Diabetes of the dog

Question 1

What cells are produced at the islet of Langerhans?

Answer 1

A: glucagon
B: insulin
D:somatostatin
F: Pancreatic polypeptides

Question 2

Hypoglycemic counter-regulatory hormones

Answer 2

Epinephrine
Cortisol
Glucagon
Growth Hormone

Question 3

Type 2 diabetes

Answer 3

Insulin resistance
Due to genetics, impaired insulin secretion, islet amyloid and environment (obesity)

Question 4

Type 1 diabetes

Answer 4

Genetics + immune system (juvenile)
Progressive and complete

Question 5

What defines DM in dogs?

Answer 5

Hyperglycemia
Glucosuria (renal threshold of glucose)
180-220 mg/dL in dogs

Question 6

Insulin dependent DM (IDDM)

Answer 6

All dogs
↓ insulin, no insulin release after glucose admin, need exogenous insulin
Reduction in size and # of B cells

Question 7

Non-insulin dependent DM (NIDDM)

Answer 7

Obesity-induced carb intolerance
Uncommon in dogs (hyperadrenocorticism)

Question 8

Signalment for DM

Answer 8

4-14y (peak @ 7-10y)
Female > male

Question 9

Juvenile DM

Answer 9

Rare and concurrently exocrine pancreatic insufficiency
2-6m of age
shepherds, keeshounds

Question 10

CS of DM

Answer 10

PU/PD/PP
WL with good appetite
Cataract, KCS
Thinning/ unkempt haircoat, hepatomegaly, m weakness and lethargy

Question 11

Chemistry of DM

Answer 11

Hyperglycemia, -cholesterolemia, -trygliceridemia
Lipemia, ↑ ALT and ALP

Question 12

Urinalysis of DM

Answer 12

Glycosuria
Variable ketonuria
Proteinuria and bacteriuria (UTI)
USG <1.025

Question 13

Diagnostic testing of DM

Answer 13

Frutosamine (average glucose over 2w)
Glycosylated hemoglobin (A1C)

Question 14

DDX for hyperglycemia glucosuria or insulin resistance

Answer 14

Hyperadrenocorticism
Hypersomatotropism (acromegaly)
Pancreatitis
EPI
Fanconi syndrome (glucosuria only, normal blood glucose)

Question 15

Insulin components

Answer 15

Amphorus: soluble, short- acting component
Cystalline: less soluble, long acting

Question 16

Short-acting insulin

Answer 16

Regular insulin (Humulin R or Novolin R)
Lispro (humalong) and Aspart (novolong)- human

Question 17

Regular insulin

Answer 17

Given IV, IM, SC
Used to tx DKA in vet med
Onset of action 10-30 min
Duration of action 3-10hrs, depending on route

Question 18

Intermediate- acting insulin

Answer 18

NPH (Humulin N or Novolin N)
Porcine origin Lente (vetsulin)
PZI insulin

Question 19

NPH

Answer 19

Contains protamine and zinc to delay absorption of insulin
Recombinant human DNA tech (preventing antiinsulin abs)

Question 20

Porcine origin Lente (vetsulin)

Answer 20

K9 and porcine insulin have identical aa sequence (eliminates antiisulin abs)
35% amorphous and 65% crystalline

Question 21

PZI insulin

Answer 21

ProZinc= protamine zinc recombinant human insulin
More consistently absorbed and long duration than NPH cats

Question 22

Glargine (long lasting)

Answer 22

Produced by recombinant DNA tech using E. coli
Results in delayed, prolonged, constant absorption of insulin

Question 23

Insulin Detemir (levemir)

Answer 23

Long-acting, recombinant insulin analogue
Slow absorption and long effect due to fatty acid modification → binds reversibly to albumin

Question 24

When would you use insulin detemir

Answer 24

Bigger dogs who aren’t regulated using other insulin types

Question 25

Basal insulins

Answer 25

Long duration of action Insulin gargine (Toujeo) Insulin degludec (tresiba)

Question 26

Goals of therapy

Answer 26

Don't make your patient hypoglycemic Elimination of CS

Question 27

Dietary Therapy

Answer 27

Reduce weight in overweight or obese animals Complex CHOs, moderate to high fiber (controls hyperglycemia)

Question 28

What causes poor glycemic control in stable diabetics (physiologically)

Answer 28

UTI (most common cause) Hyperadrenocorticism Pancreatitis Neoplasia bacterial pyoderma, otitis

Question 29

What causes poor glycemic control in stable diabetics (owners)

Answer 29

Old insulin Inappropriate handling or administration Insulin ab development (rare)

Question 30

Complications of DM

Answer 30

Poor glycemic control in stable diabetics KCS Diabetes induced cataracts (>60%): uveitis, synechia, glaucoma