Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 17 > Approach to Diabetes Mellitus > Flashcards

Approach to Diabetes Mellitus Flashcards

1
Q

what is diabetes mellitus

A

a state of chronic hyperglycemia caused by abnormalities of carbohydrate, protein and lipid metabolism which may be due to either an absolute lack of insulin or to factors that oppose its action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the livers role in glucose metabolism

A

Involved in fatty acid synthesis

Glucose uptake

Glycogen synthesis

Gluconeogenesis

Ketogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the muslces role in glucose metabolism

A

Amino acid uptake

Protein synthesis

Glucose uptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the role of adipose tissue in glucose metabolism

A

fat synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the brains role in glucose metabolism

A

Insulin does not increase glucose uptake by brain or blood cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the factors that lead to insulin resistance (6)

A
  1. growth hormone
  2. glucose toxicity
  3. auto-antibodies
  4. cortisol

5. progesterone

6. obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are factors that can lead to islet cell exhaustion/destruction (4)

A
  1. immune mediated destruction
  2. pancreatitis
  3. islet cell amyloidosis
  4. insulin production increased
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does islet cell exhaustion/destruction lead to

A

insulin production reduced relative to requirement

which leads to diabetes mellitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the signalment of uncomplicated diabetes mellitus (3)

A
  1. any age (commoner in older animals)
  2. either sex: females more likely
  3. any breed: terriers?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are high risk breeds

A

Samoyed

Tibetan terrier

Carin terrier

Yorkshire terrier

Mini schnauzer

border terrier

mini poodle

border collie

CKCS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are low risk breeds

A

Cocker spaniel

Springer spaniel

Golden retriever

German shepherd

Boxer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the clinical history of uncomplicated diabetes mellitus (7)

A
  1. polyuria, polydipsia
  2. weight loss
  3. polyphagia
  4. weakness/exercise intolerance
  5. recurrent urinary tract infections
  6. blindness (in dogs with cataracts)
  7. recent estrus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the clinical signs of uncomplicated diabetes mellitus (5)

A
  1. bright and alert
  2. thin
  3. cataracts?
  4. neuropathies (plantigrade posture in cats)
  5. dermatopathies (hair coat may be sparse, hairs may be dry, brittle, and lustreless, scales from hyperkeratosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the ddx for PUPD (7)

A
  1. diabetes mellitus
  2. chronic renal failure
  3. hyperthyroidism (cats)
  4. hyperadrenocorticism (dogs)
  5. hepatic disease
  6. pyogenic infections
  7. hypercalcemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are ddx for weight loss (9)

A
  1. diabetes mellitus
  2. chronic renal failure
  3. neoplasia
  4. hepatic disease
  5. hyperthyroidism (cats)
  6. chronic infections
  7. maldigestion, malabsorption
  8. cardiac cachexia
  9. others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how do you confirm diagnosis of diabetes mellitus (2)

A
  1. urinalysis
  2. serum biochem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is seen in urinalysis of a diabetes mellitus patient (2)

A

Urine specific gravity is typically > 1.025

Glycosuria

Variable ketonuria

Proteinuria

Bacteruria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is seen on serum biochem of diabetes mellitus (4)

A
  1. Hyperglycemia: stress induced especially in some cats, some drugs
  2. Hypercholesterolemia
  3. Increased ALT
  4. Increased ALP
19
Q

what is seen on hematology with diabetes mellitus

A

Typically normal

Neutrophilic leukocytosis, toxic neutrophils if pancreatitis or infection present

20
Q

what are glycated blood proteins

A

fructosamines are glycated proteins that result from an irreversible, non enzymatic insulin independent binding of glucose to serum proteins

The extent of glycosylation is directly related to the blood glucose concentration

The higher the average blood glucose concentration during the preceding 2-3 weeks the higher the serum fructosamine is

Serum fructosamine is not affected by acute increases in the blood glucose concentration as occurs with stress, excitement etc

21
Q

how are diabetic patients stabalized

A
  1. diet
  2. exercise
  3. insulin
22
Q

what are the requirements of the success in managing diabetes mellitus

A
  1. owner compliance: the owner administers the treatment
  2. vet support: team approach, flexibility, practice documentation
23
Q

what are the available insulins

A

beef, pork, recombinant human

beef is closest to cat

pork is closest to dog

24
Q

what concentrations of insulins are available

A

40 IU/ml

100 IU/ml

25
Q

what are the types of insulins

A

soluble (short acting)

isophane

lente

PZI (long peak, long duration of action)

26
Q

what are the energy requirements of diabetes mellitus

A

obese animals: 70% of calculated requirement for target weight

thin animals: 100% for optimal weight

normal: 100% of calculated requirement

27
Q

what carbohydrates are in a diabetic diet

A

try to avoid simple sugars

complex CHOs: starches (slow digestion), dietary fibre (reservoir effect)

28
Q

what is the % ME of energy for canine diabetes mellitus

A

50-55% ME from complex CHOs

29
Q

what is the % ME of fat for canine diabetes mellitus

A

restricted <20% ME

30
Q

what is the % ME of protein for canine diabetes mellitus

A

moderate 14-30% ME

31
Q

what is the CHO content in feline diet for diabetes

A

Inefficient carbohydrate metabolism:

Glucokinase activity reduced

Preferential metabolism of glucose compared to fructose

Glucose is a weak stimulator of insulin secretion

32
Q

what is the main source of glucose in cats

A

gluconeogenesis from protein catabolism

arginine is stimulator of insulin secretion

33
Q

what is the % ME of protein in feline diabetes mellitus diet

A

50-55% ME protein

34
Q

what is the CHO content in feline diabetes mellitus diet

A

no simple and reduced complex CHOs

limited ability to digest starches

dietary fibre reduces palatability

35
Q

what is the one patient where you can potentially cure diabetes melllitus

A

intact female dog

should be spayed asap

36
Q

at what dose of lente insulin would you worry about insulin resistance

A

> 2 IU/kg

37
Q

how are clients to use urinalysis to monitor blood glucose levels

A

Can be helpful in dogs that have problems with recurring ketosis or hypoglycemia to identify ketonuria or persistent negative glycosuria

Client is instructed not to adjust daily insulin doses on the basis of morning urine glucose measurements except to decrease the insulin dose in dogs with recurring hypoglycemia and persistent negative glycosuria

Many diabetic dogs develop complications because clients were mislead by morning urine glucose concentrations and increase the insulin dose which results in insulin overdosing, hypoglycemia and glucose counter regulation

Persistent glycosuria throughout the day and the night suggests inadequate control the diabetic state and the need for more complete evaluation of diabetic control using other techniques

38
Q

how can diabetes mellitus be monitored (5)

A
  1. home records: urine glucose, ketones
  2. urination, thirst, appetite, demeanour
  3. hyoglycemic episodes
  4. clinical exam: weight, eyes
  5. biochem: frutosamines, blood glucose? curves?
39
Q

what are continuous glucose monitoring systems

A

How much glucose is in the skin is proportional to how much glucose is in the blood

40
Q

what is HbA1c

A

Glycated hemoglobin A1 in dogs:

41
Q

what would you do if DM dog isnt eating but is otherwise bright and happy

A

decrease insulin by 50%

if eats in next 2 hours can give remainder

remember the grazing do

if ill needs to come in

42
Q

how would you manage DM in surgery

A

Stabilize diabetes

Day of surgery:

1/2 insulin dose: no food

Operate early in day

Dextrose infusion

Feed 1/2 normal food as soon as able

Monitor blood glucose

43
Q

what are complications of DM

A

Failure to stabilize

Cataracts (dogs)

Ketoacidosis

Hypoglycaemia

Neuropathies (cats)

Module 17 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions