic animal would make you think that there is an insulin-related problem?
previously well controlled diabetic patient becomes suddenly unregulated!!!!
what are 3 reasons for how insulin can lose its effect?
- agitation - bottle should be ROLLED gently (vetsulin should be shaken)
- exposure to heat or extreme cold
- bacterial contamination - ALWAYS store in the fridge & follow the manufacturer’s instructions regarding shelf life
T/F: always discard a suspected bottle if a previously stable diabetic deregulates
true
what kind of patient presentation for a diabetic animal would make you think that there is an client-related problem?
newly diagnosed diabetic!!!
what are some ways in which a client may be making a mistake when giving their pet insulin? how can these mistakes be counteracted?
owner fails to expel air bubbles/owner draws the apparatus back while injecting
owner can’t see the markings on the syringe - need to use the smallest possible syringe, use an insulin syringe magnifier, switch to an insulin pen (more accurate especially at lower doses, easier to use, but more expensive)
owner may be injecting the insulin into the pet’s hair, intradermally, or ‘through and through’ - shave patches of hair so that they can see the needle, use an > 11 mm needle because ultra-comfort needles are too short
mismatch between U/ml of insulin & syringe
what is so very bad about U/ml & insulin syringe mismatch?
U40 insulin with a U100 syringe - SUBSTANTIAL UNDER DOSE
U100 insulin with U40 syringe - results in 2.5X overdose
how can you figure out if a complicated diabetic patient is having issues due to client-related issues?
watch the owner draw up insulin & give a test dose of saline to identify if the client is the issue
T/F: before considering patient-related issues, you need to consider insulin & client-related issues first as these are easier to identify & fix
true
what do you need to look at for patient-related problems in complicated diabetics?
BG data!!!!!!!!!
need to know if insulin has any effect, nadir, average BG, & duration of effect
what are the 3 categories that patient related problems are divided into for complicated diabetics?
- episodes of hypoglycemia
- short or unpredictable duration of effect of the insulin
- insulin resistance
what does the somogyi overswing effect look like? when do we commonly see it?
looks like insulin resistance, but in fact, the patient is OVERDOSED!!!!!!!!!
happens when insulin is increased based on spot checks of BG
what are some reasons that we may see episodes of hypoglycemia in a diabetic animal with patient-related problems?
current insulin dose is too high
cat or post-diestrus female dog is going into diabetic remission
irregular exercise program - unaccustomed exertion will cause problems so clients need to keep pets on a regular schedule (20 minute walk after meals ideal for dogs)
consider other hypoglycemic disorders - addison’s, insulinomas, large liver tumors, & beta blocker administration
what are some reasons that we may see short or unpredictable duration of insulin effect in a diabetic animal with patient-related problems?
insulin isn’t a good choice for the patient - lente in a cat or PZI for a dog
insulin is erratically absorbed from SQ space - repeated use of the same site can cause problems
intestinal disease - may impact nutrient absorption (secretion of key gi hormones, incretins, may be impacted & alter glucose homeostasis & response to food intake)
