Anti-Diabetes Drugs III

What is used to treat DKA?

• must correct imbalance (Na+, K+, and P) before administering insulin (insulin can worsen hypokalemia)

• insulin administered after fluid therapy has normalized serum potassium

• must slowly reduce blood glucose otherwise Somogyi effect will ensue

What are the non-insulin drugs available and what are their main functions?

Sulfonylureases (glyburide and glipizide): for cats whose owners refuse to give insulin shots, but do not want to euthanize

Incretins (GLP-1) like liraglutide and exenatide: as an adjunct to insulin for dogs who are refractory and post-remission cats that need to stay on a normal carb diet

What drug used to treat type 2 DM has many uses in endocrine pharmacology?

bromocriptine

If a diabetic dog demonstrates the Somogyi effect while on Vetsulin, what type of insulin would be the next choice? 

since you may be giving the appropriate dose of insulin but it is just released from the injection site too fast, try an insulin with a longer duration such as PZI.  Use the same dose (i.e., number of units) of PZI and repeat the BG curve in a week or so after starting the PZI.

Why, in general, are prandially administered non-insulin drugs not recommended in cats.

they are unpredictable eaters

Why zinc is additionally important in DM?

zinc crystallizes insulin and can promote glucose transport into cells by inhibiting enzymes that block insulin signaling and by stimulating the insulin receptor pathway

How is insulin used in the various bovine DM-like diseases?

Ketosis: propylene glycol + corticosteroid (enhances BG) → if severe give IV glucose and follow up with PZI insulin later

Fat cow ketosis (type 2 DM): NPH insulin BID with IV glucose

What is streptozotocin and when is it used?

an alkylating anti-cancer agent that is toxic to DNA, obtained from Streptomyces → specific for killing islet cells of the pancreas since it resembles glucose → can be transported through GLUT2, but not GLUT4 → used to treat insulinomas

What is high fructosamine indicative of?

poor glycemic regulation

How do SGLT2 inhibitors used as non-insulin diabetes mellitus treatment cause UTIs?

they prevent glucose reuptake in the tubules so glucose is lost in urine → glucosuria can lead to UTIs

How is insulin used in the various equine DM-like diseases?

Equine metabolic syndrome: characterized by hyperinsulinemia with insulin resistance (resembles type 2 DM) → low carb diet, soak hay in water to rid of soluble carbs, metformin timed with feeding

How does xylitol harm dogs?

potently mimics glucose as far as insulin release → rapid hyperinsulinemia leads to acute hepatic necrosis