DM

Question 1

Types

Answer 1

Type 1: IDDM
- immune mediated destruction of langerhans

Type 2: NIDDM
- due to amyloid deposition

canine: only type 1
feline: type 1/ sometimes 2

Question 2

Pathogenesis

• type 1
• type 2

Answer 2

Type 1:
islet cell pathology due to pancreatitis/amyloidosis/immune -mediated destructtion –> islet cell destruction –> insulin production reduced relative to requirement –> CM

Type 2:
peripheral resistance to insulin (obesity/progesterone/cortisol/glucose toxicity/growth hormone) –> islet cell insufficiency –> insulin production reduced relative to requirement –>

Question 3

CS (9)

Answer 3

• PU/PD
• weightloss
• polyphagia
• weakness/ exercise intollerance (increase glucose in blood but lack in muscles)
• recurrent urinary tract infections
• blindess
• BAR
• thin
• cataracts

Question 4

Confirming Dx

• urinalysis (4)
• biochem (4)

Answer 4

Urinalaysis

• glucosuria
• cystitis: WBS, RBC & protein
• Ketosis: ketone bodies

serum biochemistry

• hyperglycaemia
• increased liver enzymes (bile acids often normal)
• increased cholesterol
• glycated blood proteins (fructosamines)

Question 5

Fructosamines

Answer 5

• glycated blood proteins
• long term high glucose in blood

affected by:

• glucose concentration
• albumin concentration
• albumin half life

Question 6

The daily routine

Answer 6

• amount of food
• timing of food
• amount of insulin
• timing of injections
• exercise
• environment

Question 7

Types of insulin

Answer 7

short: soluble –> 45 minutes

intermediate acting

• isophane: NPH (neutral protamine hagedor) (1-2 hours)
• lente: zinc suspension - produces a biphasic response (2-6 hours and 8-12 hours)

long acting:
- protamine zinc insulin

Question 8

Energy requirement for DM animals

Answer 8

• obese: 70% of recommended intake
• thin: 100% of recommended intake
• normal: 100% of recommended intake

Question 9

Canine DM diet

Answer 9

• complex CHO are good (rice and potatoes)
• simple sugars are bad! (dog treats)

complex CHO (50-55%)
Protein (14-30%
Fat (<20) resticted!

chappie!

Question 10

Feline DM diet

Answer 10

inefficient CHO metabolism
efficient protein catabolism:gluconeogenesis is a major source of flucose

Protein (50-55%)
fat (<20) restricted!

Question 11

Stabilising blood glucose in Dogs

• aim
• start at
• blood measurements
• urine measurements

Answer 11

• want slightly increased but steady
• 1ug/kg, feed 0 and 8 hours

blood sample:

• no glucose: reduce by 5%
• 2% increase by 5%

urine:

• less than 5nmol/l: reduce by 10%
• 5-10nmol/l: no change
• > 10nmoll/l: increase by 5%
• > 15nmol/l: increase by 10%

repeat until stable

Question 12

Stabilising blood glucose in cats

Answer 12

• want slightly increased but steady
• 0.5iu/kg lente insulin twice a day

-0.5iu/kg PZI once or twice daily and feed twice daily

Question 13

Monitoring DM

• if ill
• surgery

Answer 13

Look at CS!

If the dog is unwell and doesn’t eat:

• give half of insulin
• if eats in next 2 hours can give the rest
• if not it needs to come in to be monitored

surgery:

• give half insulin and no foor
• do op early
• give dextrose
• give half of food ASAP

Question 14

Overdose

Answer 14

• somogyi overswing
• when an overdose of insulin causes a dog to become so hypoglycaemic, the body fights back and overrides resulting in hyperglycaemia
• looks like it needs more insulin when it actually needs to just wait for some of it to wear off BE CAREFUL
• avoid by increasing the dose slowly.