Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

Exam 4 - Feline Diabetes Mellitus Flashcards

1
Q

what signalment of cat is most at risk for feline diabetes mellitus?

A

older indoor male cats are most at risk!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

T/F: many cats exist in a pre-diabetic/diabetic state for long periods prior to diagnosis

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

why can diagnosing diabetes in cats challenging?

A

stress in cats can cause substantial hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the 3 main causes of feline diabetes?

A
  1. sustained insulin release - most common, similar to type 2 in humans
  2. secondary to chronic pancreatic disease
  3. type 1 diabetes mellitus - immune mediated destruction, very rare in cats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what genetic predispositions for diabetes have been identified in cats?

A

european & australian burmese cats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the pathogenesis of how sustained insulin resistance leads to the development of feline diabetes mellitus?

A

insulin resistance initially drives an increase in insulin secretion which results in the deposition of islet amyloid polypeptide (IAPP) within the pancreas

IAPP is co-secreted with insulin - it slows gastric emptying & enhances feelings of satiety

pancreatic amyloidosis impairs beta cell function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the pathogenesis of how chronic pancreatic disease leads to the development of feline diabetes mellitus?

A

persistent inflammation of the exocrine pancreas damages the islets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is insulin resistance? how is this a problem in cats with diabetes?

A

insulin sensitivity reflects the responsiveness of the tissues to the insulin - insulin attaches to cell surface receptors which triggers a series of intracellular events (glucose channels are opened & glucose enters cells)

in diabetic cats, numerous factors make it more difficult for this process to work as intended - insulin resistance means it takes more insulin to get the job done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

T/F: there is a 4 fold increase risk of diabetes mellitus if a cat is obese

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the number one cause of insulin resistance in cats?

A

obesity!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how can lack of exercise/poor muscle mass cause insulin resistance?

A

muscle is a great sink for glucose - loss of muscle tissue & a sedentary lifestyle can cause insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how do inflammatory conditions cause insulin resistance in cats?

A

cytokines antagonize the effects of insulin - conditions like chronic pancreatitis, chronic stomatitis, & chronic cholangitis

acute inflammation can impact insulin sensitivity in the short term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what drugs can cause insulin resistance in cats?

A

glucocorticoids - prednisolone, depomedrol

progestagens - megestrol acetate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how can acromegaly cause insulin resistance in cats?

A

usually caused by growth hormone secreting pituitary tumor

growth hormone is a powerful antagonist to insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how does diet type influence diabetes mellitus in its development?

A

secretion of key hormones from gi tract influenced by diet type

hormones impact insulin secretion & hepatic gluconeogenesis - important for efficient handling of ingested nutrients - these hormones are called incretins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the incretins?

A

glucose-dependent insulinotrophic peptide (GIP)

glucagon-like peptide (GLP-1) - most important one with respect to pancreatic health, powerful trophic effect on beta cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the best stimuli for incretins in cats?

A

fats & proteins!

high carb diet - results in poor incretin release & compromised beta cell health

diets with <14% of metabolizable energy from carbs are recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the steps of getting to diabetes mellitus starting with insulin resistance?

A

pancreas has to secrete more insulin to maintain euglycemia - amylin (IAPP) is co-secreted with insulin, but in cats & people, it gets stuck in pancreas resulting in pancreatic amyloidosis leading to compromise in beta cell function

eventually insulin production is not enough to maintain euglycemia - BG will go out of reference range but stays in renal threshold (pre-clinical DM) - need to intervene if we see a cat in this state by changing diet/addressing obesity

BG >200 mg/dl causes glucose toxicity (but cat is not overtly diabetic) - damages many cells but particularly nerves, causing diabetic neuropathy & causes apoptosis of beta cells (not all die, some can be coaxed back to life)

when BG gets higher than the renal threshold, owner will notice PU/PD - many cats are hyperglycemic for months before this point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

T/F: if we can reverse insulin resistance in a cat & manage their BG, the hiding beta cells may start to function again & the cat can be weaned off of insulin

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what range do we have that supports remission of diabetes mellitus in cats? what factors support remission?

A

30-80% of cats

aggressive control of BG (keeping it under < 200 mg/dl) supports remission

at-home monitoring lets owner keep tight control & supports remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are some clinical signs of diabetes mellitus in cats?

A

pu/pd/pp & weight loss

cats hover in a pre-clinical state for months, so signs may be less than in dogs

can stumble on a diabetic cat in a routine exam - cat doing well, no signs noticed by owner, & cat has lost some weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what does it mean if you see diabetic neuropathy in a cat on physical exam?

A

suggests a long period of hyperglycemia

limits likelihood of remission

23
Q

what are some examples of causes you should look for on physical exam for a cat with diabetes?

A

dental/oral disease

chronic skin issues

endocrinopathy - hyperadrenocorticism (pot belly, thin skin), hyperthyroidism (palpable thyroid nodule, heart murmur), or acromegaly (large cat, big feet, prominent mandible, renomegaly)

24
Q

T/F: cats with diabetes mellitus usually do not develop cataracts

A

true

25
Q

T/F: hyperglycemia in a cat = diabetes mellitus

A

false - rarely goes over 350 mg/dl, lasts for a few hours, & can start at home when the cat sees the carrier

26
Q

how do you prove persistent hyperglycemia in a cat with diabetes mellitus?

A

collect urine at home & check BG at home

fructosamine & ketonuria

27
Q

what changes are seen on biochemistry panels of diabetic cats?

A

hyperglycemia - bg > 300 mg/dl

hypercholesterolemia & hypertriglyceridemia

+/- minor elevation in ALP (vacuolar change due to lipid mobilization)

28
Q

what changes are seen in the electrolytes in a diabetic cat?

A

hyponatremia is common - partially dilution due to hyperglycemia but some increase in urinary loss of sodium

potassium - usually normal in stable DM cats

29
Q

T/F: measuring serum fructosamine in a cat is a great way to prove sustained hyperglycemia in a diabetic cat

A

true

30
Q

why are fructosamine levels great for diagnosing a cat with diabetes mellitus?

A

fructosamines are a group of proteins (primarily albumin) that become permanently attached to a glucose molecule (glycated)

amount of fructosamines is proportional to BG levels - gives us a look back over the last 2 weeks

amounts of fructosamines are lowered by diseases that impact albumin turnover (hyperthyroidism, gi disease)

31
Q

why run a total T4 on diabetic cat?

A

illness will tend to move down T4 in a cat

robust value (high end of reference) should be taken seriously

increased value indicates concurrent hyperthyroidism

32
Q

how long should you administer insulin to a diabetic cat prior to testing for acromegaly? how do you test for it?

A

6 weeks - GH levels fluctuate markedly so we measure a surrogate

insulin like growth factor 1 is measured instead - released from the liver in response to GH, levels are more stable, requires insulin to be expressed, so levels are low in untreated diabetics

33
Q

what are the goals of treatment for a diabetic cat?

A
  1. resolve pu/pd
  2. minimize signs of hypoglycemia
  3. avoid DKA & peripheral neuropathy
  4. optimize weight, activity level, & body condition
  5. satisfied owner
  6. +/- diabetic remission
34
Q

what are your two options for first choice insulins for managing diabetic cats?

A

insulin glargine - U100

protamine zinc insulin - U40

35
Q

what is the starting dose of insulin glargine for diabetic cats? when is its peak activity (anticipated nadir) anticipated post injection? typical duration?

A

1 unit/cat twice daily or 0.25 U/kg ideal body weight - BID dosing means the constant presence of insulin which is an ideal way to keep bg below 200 mg/dl all of the time

12-24 hours post injection

lasts 12-24 hours

36
Q

what is the starting dose of protamine zinc insulin for diabetic cats? when is its peak activity (anticipated nadir) anticipated post injection? typical duration?

A

1 unit/cat twice daily or 0.25 U/kg of ideal body weight

2-6 hours post injection

lasts 12-24 hours

37
Q

why is it ideal to give a diabetic cat its first dose of insulin in the hospital?

A

give dose & check bg every 2 hours

need to identify hypoglycemia - not to determine the perfect dose!!!

stress may impact your reading - don’t increase the dose for the first week

38
Q

how is diet & body weight managed in diabetic cats?

A

switch to diabetic diet if possible - carbs provide <14% of metabolizable energy (3 g/100 kcal) - feed twice daily if possible (okay to feed ad lib if cat is not overweight & used to this plan)

aim for gradual weight loss in fat cats - 2% of body weight per week is ideal (0.4 kg/month in a 5 kg cat) - wet food may help improve feelings of fullness

39
Q

why do you need to get the owner of a diabetic cat on board with at home bg monitoring?

A

data from cats tested at home is much more reliable - owner can identify decreasing insulin needs if the cat is going into remission!

40
Q

T/F: an owner may only need to check bg for a curve for the cat if using insulin glargine

A

true

41
Q

how often should blood glucose curves be done in newly diagnosed diabetic cats?

A

every 2 weeks initially & then every 6-8 weeks

42
Q

T/F: fructosamine levels can be used to assess response to insulin in a stable diabetic cat

A

true

43
Q

how is fructosamine used to monitor a diabetic cats response to their insulin dose?

A

low value indicates periods of hypoglycemia & high value indicates suboptimal regulation

if high, you don’t know why! doesn’t necessarily indicate the need to increase the dose (risky to increase insulin without knowing nadir)

44
Q

what is blucare?

A

urine glucose testing for diabetic cats - not yet available in USA

very sensitive test - good way to identify long periods below the renal threshold

45
Q

why is measurement of water intake an unreliable way of monitoring a diabetic cat?

A

BG is usually > 250 mg/dl before polydipsia occurs, so the cat is likely to be persistently hyperglycemic

a period of hypoglycemia can be masked by prolonged hyperglycemia (may lead to an inappropriate increase in insulin dose)

46
Q

what do you do if nadir for a blood glucose curve is < 80 mg/dl in a diabetic cat?

A

decrease dose by 25-50% - warn owner that cat may be going into remission (insulin needs may drop fast)

47
Q

what do you do if nadir for a blood glucose curve is 80-250 mg/dl all day in a diabetic cat?

A

stick to your current dose

48
Q

what do you do if nadir for a blood glucose curve is > 150 mg/dl in a diabetic cat?

A

increase dose by 1/2 unit - be sure this isn’t stress induced

cat should be showing signs indicating hyperglycemia - allow several days (at least 3, up to 7) to see effect before increasing again

49
Q

how should insulin dose adjusting be done if measuring effect by fructosamine levels or water intake in a diabetic cat?

A

make 1/2 unit changes

50
Q

T/F: diabetic remission in cats most often occurs within the first 90 days

A

true

51
Q

what is the ideal candidate for a cat to achieve diabetic remission?

A

fat cat who was on a high carb diet that is now on a low carb diet

52
Q

T/F: addressing dental disease in diabetic cats may help with achieving remission

A

true

53
Q

what are some ways that owners may help their diabetic cat achieve remission?

A

highly motivated owners can try to support remission with intensive monitoring - owners should understand that this can happen quickly & they need to be ready to decrease insulin dose

bg is checked before every insulin dose & approximately 6-8 hours later

goal is to keep bg between 65-220 mg/dl all day

SA DX & TX II (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions