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SA dx/tx > Canine Diabetes Mellitus > Flashcards

Canine Diabetes Mellitus Flashcards

1
Q

What are the causes of canine DM?

A

Immune mediated b cell destruction
Secondary to chronic pancreatic disease
Diestrus diabetes
Drug-related

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2
Q

Describe DM caused by immune mediated b cell destruction

A

Most common cause
Results in absolute insulin deficiency

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3
Q

Describe DM caused by secondary to chronic pancreatic disease

A

About 1/3 of cases
Persistent inflammation of the exocrine pancreas damages the islets
Islet loss results in essentially zero insulin secretion

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4
Q

Describe DM caused by diestrus

A

Also known as “canine acromegaly”
Progesterone in the diestrus phase triggers release of GH by mammary tissue
GH is a powerful antagonist to insulin
DM may be reversible if dog is spayed ASAP

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5
Q

Describe DM caused by drugs

A

Cyclosporine damages beta cells and impacts insulin sensitivity

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6
Q

Do dogs get obesity related DM?

A

No

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7
Q

Does steroid administration cause DM in dogs?

A

No

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8
Q

What breed of dog is notorious for diestrus diabetes?

A

Norwegian Elkhound

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9
Q

What is a dogs renal glucose threshold?

A

160-200 mg/dl

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10
Q

When do you see polyuria in DM patients?

A

When blood glucose is greater than the renal glucose threshold

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11
Q

What is the hallmark clinical signs of canine DM?

A

Sudden pu/pd/pp with rapid weight loss

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12
Q

What two diagnostics are needed to diagnose DM?

A

Glucosuria and hyperglycemia

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13
Q

What is seen on urinalysis of DM patients?

A

Glucosuria
Might have ketonuria
Often concentrated despite severe pu/pd
Might have UTI

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14
Q

What is seen on serum biochem of DM patients?

A

Hyperglycemia (usually over 300, rarely exceeding 600 mg/dl)
Hypercholesterolemia
Hypertriglyceridemia
Elevated ALP activity

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15
Q

Do dogs get stress hyperglycemia?

A

No

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16
Q

With hypercholesterolemia, hypertriglyceridemia, and elevated ALP, should you chase Cushings?

A

Not unless you have clinical signs

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17
Q

What electrolyte abnormalities are common?

A

Hyponatremia

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18
Q

What is notable about the CBC of DM patients?

A

Stress leukogram is expected
Anemia is not expected - suggests concurrent disease

19
Q

What does an elevated PLI suggest?

A

Pancreatitis

20
Q

What is the #1 goal of treatment?

A

A satisfied owner

21
Q

What are engineered insulins referred to as?

A

Insulin ______

22
Q

What are suitable first choice insulins for dogs?

A

Plan A = Lente
Plan B = Insulin Detemir
Plan C = NPH

23
Q

What is Regular insulin, its duration, and uses?

A

Human molecule
U100
Duration 4-6 hours
Used for DKA

24
Q

What is NPH, its duration, and uses?

A

Human molecule
U100
Duration 8-10 hours
Used in dogs BID

25
Q

What is Lente, its duration, and uses?

A

Porcine molecule
U40
Duration 10-12 hours
Used in dogs BID
Two peak formulation
Designed to blunt post-prandial rise
Comes in a pen system

26
Q

What is PZI, its duration, and uses?

A

Human molecule
U40
Duration 12 hours
Used in cats BID or SID
Dogs rarely do well on PZI

27
Q

What is Detemir, its duration, and uses?

A

Engineered
U100
Duration 10-12 hours
Potent - lower starting doses
Used in big dogs

28
Q

What is Glargine, its duration, and uses?

A

Engineered
U100
Duration >12 hours
Routinely used in cats BID

29
Q

What is Glargine U-300, its duration, and uses?

A

Engineered
U300
Duration >12 hours
Slow release can be helpful in some patients

30
Q

What is the starting dose of Lente and NPH?

A

0.25 U/kg BID

31
Q

What is the starting dose of Insulin Detemir?

A

0.1 U/kg BID

32
Q

What is the issue with Insulin Detemir?

A

Hard to dose in small dogs

33
Q

Why should you not aim for optimal control in the 1st dose of insulin?

A

Stress of illness will antagonize insulin, relationship with insulin will change, insulin becomes more powerful after a few doses

34
Q

What should your initial approach be for the first dose of insulin?

A

Administer the first insulin dose and feed in the morning
Measure BG every 2 hours for 8-12 hours
If BG remains >150 mg/dl send home on this dose
If BG goes <150 mg/dl, decrease the dose by 10-25%
If possible, re-monitor response
Repeat BGC in 1 week

35
Q

What should you feed DM dogs?

A

A complete and balanced diet low in simple sugars
Equal sized meals twice daily at the time of each insulin injection
Consistency is key

36
Q

What can help improve insulin efficacy after each meal?

A

A short 15-30 min walk

37
Q

When should you recheck the patient if not using a continuous interstitial monitor?

A

Every 1-2 weeks for the first month

38
Q

When should you recheck with a dosing change?

A

Within 2 weeks

39
Q

When should you recheck in the clinic if everything is going well?

A

Every 3 months

40
Q

Treat the …

A

Patient, not the numbers

41
Q

How should you record a blood glucose curve?

A

Test BG every 2 hours until next dose of insulin
Repeat BG within 1 hour if any glucose value is <100 mg/dl

42
Q

What is the nadir target for DM dogs?

A

100-150 mg/dl
Ok to get close to 80 mg/dl in stable patient

43
Q

When should you adjust the dose?

A

If nadir is:
<100 mg/dl decrease insulin by 25%
>150 mg/dl increase insulin by 10%
100-150 and average glucose is <250 mg/dl = no change
100-150 and average glucose is >250 mg/dl
nadir is <6 hours after insulin = change to longer acting insulin
nadir is >10 hours after insulin = change to shorter acting insulin

44
Q

How many doses can a client skip?

A

One

SA dx/tx (26 decks)

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