Med I - Canine And Feline Dm

Front 1

Diabetes Mellitus
-definition

Back 1

-relative or absolute absence of insulin production or action
-metabolic disease characterized by abnormal CHO and lipid metabolism

Front 2

Ketoacidosis
-definition

Back 2

-metabolic acidosis caused by the accumulation of ketoacids
-can occur without acidosis

Front 3

3 Main ketone bodies

Back 3

-acetoacetic acid
-beta-hydroxybutyrate
-acetone*

*not a metabolic acid

Front 4

Gucosuria
-define

Back 4

-glucose in the urine
-always abnormal

Front 5

Ketoacidosis
-mainly due to

Back 5

-diabetes

Front 6

Main hormones produced in the islet of langerhans

Back 6

-glucagon
-somatostatin
-insulin

Front 7

Cells producing:
-glucagon
-insulin
-somatostatin

Back 7

-glucagon = alpha-cells
-insulin = beta-cells
-somatostatin = delta-cells

Front 8

Majority of the Islet of Langerhans made up of

Back 8

-Beta-cells

Front 9

Islet of Langerhans
-function influenced by

Back 9

-circulating hormones
-gut hormones
-autonomic nerves
-nutrients

Front 10

Why is there generally a higher response to oral glucose than IV glucose?

Back 10

-gut hormones

Front 11

Actions stimulated by insulin

Back 11

*blocks catabolism

Glucose uptake:
-muscle
-adipose
-liver

Amino acid uptake:
-muscle

Free fatty acid uptake:
-adipose

Glucose conversion to glycogen in liver

Front 12

Actions inhibited by insulin

Back 12

-muscle breakdown to amino acids
-adipose tissue breakdown to free fatty acids

Front 13

Actions stimulated by glucagon

Back 13

-glycogenolysis & gluconeogenesis in liver
-glucose release from liver
-adipose tissue conversion to ketone bodies

Front 14

Major pathology of diabetes

Back 14

Islet defect
-impaired insulin secretion (Dog = beta cell loss, Cat = impaired cell function)

Peripheral defect
-impaired insulin action (cat = insulin resistance)

Front 15

Where is impaired insulin action a main concern?

Back 15

-muscle

Front 16

Diabetes classifications

Back 16

-Type 1 = insulin dependent (islets targeted)
-Type 2 = non-insulin dependent
-Transient DM = variable need for insulin; glucose toxicity
-Type 3 (Secondary) DM = physiologic/pathologic factors causing insulin resistance

Front 17

Type 1 diabetes
-most common in

Back 17

-Dog

Front 18

Type 2 diabetes
-most common in

Back 18

-cats

Front 19

Transient diabetes
-most common in

Back 19

-cats

Front 20

Type 3 (secondary) DM
-example

Back 20

-gestational diabetes in dogs (resolution after birth)

Front 21

-Pathology
-effect

Back 21

-Lymphocytic insulinitis

-targets beta-cells

Front 22

-pathology
-effect

Back 22

-Amylin deposition
--production by beta-cells

-possible etiology in cats

Front 23

Relationship between obesity and insulin resistance

Back 23

-cost to maintain normoglycemia is higher
-insulin is not as effective in the obese patient

Front 24

Insulin resistant
-aka

Back 24

-glucose intolerant

Front 25

Relationship between body condition score and glucose tolerance
-why?

Back 25

-higher BCS = more glucose intolerant
-elongation of glucose tolerance curve

-insulin is not activated as quickly and is not as effective in patients with a higher BCS

Front 26

Animals that typically have a longer glucose tolerance curve

Back 26

-carnivores

*reason why different normal are needed b/n species

Front 27

Islet pathology and/or peripheral insulin defect promotes _____.

Back 27

-glucose intolerance

Front 28

What is a definite that will be needed at the time of diagnosis for DM?

Back 28

-insulin

Front 29

Renal threshold for glucose absorption in:
-dog
-cat

Back 29

-dog = 180 mg/dl

-cat = 200+ mg/dl

*above these values in circulating blood, we can call diabetic

Front 30

Pre-diabetic
-circulating glucose values

Back 30

150-220 mg/dL

Front 31

Diabetes Mellitus
-signalment generalizations (gender, age, breed)

Back 31

Gender
-Dogs: female
-Cats: male

Age
-middle aged and older

Breed
-Dogs: Cairn terriers, poodles, dachshunds, min schnauzer
-Cats: Burmese (Australia), Siamese

Front 32

Diabetes Mellitus
-clinical signs

Back 32

-classical triad (Polydipsia, Polyphagia, Polyuria)
-weight loss
-obesity
-occasional cataracts (dogs), neuropathy (cats), asymptomatic hyperglycemia

Front 33

Diabetes Mellitus
-minimum data base

Back 33

-CBC
-Serum biochem (w/ T4 in cats)
-Urinalysis
-Urine culture
-Serum fructosamine (optional)

Front 34

Diabetes mellitus
-CBC results

Back 34

-usually normal

Front 35

Diabetes Mellitus
-Biochemistry panel results

Back 35

-hyperglycemia
-elevated ALP & ALT ("noisy")
-Inc. serum triglycerides

Front 36

Approx. normal blood glucose level across most species

Back 36

-100 mg/dl

Front 37

Diabetes mellitus
-urinalysis & urine culture results

Back 37

-glucosuria
-ketonuria
-proteinuria
-pyuria
-bacteria

Front 38

What does finding of glucosuria mean?

Back 38

-Blood glucose has been above threshold for a period of time

Front 39

Diabetes mellitus
-reason for increased serum triglycerides in biochem panel

Back 39

-insulin deficiency
--lipoprotein lipase becomes inactive
---inc. in circulating VLDLs and chylomicrons

Front 40

Diabetes mellitus
-distinguishing from stress hyperglycemia

Back 40

-glucosuria rarely present
-ketonuria never present
-recheck urine glucose at home in 48-72 hrs
-serum fructosamine test (will only be high if stress hyperglycemia is aroung for more the 3-4 days)

Front 41

Serum fructosamine test
-shows a representation of what?

Back 41

-average. glucose levels in the 2 wk period before the test

Front 42

Diabetes mellitus
-actions in starting treatment

Back 42

-client education/training (syringe handling, hypoglycemia awareness, etc.)
-determining the insulin type to be used
-assessing other factors (diet, meds, supplements, etc.)
-follow-up plan (rechecks, callbacks, progress reports)

Front 43

Diabetes mellitus
-goals of treatment

Back 43

-eliminate clinical signs
-address contributing factors
-control hyperglycemia
-avoid hypoglycemia
-make treatment convenient

Front 44

Diabetes mellitus
-ways to control hyperglycemia

Back 44

-insulin
-exercise/diet (rare efficacy when used alone)
-oral hypoglycemic drugs

Front 45

Diabetes mellitus
-treatment of choice

Back 45

-insulin

Front 46

What would ideal insulin therapy accomplish?

Back 46

-it would replicate the physiological insulin profile

Front 47

Normal insulin profile
-describe

Back 47

-normal basal level (never 0)
-spikes (regular with meals)

Front 48

Short acting Insulins
-primary use

Back 48

-CRI for emergency treatment

Front 49

Intermediate Acting Insulin
-primary use

Back 49

-dogs
-occasional cats

Front 50

Long-Acting Insulin
-primary use

Back 50

-Cats
-occasional dogs

-Basal insulin

Front 51

Short acting insulins

Back 51

-Regular insulin (human rDNA insulin)
-Insulin lispro (analogue insuling)

Front 52

Intermediate acting insulins

Back 52

-NPH insulin*** dogs
-Humulin (human rDNA)
-Vetsulin (porcine) dogs & cats

Front 53

Long acting insulins

Back 53

-Glargine (analogue)
-Detemir (analogue)
-ProZinc (human rDNA)*** Cats

Front 54

Insulin
-"U"

Back 54

-unit
-insulin conc. in units/mL

Front 55

U100 insulin
-insulins

Back 55

-all human insulins

-NPH
-HumulinR
-Lantus

Front 56

U40 insulin
-insulins

Back 56

-only vet products

-ProZinc
-Vetsulin

Front 57

Converting factor for U100 to U40

Back 57

U100 is 2.5x more concentrated than U40

Front 58

Initial insulin dosing
-guidelines

Back 58

-0.25-0.5 units/kg

-same for dogs and cats
-same for most at-home insulins
-most insulins dosed BID

Front 59

Initial insulin dosing
-what is the usual dose range
-why would you want to possibly start dosing at the lower end of the range

Back 59

-0.25-0.5 units/kg

Start at the lower end if:
-concern of hypoglycemic
-mild hyperglycemia
-very thin patient

Front 60

Initial dose
-rare to start cats above what dose

Back 60

-3.0 units/dose

Front 61

Changing insulin dose/type
-guidelines

Back 61

-think small & slow
-10-25% change with 1 week adjustment
-Cat doses change by 0.5-1 U increments
-switching from once to twice daily reduce AM dose by 25%
-change type, start over with 0.5-1.0 U/kg

Front 62

Reason to alter diet in an animal with Diabetes Mellitus

Back 62

-trouble regulating with insulin

Front 63

Diabetes mellitus
-possible diet changes (reasons)

Back 63

-low fat (alleviate lipid abnormalities)
-high fiber (smooth glucose absorption)
-high protein/low CHO (cat)

Front 64

Diabetes mellitus
-optimal dog feeding

Back 64

-2x/day on schedule

Front 65

Diabetes mellitus
-optimal cat feeding

Back 65

-free choice feeding
-diet if obese

Front 66

Why is exercise important in diabetic animals?

Back 66

-alteration of insulin needs

Front 67

Diabetes mellitus
-how is monitoring clinical signs helpful/not helpful

Back 67

Helpful
-lacking clinical signs usually means serum glucose is below renal threshold (250 mg/dl)

Not helpful
-insensitive indicator of physiologic control

Front 68

Diabetes mellitus
-how is monitoring urine for glucose and ketones helpful/not helpful?

Back 68

Helpful
-parallels clinical signs
-even controlled diabetics have glucosuria
-sudden changes in glucose/ketones may indicate pre-clinical problems

Not helpful
-lacking glucosuria doesn't distinguish excellent diabetic control from hypoglycemia

Front 69

Diabetes mellitus
-how is monitoring serum glycated proteins helpful/not helpful?

Back 69

Helpful
-provide info when history not available
-idea of avg. glucose over preceding 2 wks

Now helpful
-large "normal" range
-affected by many variables

Front 70

Diabetes mellitus
-how is monitoring the glucose curve helpful/not helpful?

Back 70

Helpful
-can optimize insulin treatment
-can be taught to clients to help provide superior results
-good for detecting hypoglycemia

Not helpful
-hardly helpful especially in cats due to high level of day-to-day variability

Front 71

Diabetes mellitus
-alternative therapies occasionally used

Back 71

-acarbose
-sulfonylurea drugs
-metformin
-thiazolidinediones

Front 72

Acarbose
-function in DM treatment

Back 72

-inhibits glucosidase reducing intestinal starch absorption

Front 73

Sulfonylurea drugs
-function in treatment of DM

Back 73

-enhances beta cell insulin release
-only Cats

Front 74

Metformin
-function in DM treatment

Back 74

-dec. hepatic glucose production

Front 75

Diabetes mellitus
-new therapies

Back 75

-Incretin mimetics
-Dipeptidyl peptidase inhibitors

Front 76

Incretion mimetics
-function in DM treatment

Back 76

-hormone that is a GLP-1 agonist, boosting the effects of insulin

Front 77

Dipeptidyl Peptidase Inhibitors
-function in DM treatment

Back 77

-enzyme inhibitor that decreases degredation of GLP-1