Lecture 24: DM

• What are the clinical signs commonly associated with Diabetes Mellitus?

  
  

  a. Hypotension, bradycardia, poor appetite

  b. Bradypnea, polydipsia, weight gain

  c. Polyuria, polydipsia, polyphagia

  d. Tachycardia, hypothermia, excessive sweating

  c. Polyuria, polydipsia, polyphagia
• Which type of Diabetes Mellitus is characterized by insulin resistance and dysfunctional beta cells in cats?

  
  

  a. Type I IDDM

  b. Type II NIDDM

  c. Gestational Diabetes

  d. Type III MODY

  b. Type II NIDDM
• In the diagnosis of Diabetes Mellitus, which criteria must be present?

  
  

  a. Bradycardia and hypotension

  b. Hypernatremia and metabolic alkalosis

  c. Persistent fasting hyperglycemia and glycosuria

  d. Bradypnea and hypoglycemia


  c. Persistent fasting hyperglycemia and glycosuria
• What additional condition should be evaluated in a Diabetes Mellitus diagnosis apart from hyperglycemia and glycosuria?

  
  

  a. Cholecystitis

  b. Urinary tract infection

  c. Osteoporosis

  d. Migraine

  a. Cholecystitis
• Persistent fasting hyperglycemia hyperglycemia with glucosuria plus appropriate CS

  Diabetes mellitus
• What animal gets type I insulin dependent diabetetes?

  Dogs
• What type of animals get type II DM?

  Cats
• Why can cats progress to IDDM?

  Due to destruction of islets of Langerhans (and consequently loss of B-cells)
• CS signs of DM

  -PU/PD/polyphagia with WL

  -Cataracts, plantigrade stance

  -Lethargy, not grooming, reclusive

  -Sick, weak with DKA
• PE findings of a dog with DM

  -Obesity

  -Muscle/weight loss

  -Alopecia, dry/brittle

  -Scales, hyperkertosis

  -hepatomegaly

  -Cataracts, anterior uveitis

  -Diabetic neuropathy (uncommon)

  -DKA symptoms if severe enough
• PE findings of cats with DM

  -Obesity

  -Muscle/WL

  -Dry, unkempt coat- no luster

  -Hepatomegaly

  -Hind limb weakness to plantigrade

  -DKA symptoms if severe enough
• DM is a persistent _____ hyperglycemia

  fasting
• How do we make a diagnosis of DM?

  appropriate CS, persistent fasting hyperglycemia, glycosuria
• Why do we need to have all 3 criteria to diagnose DM?

  -Glucosuria helps rule out other causes of hyperglycemia

  -Hyperglycemia helps rule out primary renal glycosuria
• Diagnostics for DM

  -CBC/Chem/UA

  -Urine culture and sensitivity

  -Pancreatic lipase immunoreaction

  -Abdominal US
• Treatment goals of DM

  -Manage CS

  -Reasonable treatment plan for owners
• Why might you recommend using anti-glycemic medications in cats?

  Typically cats are too sensitive for insulin
• Diet recommendations for DM

  -Reduce obesity

  -Increase fiber
• Why should you encourage exercise in patients with DM?

  Reduces obesity, increases mobilization of insulin from injection site, increase glucose uptake in cells
• What is the approximate duration for a well-regulated blood glucose level to indicate controlled clinical signs in Diabetes Mellitus?

  
  

  a. 2 hours

  b. 24 hours

  c. 1 week

  d. 6-8 hours


  d. 6-8 hours
• Which insulin type has a duration of action of 10-16 hours?

  
  

  a. Glargine

  b. Detemir

  c. NPH

  d. Regular

  a. Glargine
• Do owners have to give insulin even if a patient is not eating?

  Yes, some because the hyperglycemia is still present
• What is the criteria for DM to be considered well-regulated?

  -Managed CS

  -Minimize frequency and severity of complication and concurrent issues

  -Keep BG "as close to normal for as long as possible"

  -Renal threshold for glucose approximately 180 in dogs and 280 in cats

  -Generally controlled CS if BG is above 220 for about 6-8 hours
• What animals do we have to do a lot more "tweaking" with treatment?

  Cats
• Short acting insulin (4-6 h)


  Regular (Humulin-R)
• Intermediate acting insulin (6-12 h)


  NPH (Humulin-N, Novolin-N) and Lente (Vetsulin, Caninsulin)
• Long acting insulin


  -Protamine zinc (10-16 hr)

  -Glargine (Lantus) (8-24 hr)

  -Detemir (Levemir) (8-24 hr)
• U-40 insulin


  Lente and PZI
• Dog insulin options


  Lente and NPH
• Cat insulin options


  PZI and glargine
• DKA insulin options

  Regular
• What should you do if patient has new stable DM

  -Do evaluation

  -Start insulin

  -Glucose curve at 10-14 days

  -Adjust dose up/down based on results (be cautious)

  -Adjustment in does warrants a follow up in 10-14 days for glucose curve
• What should you do if patient has DKA and is sick?

  -Treat in-hospital (IV fluids, Humulin-R)

  -Monitor BG for response

  -Switch to maintenance insulin when stable and eating

  -Recheck 1-2 weeks after discharge; follow up until regulated
• What electrolytes are commonly elevated on presentation of DM patient

  Potassium and phosphorus
• What can hyperkalemia cause?

  Acidosis and decreased renal perfusion
• What can hyperphosphatemia cause?

  Decreased renal perfusion, dehydration
• How do we treat hyperkalemia and hyperphospatemia?

  -Correction of acidosis and fluid therapy

  -Improve hydration and GFR
• What are the issues with interpreting glucose curve for insulin response?

  -Day to day variability

  -Peak effect changes

  -BG must be high when insulin is administered

  -Must evaluate peak effect and duration of effect
• Plan for interpreting the glucose curve

  -Try to have a peak effect reach low 100s (do not worry about the time it happens)

  -Try to have insulin working around 8 hours

  -Check BG awhile from before eating to after second insulin dose

  -Average BG for day around 250 mg/dL
• How often should you check BW, UA, urine C/S if DM is stable?

  4-6 months