diabetes

Question 1

DM classification

Answer 1

type 1 (dogs)- immune mediated destruction of beta cells, insulin Ab
type 2 (cats)- insulin resistance (increased resistance-> decreased secretion (inflammation)

Question 2

DM C/S

Answer 2

Question 3

diabetes dx

Answer 3

persistent fasting hyperglycemia/glucosuria
CBC- can have neutrophilia
chem- hyperglycemia, high cholesterol, triglycerides, high ALP in dogs

UA- isosthenuria, glucosuria, evidence of UTI
fructosamine- high in cats (differentiates from stress hyperglycemia)

Question 4

diabetes tx

Answer 4

dogs: intermediate acting insulin (caninsulin 0.25-0.5IU/kg BID), or vetpen (two sizes)

cats: need long acting insulin
glargine (10-14h) 1-2IU/cat
prozinv- 1-3IU q12

other tx in cats: glipizide (not effective, supposed to stimulate insulin secretion)
bexacat- increases urine glucose excretion, early DM

Question 5

diabetic diet for dogs

Answer 5

higher fiber, feed q12 w/o treat
consider weight loss if fat
moderate fiber GI diet
normal adult diet if thin

Question 6

diabetic diet for cats

Answer 6

higher protein (carnivore)
consider weight loss first (lower carbs)

cats w CKD-> usually lower protein, aim for low phosphorus, maintain BCS

Question 7

diabetic monitoring

Answer 7

recheck in 1wk BG
3wks, 8wks C/S
12wks BW/UA
q3-6m

Question 8

BG curve terms

Answer 8

highest BG- before insulin (ideally <15)
nadir- lowest BG (5-7.8)
duration of action- time for insulin to BG >10-15, should be 10-12h

Question 9

BG curve interpretation

Answer 9

insulin dose: check nadir
<5- decrease by 0.5U/25-30%
>10: increase dose or
stress BG
somogyi effect
insulin resistance
5-9: no change if C/S and duration OK

if dose changes dont work check peak time (insulin to nadir)
<5h: change to q8, change type
5-8 continue w q12
>8 change to q24

duration of action
<8-10h longer acting insulin
10-12h continue
>12-14h change to q24 or shorter acting

Question 10

max insulin for dogs and cats

Answer 10

dogs: 2.2IU/kg, cats >1.5
insulin resistance-> consider other insulin and other tx

Question 11

transient DM/remission

Answer 11

15-30% of acts 4-6wks after tx
keep on weight control, diabetic diet
remission= 4wks without insuliny

Question 12

hypoglycemia

Answer 12

suppresses insulin secretion-> persistent hyperglycemia from counterregulatory hormones (somogyi)

Question 13

somogyi effect

Answer 13

rebound hyperglycemia from counterregulatory hormones