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SEM 5: SAM 1 > Feline Diabetes Mellitus > Flashcards

Feline Diabetes Mellitus Flashcards

1
Q

What sex, breed and age of cats are more at risk for developing diabetes mellitus?

A
  • Males > females
  • Burmese cats
  • Biphasic age peaks: 5-7 yrs old, or 12-14 yrs old
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2
Q

What concurrent medications are a risk factor for causing diabetes mellitus in dogs and cats?

A

Corticosteroids!!!

  • cortisol competes w insulin, worsening hyperglycemia
  • Also megestrol aceteate
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3
Q

How does Type II DM lead to peripheral insulin resistance?

A
  • Amyloid is secreted when insulin is secreted
  • Constant insulin release leads to accumulation of amyloid in beta cells of the endocrine pancreas
  • Leads to ↓ blood supply, ↓ insulin response to ↑ glucose, and ↓ insulin secretion
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4
Q

How is obesity a risk factor for developing Type II DM in cats?

A

50% ↑ wt = 50% ↓ in insulin sensitivity

  • Fat cat has to produce 2x as much insulin → more prone to insulin resistance and amyloid deposition
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5
Q

85-95% of cats get Type _____ diabetes mellitus

A

2

(Beta cell failure → insufficient insulin secretion, reduced insulin sensitivity)

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6
Q

50% of cats with diabetes mellitus have concurrent _________ disease

A

Pancreatitis

(pancreatitis can cause DM, but DM can also cause pancreatitis… hard to tell what came first)

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7
Q

True or False: Cats with Type II DM are insulin dependent and do not go into remission

A

False - Type II DM can go into remission!! Type I is insulin dependent

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8
Q

What drug should be avoided in a cat in remission from Type II DM?

A

don’t give steroids !!! cortisol competes w insulin

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9
Q

A cat presents for polydipsia and urinating outside of the litter box. What are the top 5 Ddx for PU/PD in cats?

A
  1. Kidney dz
  2. Diabetes mellitus
  3. Hyperthyroidism
  4. Hypercalcemia
  5. Liver failure
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10
Q

A cat presents for polydipsia and urinating outside of the litter box. What are the top 5 Ddx for pollakiuria in cats?

A

Pollakiuria = increased frequency of urination

  1. iFLUTD
  2. UTI
  3. Cystolith
  4. Behavioral
  5. OA
  6. PU/PD
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11
Q

What are the clinical signs seen in cats with DM?

A
  1. PU/PD
  2. Weight loss
  3. ↑ weight loss
  4. Poor hair coat (dull, sticky)
  5. 10% of cats with DM have neuropathic DM → plantigrade stance
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12
Q

True or False: Neuropathic DM causing plantigrade stance is usually irreversible

A

False - reversible after stablizing DM

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13
Q

A 13yr old cat presents for polydipsia and urinating outside of the litter box. A urinalysis is ran.
Glucose: +++
USG: 1.035
What can you say from these results?

A
  • USG is useless and unreliable, glucosuria causes false ↑ in USG
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14
Q

A 13 yr old cat presents for polydipsia and urinating outside of the litter box. You run a minimum database and the blood glucose is 425. How can you tell if the hyperglycemia is due to diabetes mellitus or stress associated with the vet visit?

A
  • Run a Fructosamine
  • If fructosamine is HIGH, you know the cat has been hyperglycemic for atleast 2 weeks
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15
Q

What are the Ddx for plantigrade stance in cats?

A
  1. Hypokalemia
  2. Diabetic neuropathy/DM
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16
Q

True or False: Auto-antibodies to Lente insulin must be considered in an unstable diabetic, especially in cats > dogs

A

False!

Antibodies against insulin have not been reported in cats, but definitely has been reported in dogs

17
Q

How is blood pressure affected by diabetes mellitus in cats?

A

DM does not necessarily cause hypertension in cats (it does in dogs), but secondary causes of DM (Ex: HyperAdrenocortisism, Acromegaly) do predispose an animal to hypertension…. so hypertension is somewhat common finding in DM patients

18
Q

A 13 yr old cat presents for polydipsia and urinating outside of the litter box. You run a minimum database and find a glucose level of 425, elevated ALT and ALKP, and a low T4. How can you interpret the low T4?

A

Diabetes causing euthyroid sick syndrome…. can’t say anything about it. Must clear underlying issue and reassess!

19
Q

A cat presents for polydipsia and urinating outside of the litter box. You run a minimum database and find a glucose level of 425, elevated ALT and ALKP, and a low T4. What could be the cause of the elevated ALT and ALKP?

A

Hepatic lipidosis common in DM cats

20
Q

What is the diet of choice for a diabetic cat?

A

High protein low carb diet, ad lib feeding

(Dogs: high fiber low carb diet)

21
Q

Which of the following insulin has the highest rate of remission in cats with DM?

A. U-40 pork lente
B. Glargine
C. Detemir
D. PZI
E. NPH

A

B. Glargine

(works for 24 hrs and is cumulative)

22
Q

______% of cats with DM can go into remission

A

50-90%

23
Q

What is typically the first clinical sign of hypokalemia seen in cats?

A

Inappetance

24
Q

Why is a blood pressure measurement included in the workup of a diabetic patient?

A
  • Dogs w DM predisposed to hypertension
  • Secondary causes of DM like HyperAdrenocorticism and Acromegaly predispose cats to hypertension
25
Q

How is a high protein diet beneficial for management of diabetic cats?

A

↑ protein → ↑ effectiveness of hexokinase → less glucose in blood → ↓ CS of DM

↑ protein → decreases postprandial glucose surge

26
Q

List the SGLT2 inhibitors used to manage newly diabetic cats

A
  1. Velagliflozin
  2. Benagliflozin
27
Q

What considerations must be made when deciding whether to start a SGLT2 inhibitor?

A
  • Must be used without insulin
  • Must not have recently received insulin
  • Not for DKA patients
  • Only used in cats with DM
28
Q

Which of the following insulin types can cause a variation in BG levels, intermittent glucosuria, and peaks and troughs on a BG curve?

A

Lente insulin (harder to enter remission)

29
Q

How can you interpret a BG curve showing a high flatline at 450.

A
  • Either insulin resistance or giving too little insulin
30
Q

How would you interpret a BG curve showing evidence of Somogyi?

A. The patient needs more insulin
B. The patient needs less insulin
C. The patient needs a longer acting insulin
D. The patient is demonstrating insulin resistance

A

B. The patient needs less insulin

31
Q

List all treatment options for managing DM in cats

A
  1. Insulin
  2. Glipizide PO
  3. a-glucosidase inhibitors
  4. Incretins
  5. SGLT2 inhibitors (Velagliflozin, Benagliflozin)
  6. High protein low carb diet

(Different from dogs: Only insulin and high fiber low carb diet used for tx of DM in dogs)

32
Q
A

SEM 5: SAM 1 (35 decks)

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