Diabetes Mellitus in Dogs and Cats Flashcards

Question

How is a Maintenance/ Stabilizing Dose of Insulin done at home?

Answer 1

1) The following morning after Starting Dose is administered at the vet, urine glucose should be measured. If it is negative, this indicates the stabilizing dose can be lower than what was given as a Starting dose 2) Blood glucose is done once every 3 days at the vet, and timed for 4-6 hours post injection in the morning 3) Stabilization period takes 3+ weeks 4) Stabilization dose is reached when the same dose has been used for 3 consecutive measurements/ vet visits 5) Animal must then be monitored once every week for 3 weeks, then every 1-3 months note: this stabilization period is long and requires owner compliance Caution: cat owners need to be aware that remission is possible and they need to look out for signs of hypoglycemia

Answer 2

1) Daily blood glucose - Low (<3.5 mmol/L) - decrease insulin dose - Normal (3.5 - 8.0 mmol/L) stay the same - High (>8.0 mmol/L) - increase dose Adjust insulin dose on a daily basis 2) Stabilization period 10 - 14 days 3) Stabilization dose is reached when the same dose has been used for 3 consecutive measurements 4) Animal must then be monitored once every week for 3 weeks, then every 1-3 months note: rapid stabilization and no owner intervention needed

Answer 3

``` ~ 10% adjustment So, in: - Small dogs: 1-2 IU - Medium dogs: 2-4 IU - Large dogs: 4-6 IU ``` 25 - 30% adjustment if the animal is hypoglycemic!

Answer 4

- Owners opinion of control and quality of life - Animals weight - Blood glucose - Serum fructosamine concentration: high levels indicate high glycation and thus high glucose levels

Answer 5

Clinical signs are seen 3-5 weeks after estrus- correlating with peak progesterone levels and therefore GH concentrations

Answer 6

- Related to high blood glucose and accumulation of sorbitol and fructose - This attracts water into the lens, swelling and rupture of lens fibres and results in blindness

Answer 7

- Excessive insulin dose: too high a dose or accidentally injected twice by 2 different family members - Too little food/ not eating - Excessive exercise - Can be spontaneous too

Answer 8

- Hunger - Weakness - Lethargy - Confusion - Ataxia - Twitching - Convulsions - Coma

Answer 9

- corn syrup or maple syrup rubbed on the gums of the animal | Ensure no xylitol is in the product

Answer 10

- Cataracts: though this is almost inevitable to happen even in controlled diabetes! - Hypoglycemia - UTI's - Pancreatitis - Others: Diabetic neuropathy, Diabetic nephropathy and Systemic hypertension

Answer 11

14 - 16 mmol/L Above this and the kidneys are unable to reuptake all glucose, and therefore spillover occurs into the urine

Answer 12

- PU/PD - Polyphagia - Weight loss - Hepatomegaly - Poor haircoat - Plantigrade stance: representing a peripheral neuropathy

Answer 13

- Hematology: stress leucogram - Biochem: elevated cholesterol, ALP, ALT (not as marked as in dogs) and Glucose - Urinalysis: Glucosuria +/- ketonuria, UTI Caution: it is common in stressed cats to develop hyperglycemia and subsequent glucosuria Therefore definitive diagnosis requires one of the following: 1) hyperglycemia + glucosuria + ketonuria 2) persistent hyperglycemia + glucosuria: measured at home 3) hyperglycemia + glucosuria + elevated fructosamine

Answer 14

- Maximize the chance of recovery/ remission - Reduce hyperglycemia to prevent glucose toxicity: by doing this we will hopefully maximize beta-cell preservation and address any clinical signs - Reduce stimulus for endogenous insulin secretion by decreasing any insulin resistance: this will then decrease amylin toxicity/ amyloid deposition and prevents beta-cell exhaustion They differ from dogs because cats have a chance of going into remission and recovering fully

Answer 15

1) Insulin administration: porcine lente or human PZI (same as dogs) 2) dietary modification: low in CHO, high protein diet +/- high fibre if the cat is overweight (wet is preferred over dry) 3) Exercise if possible 4) Treat other illnesses/ complications

Answer 16

- UTI's - Peripheral neuropathy: platigrade stance = poor prognostic indicator - Don't tend to get diabetic cataracts, unlike in dogs

Answer 17

- Variable results: anywhere from 0% - 100% | - More likely to be closer to 50%

Answer 18

3 - 4 months, but can take longer

Answer 19

- Insulin - Diet - Target blood glucose concentration/ monitoring protocols - Individual factors of the cat e.g. genetics, obesity - Presence of acromegaly: acromegaly can be the cause of DM in 20-30% of cats. If the cat has acromegaly, the cat will NOT achieve remission unless the pituitary tumour is removed

Answer 20

1) Fructosamine levels: the lower the fructosamine level, the greater the chance of remission! 2) Neuropathy: suggests remission won't occur = plantigrade stance is a poor prognostic indicator 3) Age: remission increases as the cat ages, although this is counter-intuitive, it suggests that older cats are better adapted at dealing with the DM than younger ones

Answer 21

25 - 30% - most of these relapse cases have impaired glucose tolerance - Only 1/4 of cats that relapse will achieve a second remission

Answer 22

Yes, but it is very rare

Answer 23

- Adequate control of clinical signs - Majority of the day the glucose level is within the reference range but this is not always true - Control of fructosamine concentrations - Hypoglycemia does NOT occur - This does NOT mean normal glucose blood concentrations 24/7, it is alright to have peaks of mild hyperglycemia throughout the day

Answer 24

- Worsening or poor control of clinical signs - Inappropriately high levels of blood glucose - An increasing fructosamine concentration - A high insulin dose ( >2 IU/kg/injection) required - Development of ketoacidosis or hypoglycemia

Answer 25

1) Insulin factors: expiry date, heated, frozen, diluted, excessive dose, inappropriate syringe size (40 iu/ml or 100 iu/ml), poor absorption in the same injection spot (scar tissue = less absorbable), poor absorption from fat 2) Diet and exercise factors: diet changes or treats, or inconsistent exercise 3) Owner factors: insulin handling, insulin storage, injection technique, compliance, people forget to give, or end up double dosing 4) Individual animal factors: some intermediate-acting insulins end up having a shorter duration in animals, some animals are picky eaters 5) Undiagnosed concurrent diseases: obesity/ emaciation, hyperadrenocorticism or stress, metestrus, thyroid, acromegaly, pancreatitis

Answer 26

Only half the regular dose

Answer 27

Yes, but must be aware that they typically read lower than the actual glucose concentration (sometimes as much of a difference of 2-3 mmol/L) Ideally a vet designed one will give a more accurate reading AND require less blood in order to give a reading

Answer 28

An insulin dose that is too high may bring about the Somogyi effect or 'rebound hyperglycemia'. This is produced because blood glucose concentrations fall too rapidly. It is a life-saving response

Answer 29

1) Decrease insulin dose by 25-30% 2) Reassess in 3 days 3) Consider switching to twice daily insulin doses, instead of one 4) Adjust dose 5) Restabilize insulin requirement

Answer 30

Cat: obesity, hyperthyroidism, IBD, Pancreatitis, Acromegaly Dog: Obesity, UTI, skin disease, Hyperadrenocorticism, Acute Pancreatitis, Neoplasia, Hypothyroidism

Answer 31

- Insulin antibodies: switch to a different species of insulin - Poor absorption: switch type of insulin and injection site - Prolonged Somogyi: decrease dose and reassess

Diabetes Mellitus in Dogs and Cats Flashcards

(55 cards)