What are the major risk factors for diabetes mellitus in dogs?
What medications predispose dogs to diabetes mellitus?
A 7 year old 4kg Yorkshire Terrier named Bugsy presents for eating and drinking more, and urinating a lot. The owner states that even though the dog is eating more than normal, he seems to have lost weight. You do a quick urinalysis and find 3+ glucose in the urine and 2+ ketones. What is an estimated blood glucose in this patient?
Greater than 200mg/dL
*If there is glucose in the urine, the BG is above the renal threshold of 200mg/dL in dogs.
Why did Bugsy have ketonuria?
Increased fat metabolism due to inability to use carbs/sugar for energy.
You would like to take blood samples on Bugsy to confirm your suspicion of diabetes mellitus and rule out other diseases. What test should you do before taking a blood sample?
*Many diabetics are hypertensive.
Why is it important to send a urine culture on all diabetic patients?
20% have an occult UTI
Lab results are back on Bugsy!
CBC: stress leukogram
Chem: increased Glu, Chol, Trigly, ALP, ALT
Urine C&S: numerous Gram neg rods
What is your diagnosis for Bugsy?
What are the treatment goals for diabetic dogs?
Lower BG below renal threshold
Stop progression of concurrent diseases (cataracts)
Avoid significant hypoglycemia
Bugsy is ready to start insulin. What dosage will he be started at?
0.25 U/kg for most insulins
*Detemir 0.1 U/kg
*Prozinc 0.2 U/kg
You have started Bugsy on 1U of insulin in the hospital and are checking a BG every 2 hours. At the end of the day, the nadir is 169mg/dL and you decide to send Bugsy home. When will you need to check another BG level?
*If controlled, discuss at-home glucose curves with the owner.
*If at any time the BG falls below 150mg/dL, decrease the dose by 10-25%, rounded to the nearest unit.
What are the 3 important things we need to know from a glucose curve?
Duration of the insulin
In patients whose BG level may be influenced by stress, what can you measure to get a more accurate depiction of the glucose levels over the past 2 weeks?
Why is strenuous exercise contraindicated in diabetics?
Can cause severe hpoglycemia
On the day of one of Bugsy's home glucose curves he is not eating well. Convinced he'll eat in a little while, the owner gives the whole insulin dose. The next glucose reading is high at 240mg/dL, and the readings continue to be high the rest of the day. Do we need to increase Bugsy's insulin dose?
No. Since he was not eating and received a full dose of insulin, we are probably seeing the Somogyi effect. When Bugsy's BG dropped too low after his injection, a stress response was stimulated. Cortisol, epinephrine and glucagon were released, producing a rebound hyperglycemia.
*This can last up to 24 hours in dogs and 72 hours in cats
Patients who become hypoglycemic while on insulin therapy, and do not have clinical signs, will need their insulin decreased by _____%.
Checkers, a diabetic patient who was recently started on insulin therapy, comes in with sudden altered behavior, muscle twitching, ataxia, and bumping into things. You check a BG and it is low at 70mg/dL. How should the insulin dose be aadjusted?
Decrease by 50%
Check BG after next dose.
While you have Checkers in the hospital, how will you treat his hypoglycemia?
50% Dextrose diluted with saline at a 1:2 ratio
IV @ 0.5-1 ml/kg
Feed and monitor. Can use dextrose CRI if necessary.