Lecture 16 4/10/25 Flashcards
What are the common clin path findings in diabetes mellitus cases?
-normal CBC +/- stress leukogram
-high blood glucose
-high cholesterol +/- high triglycerides
-mild to moderate liver enzyme activity increases (moreso in dogs)
What are the common UA findings in diabetes mellitus cases?
-glucosuria
-minimally concentrated
-possible ketonuria
-possible acidic pH
-possible bacteriuria
When should ketosis be assessed for?
-at time of DM diagnosis
-anytime a diabetic animal is sick
-any time a cat on SLGT inhibitors is sick
How is ketosis assessed for?
-urine dipstick (acetoacetate)
-blood (beta-hydroxybutyrate)
What are the goals when evaluating a diabetic?
-assess overall health of pet
-ID complications of DM (cataracts in dogs, peripheral neuropathy in cats)
-ID concurrent problems associated with DM (infections, pancreatitis)
-ID conditions that might interfere with response to tx (hyperthyroidism in cats, hyperadrenocorticism in dogs, CKD)
-evaluate for risk factors
What are the characteristics of the financial and emotional burden of DM?
-requires frequent insulin injections and veterinary care
-30% of patients are euthanized within a year of diagnosis
-owners are concerned about costs, pet sitting, and both their own and their animal’s QOL
What are the treatment goals for DM?
-good QOL for patient and owner
-eliminate clinical signs
-normalize body condition
-avoid clinically significant hypoglycemia and DKA
How are the treatment goals for DM achieved?
-decrease hepatic glucose output
-improve insulin sensitivity
-ensure appropriate insulin availability
-reduce post-prandial hyperglycemia
-address underlying causes/comorbidities
What can lead to decreased compliance with DM treatment?
-increased dosing frequency
-injection pain
-forgetfulness/other priorities
-regimen complexity
-medication costs
Why is regular, consistent daily exercise recommended for diabetic patients?
any weight loss will help to decrease insulin resistance and insulin requirements, making it easier to achieve metabolic control
What is the ideal diet for a diabetic cat?
-low carbohydrates
-higher protein
-typically canned diet
-fed to maintain ideal body weight
What are the characteristics of commercially available diets vs prescription diets in diabetic cats?
-one study has found that pets eating commercially available wet diet was 3x more likely to achieve remission
-commercial diets are low CHO, higher fat while prescription diets are low CHO, higher protein
What is the ideal diet for a diabetic dog?
-continue same diet in 2 to 4 smaller meals a day
-if difficult to control or needing to lose weight, modify diet to have higher fiber, lower carb (metabolic focus)
Which medication(s) are required by diabetic dogs and cats?
dogs: always require insulin
cats: require insulin OR SLGT2i
What are the characteristics of SGLT2 inhibitors?
-increase glucose excretion in the urine to lower BG
-no risk of hypoglycemia because SGLT1 are not affected and can maintain a normal BG
What are the FDA approved SGLT2 inhibitors?
-bexagliflozin/bexacat
-velagliflozin/senvelgo
What are the advantages of using an SGLT2 inhibitor?
-once daily oral treatment
-no needles required
-same dose regardless of BG
-minimal risk of hypoglycemia
Why do SGLT2 inhibitors work in cats?
-they have a relative insulin-deficient state rather than an absolute state
-viable beta cells are still present
Which patients are the best candidates for SGLT2 inhibitors?
-newly diagnosed DM with no history of insulin treatment
-good appetite
-no significant comorbidities
What is the response to SGLT2 inhibitors?
-rapid effects; normal BG within 14 days on average
-84 to 88% of patients see treatment success within 1 to 2 months
What are the adverse events that can occur with SGLT2 inhibitors?
-vomiting
-diarrhea
-DKA
What are the characteristics of DKA that results from SGLT2 inhibitors?
-can be euglycemic or hyperglycemic
-usually identified within 1 to 2 weeks of starting treatment
-patient will require exogenous insulin going forward
What are the most important points regarding SGLT2i?
-must select appropriate patients
-effective and rapid acting
-no hypoglycemia risk
-be aware of potential serious complications
-can develop euglycemic or hyperglycemic DKA
-must test the blood and urine to determine ketoacidosis
-stop SGLT2i and give insulin and dextrose if DKA confirmed
What is the typical behavior of insulin?
-natural tendency to crystallize/precipitate, especially in presence of zinc
-dimers and monomers of insulin are biologically active
-pancreas beta cells produce and store insulin as hexamers
-regular insulin given SQ will form hexamers to slow release rate; otherwise fast acting due to monomer formation
How can insulin be modified to extend duration of action?
the more hexamers the insulin is composed of, the longer the duration of action will be
What are the characteristics of recombinant insulins?
-designed to mimic physiologic insulin secretion
-low day-to-day variability
What are the characteristics of rapid acting, short duration recombinant insulins?
-less hexamers
-mimic post-prandial insulin in people
-not commonly used in animals
-include lispro, aspart, and glulisine
What are the characteristics of long-acting recombinant insulins?
-more strongly form hexamers
-mimic basal insulin in people
-include glargine, insulin glargine U300, and degludec
What are the characteristics of short acting insulins?
-crystalline suspension
-potent
-rapid onset, short duration
-can be given IV, IM, SQ
-can be given as a single dose or as a CRI
What are the uses for regular insulin?
hospital use only
diabetics:
-sick for non-DM causes
-ketotic
-DKA
-general anesthesia and better control
non-diabetics:
-hyperkalemia from urinary obstruction or addison’s
How does insulin affect potassium?
it causes it to shift out of the bloodstream and into the cells
Why is it important to recognize that regular insulin is more potent than intermediate insulins?
it has a lower starting dose than the insulin forms patients are normally on at home
What are the intermediate acting insulin suspensions used at home?
-vetsulin
-prozinc
-NPH
-glargine 100
What are the long acting insulin solutions used at home?
-glargine 300
-degludec
What can be added to insulin to slow the onset and prolong duration?
-zinc
-arginine-rich protein protamine
-zinc and protamine
What happens after an insulin suspension is injected SQ?
-zinc diffuses away and/or protamine is slowly degraded
-insulin crystals slowly deprecipitate
-insulin dimers and monomers are released into blood
What is the main advantage of insulin suspensions?
there are FDA approved options for dogs and cats
What is the main disadvantage of insulin suspensions?
they must be resuspended through rolling/inversion/shaking before every dose; can lead to inconsistent resuspension and dosing inaccuracy
Why is it important that insulin solutions have low variability?
-very predictable within and between days; doses are more accurate
-can quickly dose escalate when combined with interstitial glucose monitoring
Why is it important that insulin solutions have a long duration of action?
many patients on these forms of insulin can be dosed just once a day
What are the characteristics of insulin concentration?
-denotes how many units are in each mL of insulin
-U40 is common in animal insulin; U100 in people
-syringes vary in number of units they hold
What are the characteristics of insulin pens?
-no/minimal pain
-easier for owners to use
-more accurate dosing
-not available for all insulin types
-only option for some insulin types (U300)
