Diabetes Mellitus

Question 1

What is the definition of Diabetes?

Answer 1

Clinically SIGNIFICANT insulin intolerance

Question 2

what is type 1 diabetes mellitus?

Answer 2

Normal insulin sensitivity and islet underactivity

In dogs normally due to an immune mediated destruction of the islets

This is the case for most diabetic dogs

Question 3

What kind of diabetes do dogs normally get?

Answer 3

Diabetes due to absolute insulin deficiency (type 1)

Question 4

What is type 2 diabetes melitus?

Answer 4

Insulin resistance which initially leads to islet hyperactivity then islet underactivity as the islets become exhausted

Common with cats

Question 5

Which species generally has variably reversible insulin deficiency?

Answer 5

Most diabetic cats

Commonly due to obesity, HAC or hypersomatotrophism

Question 6

Which species generally has absolute insulin deficieny due to decreased islet number?

Answer 6

dogs

Question 7

What is insulin resistance?

Answer 7

Decreased insulin activity leading to increased insulin secretion

Question 8

What are the causes of insulin resistance?

Answer 8

Pregnancy, oestrus, obesity

Hormonal abnormalities (HAC, hypo/hyerthyroidism)

Decreased exercise

Illness

Hyperglycaemia

Increases in plasma NEFA concentration due to lipid disorders or other high levels of lipids

Pancreatitis

Idiopathic

Question 9

How do you measure Pancreatitis? (in cats)

Answer 9

fPLI in the blood. On avergae higher in diabetic cats

Question 10

What kind of diabetes does hypersomatotrophism cause?

Answer 10

Type 2

Question 11

What do you generally measure to establish the presence of hypersomatrophism in cats?

Answer 11

IGF-1

Growth hormone plus Insulin –> IGF-1

Note IGF-1 probably not raised if insulin not present but GH not a good thing to measure as pulsatile secretion

Question 12

What proportion of diabetic cats in the UK suffer from acromegaly?

Answer 12

1 in 4

Question 13

What proportion of acromegalic cats have the classic phenotype?

Answer 13

1 in 4

Question 14

Do all obese cats get diabetes?

Answer 14

Nope, need beta cell dysfunction as well

Genetic component?

Question 15

What is the main age group for diabetes in dogs?

Answer 15

7-12 years

Question 16

Why are females represtented more than males?

Answer 16

Because they get diestrus related diabetes. Increased progesterone –> Increased growth hormone at site of mammary gland –> insulin resistance

Question 17

Is obesity a risk factor in the dog?

Answer 17

Not really no, they mainly get type 1

Question 18

Which breed is most predisposed to diabetes?

Answer 18

Samoyed

Question 19

What factors increase your chance of getting diabetes if you’re a cat?

Answer 19

Age, mostly over 10, obesity (3-5x increased risk), Neutering (2x increased risk) males (1.5x increased risk)

Question 20

Which breed is over-represented in cat diabetes?

Answer 20

Burmese (2.3% get it)

Tend to get it when they’re older. If they have it their offspring have a 10% chance of getting it! Genetic component

Question 21

What are the main clinical signs of an animal with diabetes mellitus?

Answer 21

Weight loss with increased appetite, polydipsia, polyuria, possibly decreased activity, depression

Will only have inappetance if has another disease as well or ketoacidosis.

Normal diabetes mellitus shouldn’t cause decreased appetite

Question 22

If a diabetes patient has ketones in the urine what does this mean?

Answer 22

They have ketosis, doesn’t necessarily mean they are ketoacidotic

“Sad” diabetics (those with ketoacidosis) have ketonuria AND acidosis.

Those with ketoacidosis will be V+, D+, dehydrated and in a bad way

Question 23

Which species can have cataracts associated with diabetes?

Answer 23

dogs

NOT cats

Question 24

Are all diabetic cats obese?

Answer 24

Nope, some have no history of obesity

Question 25

Why might you get ataxia with diabetes?

Answer 25

Diabetes can cause diabetic neuropathy

Question 26

Which species is mot likely to get stress hyperglycaemia?

Answer 26

Cats! get it with illess and stress

Question 27

What are the clinpath changes you'd expect to see in a diabetic animal?

Answer 27

Fasting hyperglycaemia Fasting hyperlipidaemia Glucosuria +/- ketonuria +/- Metabolic acidosis Altered potassium and phosphate Elevated ALP and ALT Elevated fructosamine and glycosylated haemoglobin

Question 28

What does fructosamine represent?

Answer 28

Albumin with glucose irreversibly bound When albumin is stable it represents average blood glucose over the last 3 weeks (ish) hence can be used to monitor diabetic patients

Question 29

What wil happen to fructosamine levels if there is low albumin?

Answer 29

The fructosamine levels will drop, not related to how much glucose there is!

Question 30

Why do cows get ketosis?

Answer 30

Because they are in a negative energy balance, high glucose demand leads to NEFA --\> ketone synthesis in the liver. Seen with a LOW blood sugar level.

Question 31

What are the six principles/methods of diabetic treatment?

Answer 31

Correct underlying causes Oral hypoglycaemic agents Insulin preparation Daily dose & dose frequency Amount and type of food Insulin and meal times

Question 32

Is feline diabetes generally reversible?

Answer 32

Yes, by working on the acquired factors eg reduce abdominal fat, increase activity etc

Question 33

How long do you nee to have hyperglycaemia for before histological abnormalities in the pancreas are evident? (Glucotoxicity)

Answer 33

Around 2 weeks Includes glycogen deposition and cell death

Question 34

Why should you treat cats asap?

Answer 34

The greater the duration and degree of hyperglycaemia, the more severe the damage

Question 35

What is the danger of aggressive diabetic treatment?

Answer 35

Hypoglycaemia

Question 36

WHat are the three general ways we improve the state of diabetes?

Answer 36

Decrease demand for insulin, Increase sensitivity for insulin, Increase Insulin availability

Question 37

If you have a female entire diabetic bitch, when should you neuter?

Answer 37

ASAP, no point trying to wait until diabetes is stable as will be intisically unstable until she is neutered!

Question 38

What are Sulphonylureas?

Answer 38

They are oral hypoglycaemic agents (the only ones proven to be potentially useful in dogs and cats)

Question 39

Why are oral hypoglycaemic agents not ideal

Answer 39

They are like red bull for the islets. Allow compensation for a while but burn out the islets quicker and you need total exogenous insulin sooner. Not really useful for dogs as their problem is because many of the islets destroyed. Only potentially useful for cats if it's a situation of put them on it or euthanise, will not inject.

Question 40

What is the most common sulphylurea agent used in animals?

Answer 40

Glipizide

Question 41

How long after feeding is the glucose peak?

Answer 41

Around half an hour

Question 42

How long does it take the insulin injected to take effect?

Answer 42

Around 2 hours

Question 43

What is the only licensed insulin for dogs and what species is it derived from?

Answer 43

Caninsulin. Porcine derived

Question 44

How many times do you generally have to inject cats and dogs daily?

Answer 44

BID (twice daily)

Question 45

Most insulin preparations last longer or shorter in cats?

Answer 45

shorter (but variable)

Question 46

Why is Detemir difficult to use in small dogs?

Answer 46

Very potent - small change in dose = big change in impact

Question 47

Why should you rotate injection sites?

Answer 47

Causes inflammation and fibrosis at site which will alter absorption of the insulin

Question 48

How should you go about monitoring response to treatment in diabetic animals?

Answer 48

Ask owner about water intake, polyphagia and measure weight Clinical picture is very important Glucose curves (every 2 hours for 12 hours once settled on insulin dose) Fructosamine good for telling you average but bad for detail. One off glucose measurement NOT sufficient for dose change; levels fluctuate

Question 49

What should you do to calories in diabetic animals?

Answer 49

Give normal calorie requirement i.e. 60-80 kcal/kg

Question 50

What kind of fat content should you have in diabetic food?

Answer 50

moderate

Question 51

What levels of carbohydrates should you have for diabetic cats?

Answer 51

LOW levels of carbohydrates - better control and increased remission

Question 52

Is there a proven specific diet that's best for diabetic dogs?

Answer 52

NOPE! Just that it is palatable to the dog and will therefore be eaten reliably. If there's another disease that has a specific diet prioritise this

Question 53

What kind of insulin should you give a dog and how often?

Answer 53

Lente insulin (eg caninsulin) about 12 hours apart

Question 54

If the glycaemia values look perfect but owner reports wobbly cat, should you worry?

Answer 54

YES! hypoglycaemia

Question 55

Do you get remission in dogs?

Answer 55

Not in a classic type 1 case, may be reversible if due to HAC, diestrus related etc

Question 56

What are the reported remission rates in cats?

Answer 56

25-50%

Question 57

How regularly should you monitor cats with diabetes if you're trying to get them into remission?

Answer 57

Every 12-24 hours, but don't change the dose this frequently! Animal insulins are more longer acting than those that suggest daily dose change protocols in humans

Question 58

How quickly should you reduce the insluin dose once remission achieved?

Answer 58

Don't be in a hurry Reduce by 05 - 1 mg every few days then to once daily dosing - 1 mg/cat/24h check glucose evvery 12 hrs post insulin only stop insulin totally if euglycemic at 12hrs Continue low carboydrate diet

Question 59

Does the dose tend to increase or decrease in dogs?

Answer 59

Increase tend to stabilise at around 0.75units/kg/12h Need consistent diet

Question 60

What do you start cats on as a starting dose of insulin?

Answer 60

About 1 unit/cat/12h Will end up probably on around 2 units/cat/12hr

Question 61

What drug would you give to an animal that comes in with ptonic clonic seizure?

Answer 61

Place catheter and give midazolam/diazepam

Question 62

True or false, hypoglycaemia can cause a seizure AND a seizure can cause hypoglycaemia?

Answer 62

true

Question 63

Is it easy to get hypoglycamia from fasting?

Answer 63

Nope, need to be fasting for very long time before you will get hypoglycaemia

Question 64

How badly would the liver need to be damaged to give you hypoglycaemia? (due to liver damage)

Answer 64

Very damaged, needs to be in failure

Question 65

What is a stress leukogram?

Answer 65

Lymphopenia, netrophila, monocytosis Occurs due to raised cortisol. If fitting and this is absent think addisons.

Question 66

What does normal insulin levels in the presence of hypoglycaemia suggest?

Answer 66

Unregulated insulin secretion, if hypoglycaemic, should be shutting down insulin secretion, not chucking out normal amounts.