27. Diabetes mellitus in dogs and cats Flashcards

1
Q

Type 2 insulin dependent DM?

A

↓ Action of insulin → ↑ Blood glucose

TYPE-II (INSULIN-DEPENDENT) DM

↓ Secretion of insulin due to immune-destruction of pancreatic beta

cells, islet cell hypoplasia or pancreatic destruction

Dogs > Cats

Requires insulin injections

Pathogenesis: Autoimmune; Amyloidosis; Pancreatitis

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2
Q

Type 2 Non insulin dependent DM?

A

TYPE-II (NON-INSULIN-DEPENDENT) DM

Insulin resistance duet to diabetogenic hormones or obesity (cats)

Secretion of insulin is normal but is ineffective; Delayed response in

secreting insulin or the tissues are resistant

Cats > Dogs

Alternative case: NIDDM → Prolonged hyperglycaemia → Glucose

toxicity of pancreatic cells → Destruction → IDDM

Pathogenesis: Excess counterregulatory hormones; Obesity

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3
Q

Consequences of incr. C Glucose?

A

CONSEQUENCES OF ↑ EC GLUCOSE

↑ Blood glucose

§ Glucosuria → ↓ Blood K+, Na+ & PO4

-

§ IC Dehydration → Hyperglycaemic coma

§ Glycation of proteins → Cataracts; Retinopathy;

Peripheral neuropathy; Glomerulosclerosis

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4
Q

Consequences of decr. in IC Glucose?

A

CONSEQUENCES OF ↓ IC GLUCOSE

↑ Lipolysis

§ Ketonemia → Ketonuria; Acidosis; Ketoacidosis coma

§ Weight loss

§ Hyperlipidaemia → Fatty liver

↑ Gluconeogenesis → Protein synthesis → Weakness; Poor wound

healing; ↑ Susceptibility to infection

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5
Q

DM in dogs Clinical signs?

A

DM In Dogs

Predisposed

Middle/Old-aged dogs > Young dogs; Intact females

Poodle; Dachshund; Terriers; Beagle; Puli; Labrador retriever

CLINICAL SIGNS

Uncomplicated DM (Good prognosis)

§ PU/PD § Flaking skin

§ Weight loss § Cystitis

§ Dehydration § Cataracts

§ Hepatomegaly § Retinopathy

§ Dull coat § Paresis

Complicated DM (Poor prognosis)

All the above CSx, as well as…

CSx associated with diabetic ketoacidosis

§ Kussmaul breathing § Anorexia

§ Acetone-smelling breath § Vomiting

§ Lethargy § Coma

§ Weakness

CSx associated with hyperglycaemic hyperosmolar syndrome

§ Restlessness § Ataxia

§ Nystagmus § Convulsions

CSx associated with pancreatitis

§ Abdominal pain § Vomiting

§ Diarrhoea § Lethargy

CSx associated with EPI

§ Poorly-digested faeces § Flatulence

§ Foul-smelling faeces

CSx associated with Cushing’s syndrome: Acromegaly
§ ↑ Blood glucose

§ ↑ ALT; ↑ ALP ↑ ALKP

§ ↑ BUN/Creatinine

§ ↿⇂ K+

§ ↑ Amylase; ↑ Lipase; ↑ Cholesterol (lipaemia)

§ ↑ Progesterone; ↑ Cortisol; ↑ GH

§ Metabolic acidosis

Urinalysis

§ Glucosuria (>12 mmol/l)

§ Evidence of UTI; Bacteriuria – Sediment & culture

§ Ketonuria

Fasting hyperglycaemia

Blood glucose is measured on at least two occasions after >8 hours

of fasting

Fructosamine

↑ Levels; Used in cats as fructosamine levels are not affected by

stress hyperglycaemia

Differentiation of of Type-I & Type-II: IV glucose tolerance test

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6
Q

Diagnosis of DM?

A

DIAGNOSIS

History, physical exam & Lab. D

Abdominal US

§ Diffuse hepatomegaly § Cystitis

§ Enlarged adrenal glands § Ovarian cysts

§ Pancreatitis § Uterine cysts

§ Nephropathy

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7
Q

Treatment Insulin therapy?

A

TREATMENT - INSULIN THERAPY

Caninsulin

Half the dose of insulin in cases of anorexia or vomiting

Warn the owner of the CSx of hypoglycaemia:

§ Excitement § Tremor

§ Falling convulsions § Coma

§ Weakness

Blood glucose after 6 hours post-insulin = 4-9mmol/l

Treatment of hypoglycaemia: Put honey on the lips; Give an extra

meal; Skip the following insulin dose

Follow-up

§ Follow-up appointment within 2 weeks of starting

§ Once stable: Follow up appointments every 3-6 months

Potential complications

§ Hypoglycaemia (see above)

§ Somogyi effect (post-hypoglycaemic hyperglycaemia)

PU/PD; Hyperglycaemia

Requires a serial blood glucose measurement →

↓ Insulin dose

§ Stress-induced hyperglycaemia

§ Short action of insulin (insulin resistance)

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8
Q

Treatment- others?

A

TREATMENT – OTHERS

Ovariectomy: ↓ Risk of insulin resistance → ↓ Insulin demand

Diet

Composition and amount should remain constant

§ ↑ Protein; ↑ Fibre; Complex carbohydrates

§ 1 portion given a few minutes before each insulin dose

Treatment of ketoacidosis

§ Volume replenishment: Ringer + KCl

§ Regular (human) insulin – Hmge

§ K+ replacement

§ Bicarbonate therapy

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9
Q

DM in cats?

A

DM In Cats

More common in male cats

CLINICAL SIGNS

Good prognosis

§ PU/PD

§ Weight loss; Polyphagia

§ Cataracts

§ Neuropathy → Plantigrade posture of hind limbs

LAB. D

§ Hepatic lipidosis is more severe: ↑ TBr

§ Hypokalaemia

§ Hyperthyroidism: Baseline serum T4 or serum free T4

§ Stress hyperglycaemia

Often found in healthy cats

Rarely exceeds >16mmol/l

Glucose should be tested at home or the fructosamine levels should

be measured instead

TREATMENT – INSULIN THERAPY

Type-I DM

Glipizide; Glargine

↑ Insulin secretion → ↓ Blood glucose after 1-2 months

Type-II DM

Cats with Type-II DM may be manageable without insulin –

§ Diet (difficult to control in cats)

§ Exercise

§ Ovariohysterectomy

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