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SA dx/tx > Feline Diabetes Mellitus > Flashcards

Feline Diabetes Mellitus Flashcards

1
Q

What type of cats are at increased risk?

A

Older, indoor, male cats

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2
Q

What are the causes of DM in cats?

A

Sustained insulin resistance
Secondary to chronic pancreatic disease
Dietary influences

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3
Q

What cat breeds are predisposed to DM?

A

European and Australian Burmese cats

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4
Q

What causes insulin resistance in cats?

A

Obesity
Lack of exercise and poor muscle mass
Endocrinopathies
Drugs
Inflammatory conditions

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5
Q

How does obesity cause DM in cats?

A

4x increased risk
Number 1 cause of insulin resistance
Related to adipokines produced by fat cells
Inflammatory condition

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6
Q

What endocrinopathies contribute to DM in cats?

A

Hypercortisolism
Hyperthyroidism
Acromegaly

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7
Q

How does acromegaly cause DM in cats?

A

Growth hormone secreting pituitary tumor
GH is a very powerful antagonist to insulin

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8
Q

What drugs can cause DM in cats?

A

Glucocorticoids (prednisolone, DepoMedrol) and progestagens (Megestrol acetate)

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9
Q

How do inflammatory conditions cause DM in cats?

A

Cytokines antagonize the effect of insulin

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10
Q

How do inflammatory conditions cause DM in cats?

A

Cytokines antagonize the effect of insulin
Chronic inflammation

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11
Q

How does a poor diet cause DM in cats?

A

Incretins - specifically GLP1 have powerful trophic effects on beta cells
The best stimuli for the incretins in cats are fats and proteins
High carb diets are BAD
Diets with <14% of ME from carbs are recommended

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12
Q

How does insulin resistance occur?

A

More insulin is needed to get the job done
Amylin is co-secreted with insulin
Amylin is poorly soluble and gets stuck in the pancreas
Results in pancreatic amyloidosis
Causes progressive compromise to beta cell function

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13
Q

What BG causes glucose toxicity?

A

> 200 mg/dl

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14
Q

What happens when BG goes >200 mg/dl?

A

Diabetic neuropathy
Apoptosis of beta cells

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15
Q

What happens when BG goes >250 mg/dl?

A

Pu/pd

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16
Q

What is the renal glucose threshold in cats?

A

250 mg/dl

17
Q

What are the clinical signs of DM in cats?

A

Polyuria
Polydipsia
Polyphagia
Weight loss
Diabetic neuropathy
Causes of insulin resistance

18
Q

Does hyperglycemia in a cat = diabetes mellitus?

A

No, need to prove a persistent hyperglycemia

19
Q

What would you see in a urinalysis of a DM cat?

A

Glucosuria
Can have ketonuria
Often concentrated urine despite sever pu/pd
Could have UTI

20
Q

What would you expect to see on a chemistry of a DM cat?

A

Hyperglycemia
Hypercholesterolemia
Hypertriglyceridemia
Hyponatremia

21
Q

What is a serum fructosamine measurement for?

A

Amount of fructosamines is proportional to BG levels
Allows us a look back over the previous 1-2 weeks
Amounts are lowered by diseases that impact albumin turnover
Be careful for Somogyi overswing

22
Q

What is the #1 goal of treatment?

A

A satisfied owner

23
Q

What are suitable first choice insulins for cats?

A

Insulin glargine and PZI

24
Q

What is the starting dose of insulin for cats?

A

1 unit/cat BID or 0.25 U/kg

25
Q

What is the best option for monitoring?

A

BG measurements at home

26
Q

What is the Somogyi overswing?

A

Super low glucose, body causes glucose to skyrocket for about a day
Will miss a super low if using fructosamine - will show a high average

27
Q

Why is measurement of water intake unreliable?

A

BG generally >250 mg/dl before polydipsia occurs

28
Q

How should you go about adjusting the insulin dose?

A

Nadir <80 mg/dl = decrease the dose by 25-50%
BG 80-250 mg/dl all day = keep dose
Nadir >150 mg/dl = increase dose by 1/2 unit
Cat should be showing signs indicating hyperglycemia
Allow several days to see effect before increasing again

29
Q

What option might be effective when used once daily in cats and why?

A

Insulin glargine U-300
Strong concentration slows release from the SQ space

30
Q

What does SGLT-2 inhibitor do?

A

Prevent glucose uptake by the renal tubules
Lowers BG via urine loss

31
Q

When does remission most often occur?

A

Within the first 90 days

32
Q

What cats are unlikely cats for remission?

A

Steroid dependent
Chronic disease
Dietary issues
Peripheral neuropathy

SA dx/tx (26 decks)

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