Term
| What is Type I Diabetes? describe the physiology behind it. |
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Definition
-absolute insulin deficiency
-desctruction/loss of beta-cells |
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Term
| What kind(s) of dog is commonly affected by Type I diabetes? |
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Definition
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Term
| What is Type 2 Diabetes? Describe the physiology behind it. |
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Definition
-relative insulin deficiency/insulin resistance
-usually requires exogenous insuling |
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Term
| What domestic species is most commonly affected by Type 2 diabetes? |
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Definition
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Term
| Is transient diabetes mellitus common or uncommon? Is it reversible? What are some of its causes? |
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Definition
-uncommon
-may be reversible
-Causes: diestrus in the bitch, glucocorticoids, pancreatitis |
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Term
| Describe the etiopathogenesis of DM. |
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Definition
-immune-mediated
-genetics
-pancreattis, chronic
-obesity
-insulin-antagonistic diseases
-insulin-antagonistic drugs |
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Term
| Describe the typical signalment seen with DM. |
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Definition
-older, obese
-females > males
-Breeds: Keeshond, terriers, mini Schnauzers, poodles, beagles |
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Term
| What are the the hallmark clinical signs of DM in the dog? What is the nickname for this combo of clinical signs? |
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Definition
-PU/PD
-polyphagia: satiety center requires insulin for glucose uptake
-weight loss: starvation in the face of plenty
-called the "Diaetic Triade" |
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Term
| In addition to the Diabetic Triad, what else might you seen on physical exam of a canine DM case? |
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Definition
-cataracts: 75% within the first year
-Hepatomegaly: vacuolar hepatopathy
-Delayed wound healing
-Concurrent infections |
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Term
| How do we diagnose DM in a dog? What results are we looking for? |
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Definition
-Fasting hyperglycemia + glucosuria
-In only hyperglycemia: postpradial (dog) or stress (cat)
-If only glucosuria: proximal renal tubular dz (Fanconis syndrome) or artifact |
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Term
| What other diagnostics do we run on a canine DM case? |
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Definition
-CBC: stress leukogram
-serum biochem
-UA
-bacterial urine culture & sensitivity: even if inactive sediment
-BP |
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Term
| What will we see on serum biochem for DM in the dog? |
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Definition
-inc glucose
-inc cholesterol and triglycerides
-inc liver enzymes |
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Term
| What do we see on UA for DM in the dog? |
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Definition
-glocosuria
-+/- ketonuria
-/+j pyuria, bacteriuria, hematuria |
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Term
| What are the 4 primary goals of canine DM management? |
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Definition
1) minimize clinical signs
2) avoid hypoglycemia
3) prevent or slow cataract formation (less important)
4) prevent, detect, and treat complications (DKA, UTI, HBP) |
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Term
| What is arguably the most important aspect of treatment of canine DM? |
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Definition
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Term
| What are the components of client education in a canine DM case? |
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Definition
-goasl of therapy
-how to handle and administer insulin
-signs of poor glycemic control
-signs of hypoglycemia
-takes time to get drugs right, cost money, reckecks often, there is a lot to ask of the owner that needs to be relayed cause they will be suprised at the cost of everything |
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Term
| Describe the diet we use for DM in dogs. |
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Definition
-consistent caloric intake and feeding schedule
-high fiber, complex carbs, low fat: slow absorption fo glucose and slow spike |
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Term
| What are our diet goals with canine DM? |
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Definition
-minimize postprandial glucose spikes
-help manage obesity
-delay GI transit time
-science diet w/d, Purina OM or DCO |
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Term
| What changes do we make in regards to exercise for dogs with DM? |
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Definition
-consistent in duration and intensity
-consistent time of day
-promotes weight loss
-lwoers blood glucose: inc mobilizaiton insulin at injection site |
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Term
| What are our considerations for canine insulin? |
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Definition
-Origin: Human recombinant, beef similar to feline but not on markey, pork similar to canine and on market
-availability
-cost: expensive
-inherent pharmacologic props |
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Term
Describe short-acting insulin in regards to the following information:
a) Onset
b) Peak
c) Duration
d) Species in which it is used |
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Definition
a) 10-30 m
b) 0.5-2h
c) 1-4h
d) any |
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Term
Describe intermediate insulin in regards to the following information:
a) Onset
b) Peak
c) Duration
d) Species in which it is used |
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Definition
a) 0.5-3h
b) 2-10h
c) 6-16h
d) dogs |
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Term
Describe long-acting insulin in regards to the following information:
a) Onset
b) Peak
c) Duration
d) Species in which it is used |
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Definition
a) 1-8h
b) 4-16h
c) 6-28h
d) cats |
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Term
| What product is our typical short-acting insulin? |
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Definition
| -Regular Insulin: ______ R |
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Term
| What product is our typical intermediate insulin? |
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Definition
| -Neutral Protamine Hagedorn (NPH): _____ N or Porcine Insulin Zinc Suspension (veterinary approved) |
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Term
| What product is our typical long-acting insulin? |
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Definition
-Protamine Zinc Insulin (veterinary approved)
-Insulin Glargine or Detemir |
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Term
| What are the routes of administration for regular insulin, Humulin R? |
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Definition
-IV (CRI), SQ, IM
-duration of 1-4 h |
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Term
| What is Vetsulin? Which species is it approved for? Duration? Which syringe? |
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Definition
-porcine insulin zinc suspension
-35% amorphous & 65% crystalline
-dogs
-duration approx 14h
-U40 |
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Term
| What is Neutral Protamine HAgedorn? Duration? Onset? Peak? Which syringe? |
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Definition
-Recombinant Human Protein: Humulin N or Novolin N
-Duration: 6-10 h
-Onset: 0.5 - 3h
-Peak 2-10 h
-U100 syringe |
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Term
| Which syringe do veterinary insulin products come in? Examples? |
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Definition
-U40
-Vetsulin and ProZinc |
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Term
| Which syringe do human insulin products come in? Examples? |
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Definition
-U100
-NPH, Glargine, Detemir, etc |
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Term
| True or FAlse: WE can use tuberculin syringes in the place of insulin syringes. |
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Definition
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Term
| When do we administer intermediate-acting insulin? |
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Definition
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Term
| How do we store insulin when it isn't in use? How long does a bottle last? |
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Definition
-refrigerator
-vial should last at least 4 months
-roll/invert insulin bottle |
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Term
| Where do we tell clients to inject insulin? |
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Definition
-lateral thorax
-lateral abdomen
-rotate sites |
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Term
| Where do we tell clients NOT to inject insulin? |
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Definition
-more connective tissue
-variable absorption |
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Term
| How do we monitor glycemic control? |
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Definition
-Glucosuria, Urine Strips
-Glucose Curve, Fructosamine
-Clinical signs, Body weight |
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Term
| What should we have the owner log at home to monitor the animal's condition? |
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Definition
-degree of polyuria
-food consumption
-general attitude
-signs of hypoglycemia
-glucosuria or ketonuria |
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Term
| When do you recheck a canine DM case? |
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Definition
-7-10 days
-record BW, review owner's log, ask about clinical signs, serial blood glucose curve |
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Term
| How do we do a glucose curve? |
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Definition
-Nadir: lowest glucose, peak effect of insulin, related to insulin dose
-Duration: time that glucose is in target range, related to type of insulin
-Differential: Glucose difference from start to nadir, related to both dose and type of insulin |
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Term
| What are the goal glucose ranges for dogs and cats? What is the goal nadir? Goal glucose differential? |
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Definition
-Glucose range: Dog = 80-200 mg/dl & Cat = 80-300 mg/dl
-Nadir: 80-150 mg/dl halfway through dosing interval
-Glucose differential > 100-150 mg/dl |
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Term
What could the following issues on a glucose curve indicate:
a) nadir too high
b) nadir too low
c) duration too short or too long
d) inadequate differential |
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Definition
a) usually under dosed
b) usually over dosed
c) likely wrong type of insulin
d) many reasons possible |
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Term
| What is somogyi caused by? How does the body react? What do we do? |
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Definition
-overdose of insulin
-counter-regulatory hormones react to this and cause insulin resistance and hyperglycemia
-dec dose by 25-50% and may need longer acting insulin |
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Term
| What are the possible causes of an inadequate differential? |
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Definition
-improper administration
-improper handling: hsaking vial
-imroper storage: not stored in refrigerator or too hot (left in car)
-significantly under dosed
-somogyia already occuring
-insulin resistance |
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Term
| So we ever increase our insulin dose based on a spot check? |
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Definition
-NO, NEVER
-hypoglycemia is the only valuable informaiton we get from spot checks |
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Term
| Where on the dog do we use a glucose monitor? |
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Definition
| -ears, lip margin, or foot pads |
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Term
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Definition
| -glycated proteins (primarily albumin) that have irreversible binding of glucose |
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Term
| What does an elevation in fructosamine indicate? What action does it indicate? |
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Definition
-indicates poor glycemic control
-need to perform glucose curve: will not differentiate b/n insulin under dose, short duration, and somogyi |
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Term
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Definition
-Continuous glucose monitoring system
-measures interstital glucose every 5 min up to 72 hours |
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Term
| Can we use urine glucose strips as a stand alone test? HOw do we use them? What do they indicate? |
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Definition
-no
-multiple times in same day once weekly
-if always glucosuria = poor control & if never glucosuria = may be overdosed |
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Term
| Describe long-term canine DM management if no clinical signs? |
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Definition
-Fructosamine or glucose curve
-every 2-4 months initially, then every 4-6 months |
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Term
| Describe long-term management of canine DM if clinical signs. |
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Definition
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Term
| Where do we start when we realize a dog has DM? |
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Definition
| -intermediate acting insulin twice daily |
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Term
| What do we do at an initial canine DM recheck? |
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Definition
-clinical signs trump numbers!!!!!
-dosace inc by 25%
-resist the urge to spot check
-don't reassess for at least a week |
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