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49 Cards in this Set

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What are the major types of diabetes mellitus affecting small animals? Which animals are in each group?
Type 1 (insulin dependent; DOGS)
Type 2 (insulin deficient/resistant; CATS)
Type 3 (transient; either, rare)
What are some disease processes leading to insulin resistance?
Acromegaly
Hyperadrenocorticism
Hyperthyroidism
What are the 4 classic signs of diabetes mellitus?
Polydipsia
Polyuria
Polyphagia
Weight Loss
How does the cellular hypoglycemia in diabetes mellitus lead to PU/PD?
Low glucose in cells stimulates epinephrine/glucagon release which increases glucose, leading to glucosuria and osmotic diuresis.
How does DM cause ketoacidosis?
Lack of insulin stimulates lipolysis, resulting in more FFAs which are oxidized into ketones.
What effect does ketoacidosis have on electrolytes?
Ketones get in urine, act as an osmotic diuretic, and pull Ca, K, Mg, and Na into the urine. (Although you don't get hypocalcemia)
What is the formula for anion gap?
Anion gap = (K + Na) – (Cl + HCO3)
T or F:
Glucose concentration is a major contributor to plasma osmolarity.
False! Na and K are 40x more potent!
Osmolality (mOsm/kg) = 2(Na + K) + 0.05(glucose in mg/kg)
However, in hyperosmolar syndrome, glucose IS the biggest contributor 'cause it can exceed 1000 mg/dl
If a diabetic gets all dehydrated for some reason, what may occur? What signs would be seen?
Hyperosmolar DM;
Neuro signs and no ketoacidosis!
Why do cats get pancreatic amyloidosis?
Amylin is secreted along with insulin
Which of the following is NOT thought to commonly contribute to diabetes mellitus in dogs?
a) genetics
b) amyloid
c) adipokines
d) glucose toxicity
e) diet
b) amyloid
e) diet (the "carnivore connection")
What is the typical signalment for diabetes mellitus in the dog? The cat?
Dog (older female terrier, poodle, & etc)
Cat (older male Burmese)
In addition to the 4 major signs of DM, what else might be commonly seen (there is a hint here....SEEN...like EYES) in the dog? What is the pathogenesis of this?
CATARACTS!!!
Fructose and sorbitol get stuck in the lens!
In addition to the 4 major signs of DM, what else might be commonly seen in the cat? What is the pathogenesis of this?
Polyneuropathy
Fructose and sorbitol surround nerves, pull in water and cause demyelination
Why doesn't ketosis occur with hyperosmolar diabetes mellitus?
Pancreas produces a small amount of insulin
T or F:
Ketonuria doesn't necessarily mean that there is ketoacidosis.
True!
What is the target glucose level for a patient in diabetic ketoacidosis? How is this achieved?
Shoot for 75-250 mg/dl glucose
(1st stabilize pt w/fluids, start regular insulin and lower glucose 50mg/dl/hr until goal is reached)
What are the three components of monitoring DM therapy?
Clinical signs
Glucose curves
Serum fructosamine
If you're using a human glucometer on a dog, what fudge factor should you add or subtract?
add 30mg/dl to the measured value
What serum analyate can give an indication of glucose levels irregardless of stress levels?
Fructosamine levels! (normal values <350 mg/dL)

Yeah I said irregardless! I know its not a real word but who cares!?
T or F:
Glucose has little effect on urine specific gravity.
True!
4+ glucose only raises USG by 0.01.
T or F:
Diabetic remission rates are much greater in cats than in dogs.
True! 25 to 90% remission in cats (depending on the study and timeline)
T or F:
Some DM dogs can be treated by diet management only.
False! All dogs need insulin therapy!
Which of the following would be best used in sick patients?
a) humulin R
b) Lente insulin
c) PZI insulin
d) Glargine
e) Detemir
a) humulin R (short-acting insulin)
What are the ultra long-acting analogues? How are the dosages different?
Glargine
Insulin detemir (30% dosage of glargine)
T or F:
Dosing of insulin should be made on ideal, not actual body weight.
Tru dat!
When treating a stabilized dog for diabetes mellitus, which drug would probably be the best to start off with?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr
a) NPH; good to start off in the mid-range; may want to try Glargine/Detemir or PZIr later
When treating a stabilized cat for diabetes mellitus, which drug would probably be the best to start off with?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr
d) Glargine (or detemir)
Maybe PZIr
Which of the following is primarily used in cats?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr
d) Glargine (or detemir)
e) PZIr
Which of the following is least potent?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr
d) Glargine
Which of the following is insoluble at neutral pH?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr
d) Glargine
What is a dangerous possible side effect to adjusting insulin dosages too rapidly?
Samogyi phenomenon
What occurs in the Samogyi phenomenon?
Glucose gets REALLY low and cortisol, glucagon, epinephrine, and GH all ramp up, causing a compensatory hyperglycemia (often over 400 mg/dL)
What is the signalment for insulinomas?
Ferrets!!!
Also medium/large breed older dogs.
Rare in cats
Which of the following are congruent with insulinomas?
a) seizures
b) weakness/ataxia
c) hypoglycemia
d) vomiting
e) hypomagnesemia
a) seizures
b) weakness/ataxia
c) hypoglycemia
d) vomiting
What is the most consistent lab finding with an insulinoma?
HYPOGLYCEMIA
How can an insulinoma be diagnosed?
high insulin:glucose ratio
+ clinical signs;
Exploratory laparotomy
T or F:
A BAR animal shows high insulin and low glucose. Thus, insulinoma is very likely.
False!
insulin:glucose ratio has a poor specificity and this animal has no clinical signs.
Which hormones play major effects in the pathophysiology of insulinomas?
Insulin
Catecholamines
Glucagon
Which electrolytes are important to supplement when treating DKA and why?
K and P; insulin reduces K and P (remember refeeding syndrome???)
Describe the dextrose and insulin protocol in a patient with >250 mg/dl glucose.
Give insulin
No Dextrose
Describe the dextrose and insulin protocol in a patient with 75-250mg/dl glucose.
Give insulin
2.5% dextrose
Describe the dextrose and insulin protocol in a patient with <75 mg/dl glucose.
no insulin
5% dextrose
Describe the dextrose and insulin protocol in a patient with <50 mg/dl glucose.
no insulin
BOLUS dextrose
What are the regulatory cut-off points for beta cell excretion of insulin?
Glucose >110mg/dl (EXCRETE INSULIN)
Glucose <65mg/dl (STOP EXCRETION)
T or F:
Most insulinomas are malignant.
True!
What are some major differentials you should rule-out first before looking into an insulinoma in a dog?
Paraneoplastic effects (leiomyoma, hepatic cancer, HSA)
Artifacts
Iatrogenic
Liver failure (CPSS or cirrhosis)
Sepsis
Why might a dog with an insulinoma and blood glucose of 40mg/dl not have clinical signs?
Due to upregulated CNS glucose receptors and increased sensitivity
What are medical management options for insulinomas?
Prednisone + diet
(Diazoxide or streptozocin if they don't work)