Glucose

Question 1

Acute hypoglycemia

• address
• diet
• treat

Answer 1

Address the cause and supply exogenous glucose source
Diet: frequent, small meals with complex carbohydrates
Dextrose 50% solution and Glucagon

Question 2

Dextrose 50% solution

Answer 2

Acute hypoglycemia
Crystalloid fluid
Mucosal absorption, do not give SQ
Intravenous bolus of Dextrose used in emergency
Ongoing IV dextrose - no more than 5% concentration

Question 3

Glucagon

Answer 3

Acute hypoglycemia
Not as commonly used
IV injection (dosed in nanograms)

Question 4

Chronic hypoglycemia

• Address
• Treat

Answer 4

Address the cause if possible and if not, alter glucose production/use by the body
Diet: frequent, small meals with complex carbohydrates
Corticosteroids - prednisone/prednisolone

Question 5

2 causes of Hyperglycemia

Answer 5

1. Something that does not require therapy (address underlying issue - stress, exercise, steroids)
2. Diabetes Mellitus - address insulin deficiency; DM is an insulin deficiency and the hyperglycemia is a side effect of not being able to put the glucose into tissue

Question 6

Oral medications for diabetes

Answer 6

Oral hypoglycemic agents - the only clinically relevant ones used in veterinary medicine are sulfonylurea drugs such as Glipizide

Question 7

Oral hypoglycemic agents

Answer 7

Oral medication for diabetes
They cause hypoglycemia
Only useful in Type II diabetes (where the pancreas is still secreting some insulin)
Stimulate insulin secretion by the pancreatic beta cells and increase tissue sensitivity to insulin

Question 8

Glipizide

Answer 8

Only effective in about 20-30% cats
Can cause significant hypoglycemia, so glucose must be monitored
May accelerate beta cell loss

Question 9

Insulin

• produced by
• mechanism in the body

Answer 9

Produced by the beta cells of the islets of Langerhans in the endocrine pancreas
When blood glucose rises, energy dependent K+ channels close causing membrane depolarization and insulin release
Insulin binds to tyrosine kinase receptors which makes glucose transporters available so glucose can enter the cell
Low blood glucose suppresses insulin release

Question 10

Short-acting insulin

Answer 10

Regular insulin
Aka ‘crystallne’ or neutral insulin
Most commonly used for hospitalized patients who are not eating
Duration is too short to use alone for long-term management
Compared to other insulins the pharmacokinetics of short-acting insulins are generally more predictable

Question 11

Intermediate-acting insulin

Answer 11

NPH, Vetsulin/Caninsulin
NPH is added to delay absorption and extend clinical effect
Vetsulin/Caninsulin is a veterinary formula, therefore it is 40 IU/mL (human formula is 100 IU/mL)
Good starting insulin types for canines
May not provide adequate control (duration may be shorter) in felines

Question 12

Long-acting insulin

Answer 12

Protamine Zine/PZI, Glargine, Detemir
Glargine forms microprecipitates in physiologic pH which results in gradual absorption
PZI is veterinary approved; may have shorter duration than the rest
Detemir has much higher potency in dogs (4x), requires special dosing