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SA DX & TX II > Exam 4 - Canine Diabetes Mellitus > Flashcards

Exam 4 - Canine Diabetes Mellitus Flashcards

1
Q

what is the general characterization used to describe diabetes mellitus?

A

persistent hyperglycemia, resulting from defective insulin secretion, insulin action, or both

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2
Q

what is the most common cause of canine diabetes mellitus?

A

immune-mediated beta cell destruction - results in absolute insulin deficiency (strong similarities to type 1 diabetes in people)

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3
Q

what are the 4 causes of canine diabetes mellitus?

A
  1. immune-mediated beta cell destruction
  2. secondary to chronic pancreatic disease
  3. diestrus diabetes
  4. drug-related
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4
Q

what is the pathogenesis of chronic pancreatic disease causing canine diabetes mellitus?

A

persistent inflammation of the exocrine pancreas damages the islets

islet loss results in essentially zero insulin secretion

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5
Q

what is the pathogenesis of canine diestrus diabetes?

A

aka - canine acromegaly

progesterone in the diestrus phase triggers the release of growth hormone by mammary tissue which is a powerful antagonist to insulin (post-receptor effect)

DM may be reversible if the dog is spayed ASAP

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6
Q

what is the pathogenesis of drug-related disease causing canine diabetes mellitus?

A

cyclosporine has been associated with DM in dogs - damages beta cells & impacts insulin sensitivity

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7
Q

T/F: similar to people, dogs get obesity related diabetes mellitus (type 2)

A

false - they don’t!! cats & people do!

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8
Q

T/F: sudden pu/pd/pp with rapid weight loss is the hallmark sign of canine DM

A

true

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9
Q

why do clinical signs start so suddenly in patients with diabetes mellitus?

A

as soon as bg levels are > than the renal threshold (160-200 mg/dl), we see increased urine production

secondary increase in water intake due to fluid loss through urine

lack of insulin causes dramatic feelings of hunger & polyphagia

lack of insulin results in mobilization of reserves & rapid weight loss

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10
Q

what is seen upon physical exam of a patient with diabetes mellitus?

A

often unremarkable except for weight loss

cataracts may be noted at the time of diagnosis - but rare

look for evidence of diseases that may complicate management - other endocrinopathies (check skin & hair coat) & systemic illnesses

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11
Q

what is seen on urine analysis of a dog with diabetes mellitus?

A

glucosuria (very few other differentials for this - renal tubular injury/dysfunction, or spurious)

+/- ketonuria - some may be noted in newly diabetic dogs, but does not indicate DKA!!!

urine specific gravity impacted by glucosuria - often > 1.020 despite severe pu/pd

evidence of UTI - rbc, wbc, bacteria, may be subclinical

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12
Q

T/F: like cats, dogs also get stress hyperglycemia

A

false

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13
Q

what lab changes are seen on a chemistry panel of a dog with diabetes mellitus?

A

hyperglycemia usually >300 mg/dl

hypercholesterolemia/hypertriglyceridemia

elevated ALP activity - vacuolar change due to lipid mobilization

hyponatremia - partially dilutional due to hyperglycemia, some increase in urinary loss of sodium

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14
Q

what changes may be seen on a cbc of a diabetic dog?

A

stress leukogram is expected

anemia is not expected!!! suggests concurrent disease

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15
Q

what is the current consensus on subclinical UTI therapy in diabetic dogs?

A

not to culture or treat unless the dog has actual signs of a UTI

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16
Q

why do a PLI test on a diabetic dog?

A

elevation supports concurrent pancreatitis - may impact dietary recommendations

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17
Q

what are the 6 goals of treatment for a diabetic dog? which is the most important?

A
  1. resolve pu/pd - minimize signs of hyperglycemia
  2. avoid hypoglycemia
  3. avoid DKA
  4. optimize weight, activity level, & BCS
  5. minimize complications (uti, cataracts)
  6. satisfied owner - most important!!!!!! owner is life support system for the dog
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18
Q

why are porcine or human insulins preferred for use in diabetic dogs?

A

canine insulin is identical to porcine insulin & very similar to the human molecule

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19
Q

what is the only FDA approved pork insulin?

A

vetsulin

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20
Q

T/F: almost all available insulins are now based on the human molecule

A

true

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21
Q

what components of insulin make up the type when selecting one for therapy?

A

rate of onset

duration of effect

potency

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22
Q

what are engineered insulins?

A

scientists have altered the amino acid chain of the human insulin molecule to change its behavior - these are more predictable & stable than the older types of insulin

referred to as “insulin x”

insulin glargine u-100 (lantus)

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23
Q

what should be considered for insulin cost when making a decision on which option to use therapeutically?

A

consider how much of a bottle will be used

dose

stability after opening

syringes needed - U40 syringes, used for prozinc & vetsulin, are more expensive

24
Q

what does U40 mean? what does U100 mean?

A

U40 - 40 units/ml

U100 - 100 units/ml

25
Q

what insulin type is used for managing all species with DKA? how long does it last? how is it given? what syringe is used?

A

regular!!! lasts 4-6 hours if given SQ

can be given IV/IM/SQ

U100 syringe used

26
Q

what insulin type is used for diabetic cats but is unpredictable in dogs? how long does it last? how is it given? what syringe is used?

A

prozinc!!! 12 hours, sometimes longer

SQ only

U40 syringe

27
Q

what insulin type requires the use of an insulin pen for dosing in unit increments? how long does it last? how is it given? what syringe is used?

A

glargine U-300

more than 12 hours

IV/IM/SQ

U300 syringe (insulin pen)

28
Q

what insulin type is used for diabetic dogs that are bigger or failed to respond to lente/nph? how long does it last? how is it given? what syringe is used?

A

detemir - levemir, very potent

lasts 10-12 hours

IV/IM/ SQ

U100

29
Q

what insulin type is routinely used in cats that gets good control? how long does it last? how is it given? what syringe is used?

A

glargine!! lasts > 12 hours

IV/IM/SQ

U100 syringes

30
Q

what are your 3 suitable first choices for insulin in diabetic dogs?

A
  1. lente - vetsulin
  2. NPH
  3. insulin detemir
31
Q

how is lente (vetsulin) used for starting insulin therapy in diabetic dogs?

A

U40 porcine insulin product - starting dose is 0.25 U/kg twice daily - okay to round up to 0.5 U/kg in small dogs

comes with a pen system - easier for the nervous owner & more accurate with small doses than a syringe

32
Q

how is NPH used for starting insulin therapy in diabetic dogs?

A

starting dose is 0.25 U/kg twice daily

33
Q

how is insulin detemir used for starting insulin therapy in diabetic dogs?

A

starting dose is 0.1 U/kg twice daily (very potent) - U100 syringe

hard to dose in small dogs

34
Q

what is the initial approach that should be used when beginning insulin therapy in a diabetic dog?

A

administer the first insulin dose & feed in the morning (use 11 mm needles - too short may stay intradermal)

measure BG every 2 hours over 8-12 hours

if bg remains > 150 mg/dl, send home on this dose! may increase the dose by 10% if possible if bg is >250 mg/dl

if bg goes < 150 mg/dl, decrease the dose by 10-25% (round to nearest unit) & if possible, hospitalize the dog to monitor response to the lower dose

repeat blood glucose curve in one week

35
Q

what dietary strategies may be used for a diabetic dog?

A

feed a complete & balanced diet that is low in simple sugars - a ‘special’ diabetic diet has little benefit

feed enough to optimize body weight

feed equal sized meals twice daily at the time of insulin injection - consistency is key!!

can use the pet nutrition alliance website to get help for creating a diet plan

36
Q

T/F: acute exertion in a diabetic dog can result in hypoglycemia

A

true

37
Q

what can be done to improve insulin efficacy after a dog finishes their meal?

A

15 minute walk after each meal

38
Q

what is the benefit of using a freestyle libre as a send home monitoring treatment for a diabetic dog? what are the disadvantages of it?

A

continuous monitor that is fairly reliable - data for 10-14 days & lets you safely step up doses quicker & achieve control faster

disadvantages - doesn’t always work, may need to verify with alpha trak a few times a day & poor concordance if bg changes fast (venous versus interstitial reading)

39
Q

after the initial diagnosis of diabetes & start of insulin therapy, what should your recheck schedule look like?

A

recheck every 1-2 weeks for the first month if not using a libre - can do a bg curve at home or in clinic & adjust dose as indicated

recheck bg within 2 weeks of a dose change

encourage home monitoring once a month - more data & more accurate!

intermittent use of a continuous interstitial glucometer

recheck every 3 months if doing well!

treat patient & not numbers!!!!! we use the curve data to make adjustments when needed, but don’t chase the perfect curve

40
Q

how is at bg curve done at home?

A

check bg

feed & administer insulin as usual

feeding at home ensures that the pet east all food

test bg every 2 hours until next insulin dose - repeat bg within 1 hour if any glucose value is <100 mg/dl

41
Q

how is at bg curve done in the clinic?

A

have the owner feed the dog & give insulin at home

test bg every 2 hours until next dose of insulin - repeat bg within 1 hour if any value <100 mg/dl

42
Q

T/F: it is dangerous to increase an insulin dose without performing a curve or using a libre

A

true

43
Q

what is nadir for diabetic dogs? what are important considerations for this when doing a blood glucose curve?

A

100-150 mg/dl - not the actual lowest if we are doing it every 2 hours, but our best estimate!! very important to do our best to establish this value

continuous monitors will allow us to identify nadir most reliably - timing is inconsistent, so you can’t just do a spot check!

failure to identify the nadir but increasing the dose based on a spot check is a classic mistake

okay to get close to 80 mg/dl in a stable patient

44
Q

what is nadir in regards to a blood glucose curve?

A

the lowest a measurement will be during the procedure/curve

45
Q

what is the target goal for duration of a blood glucose curve? what about target average bg value?

A

10 hours - try to establish when the insulin has worn off, bg is > 80% of the pre-insulin value!

average - < 250 mg/dl

46
Q

if nadir is <80 mg/dl in a stable patient after a blood glucose curve, what should you do?

A

decrease their insulin dose by 25%!!

47
Q

if nadir is >150 mg/dl after a blood glucose curve, what should you do?

A

increase insulin by 10-20%

48
Q

if nadir is 100-150 mg/dl after a blood glucose curve, & average blood glucose is <250 mg/dl, what should you do?

A

no change to insulin dose!

49
Q

if nadir is 100-150 mg/dl after a blood glucose curve, & average blood glucose is > 250 mg/dl, what should you do?

A

glucose nadir </= 6 hours - change to a longer acting insulin!

glucose nadir >/= 10 hours after insulin, change to a shorter acting insulin

50
Q

T/F: it is okay to allow a client to decrease or skip a single insulin dose if they are concerned, but they are not allowed to increase the dose unless directed to do so by the veterinarian

A

true

51
Q

for client education, what does the owner need to know about hypoglycemia & hyperglycemia in their diabetic dog?

A

hypoglycemia is deadly but short term hyperglycemia is not!!!!

52
Q

what specific instructions should you give to the owner of a diabetic dog showing signs of hypoglycemia?

A

offer food if the dog is able to eat - carbs are ideal

rub karo syrup on gums - 0.125ml/kg will raise bg by about 50 mg/dl & may need to repeat this while insulin does its thing

53
Q

T/F: regular insulin [“R”] is analogous to endogenous insulin from the pancreas & all current R insulins are human molecules

A

true

54
Q

what defines the type of insulin?

A

whatever chemical is attached to the insulin molecule

55
Q

what is the 2 peak formulation of lente insulin?

A

30% fast acting & 70% slow acting - designed to blunt post prandial rise in blood glucose levels

56
Q

why is detemir insulin so much more potent than lente?

A

4x more insulin molecules/unit

57
Q

what 3 key questions should you consider when doing a blood glucose curve?

A
  1. did the insulin have an effect?
  2. what was the lowest value? goal of 150-250 mg/dl for the first dose!!
  3. did the insulin last about 10 hours? (nadir about 6 hours post dose)

SA DX & TX II (62 decks)

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