48 Disorders of the Endocrine Pancreas I

Diabetes Mellitus

What is the most common disorder of the endocrine PANCREAS in cats and dogs?

Type I

This type of diabetes mellitus is the destruction or loss of pancreatic beta cells with progressive and eventual insulin insufficiency

Type II

This type of diabetes mellitus is characterized by insulin resistance and dysfuctional beta cells

Insulin dependent diabetes mellitus

This classification of diabetes mellitus is characterized by permanent hypoinsulinemia and requirement for exogenous insulin therapy

TLDR you don't have insulin and need it exogenously

Non insulin dependent diabetes mellitus

This classification of diabetes mellitus is characterized obesity induced down regulation of insulin receptors, impaired receptor affinity and post-receptor defects in insulin action

TLDR you have insulin but can't use it

Insulin dependent diabetes mellitus

Which is more common in dogs, insulin dependent or non insulin dependent diabetes mellitus?

Pancreas (beta cells)

Which organ makes insulin

FALSE: loss of beta cell function is permanent and results in lifelong requirements for insulin therapy

TRUE OR FALSE: Loss of beta cell function is transient and you often need to supplement a tapering dose of insulin for a few years until the pancreas can repair.

Type II

Is type I or type II diabetes mellitus more common in cats?

Type II

Which type of diabetes mellitus is characterized by insulin resistance and beta cell dysfunction, type I or type II

Brittle diabetes

What is the term for type II diabetic cats where the dose of insulin needed to control the disease is close to the dose causing hypoglycemia?

Amylin (aka islet amyloid peptide)

What risk factor for diabetes type II is co-secreted with insulin, though it antagonizes it, and leads to progressive islet loss and loss of insulin secretory ability if overproduced?

Obesity

What risk factor of type II diabetes causes internalization of insulin receptors by fat cells, overall reducing insulin receptor affinity and impairing glucose metabolism?

Males

Which sex is overrepresented with feline type II diabetes mellitus?

Older

Older or younger animals are predisposed to diabetes mellitus

Glucocorticoids, megestrol acetate

Name two medications which are considered risk factors for feline diabetes mellitus

Glucose toxicity

note: in cats only, glucose toxicity reversal increases chances for diabetic remission

What problem is related to type II diabetes mellitus, where there is chronic, persistent hyperglycemia which itself is toxic to beta cells?

Insulin requirements fluctuate in approximately 20% of cats

The goal is to get cats with diabetes mellitus in remission. What is the problem with insulin requirements?

DOGS: Females are more likely to be affected

CATS: neutered males are overrepresented

What is the difference in sex predisposition for type II diabetes mellitus between cats and dogs?

Type II diabetes mellitus

The following cat breeds are predisposed to what problem?:

burmese, main coon, russian blue, siamese

PU/PD, polyphagia with weight loss

note: this is because the animal's body can't access energy stores because the insulin isn't working to move things into the cell and there is lots of glucose in the urine = osmotic diuresis

Describe the eating and excretion behaviors of an animal with diabetes mellitus

Dogs

Which animal with type II diabetes mellitus gets cataracts, cats or dogs?

Cats

Which animal with type II diabetes mellitus gets neurologic signs like pelvic limb ataxia, plantigrade stance, and hyporeflexia, cats or dogs?

Diabetes mellitus (type II)

This cat comes in PU/PD, plantigrade dropped hock stance, with sticky urine caked with litter stuck to the back of it's legs. Thoughts?

Diabetes melltius type II

Demonstration of persistent, fasting hyperglycemia in conjunction with glucosuria tells you what problem is going on?

Stress hyperglycemia (must do additional testing to differentiate this from diabetes mellitus)

What problem must you consider in cats ONLY if they have hyperglycemia around 300-400 and some glucosuria?

Hyperglycemia, hypercholesterolemia, hypertriglyceridemia, glucosuria, specific gravity over 1.025, maybe ketonuria

Name a few chem, UA changes that can occur with diabetes mellitus type II

Fructosamine

Which diagnostic test measures serum proteins (albumin) that have undergone a non-enzymatic, insulin dependent glycosylation (protein with glucose attached)?

Fructosamine

What diagnostic diabetes test indexes average blood glucose over the previous 2-3 weeks?

Fructosamine

What diagnostic test for diabetes mellitus is the best to distinguish this from stress hyperglycemia in cats?

Glycolated hemoglobin

Which diagnostic test measures an irreversible, nonenzymatic insulin independent binding of glucose to hemoglobin in the RBCs (hemoglobin/RBC with glucose attached)

Glycolated hemoglobin

note: aka a longer test than fructosamine

What diagnostic diabetes test indexes average blood glucose over the previous 4-8 weeks?

Proper insulin administration

What is one of the mainstays of diabetes mellitus treatment?

Hypoglycemia (causes coma, seizures, and death)

Which is ultimately worse for an animal, hypoglycemia or hyperglycemia

DOGS: provide inc. soluble fiber to slow intestinal absorption of glucose

CATS: provide high protein, low carbohydrate diet

What is the difference in changing cat versus dog diets to manage diabetes mellitus type II?

a. inc. soluble fiber to slow intestinal absorption of glucose

Select the diet most appropriate for managing canine diabetes mellitus type II:

a. inc. soluble fiber to slow intestinal absorption of glucose

b. provide high protein, low carbohydrate diet

b. provide high protein, low carbohydrate diet

Select the diet most appropriate for managing feline diabetes mellitus type II:

a. inc. soluble fiber to slow intestinal absorption of glucose

b. provide high protein, low carbohydrate diet

Cats

Which animal is adapted to be slightly insulin resistance because they need to maintain euglycemia in the face of fasting? Cats or dogs?

Glucokinase enzyme

What enzyme do cats lack, causing them to have decreased ability to store excess glucose as glycogen, like dogs can?

True

TRUE OR FALSE: Cats are obligate carnivores

feed 66 kcal/kg/day

What amount can you feed cats in kcal/kg/day to reduce obesity and control diabetes mellitus?

1. these are NOT substitutes for insulin

2. you cannot reverse beta cell glucose toxicity

3. there is limited veterinary data

Oral hypoglycemia agents are new to diabetes mellitus treatment. What 3 things do you need to keep in mind when using and recommending them?

1. inhibit intestinal glucose absorption (so you poop out more sugar)

2. improve tissue's peripheral insulin sensitivity

3. promote insulin release from pancreas

4. decrease kidney resorption of glucose (so you pee out more sugar)

What are the 4 classes of oral hypoglycemic agents for management of diabetes mellitus type II:

d. Acarbose (precose)

The point of this intestinal glucose absorption inhibitor is to decrease digestion of oligo and disacchardies so you poop out more sugar

a. Troglitazone (Rezulin)

b. Vanadium

c. Chromium picolinate

d. Acarbose (precose)

a. Troglitazone (rezulin)

c. Metformin (Glucophage)

d. vanadium

f. Chromium picolinate

Select the oral hypoglcemic agents which improve the tissue's peripheral insulin sensitivity:

a. Troglitazone (rezulin)

b. Glipizide (Glucotrol)

c. Metformin (Glucophage)

d. vanadium

e. Glimepiride (amaryl)

f. Chromium picolinate

b. Glipizide (Glucotrol)

e. Glimepiride (amaryl)

Select the oral hypoglcemic agents which promote insulin release from the pancreas and are considered "Sulfonylureas":

a. Troglitazone (rezulin)

b. Glipizide (Glucotrol)

c. Metformin (Glucophage)

d. vanadium

e. Glimepiride (amaryl)

f. Chromium picolinate

b. Glipizide (Glucotrol)

aka the Sulfonylureas

Which oral glycemia agent has direct action at the pancreatic beta cell?

a. Troglitazone (rezulin)

b. Glipizide (Glucotrol)

c. Metformin (Glucophage)

d. vanadium

c. Bexacat (bexagliflozin tablets)

f. Senvelgo (velagliflozin oral solution)

Select the oral hypoglycemic SGLT2 receptor inhibitors which cause decreased kidney resorption of glucose:

a. vanadium

b. Glimepiride (amaryl)

c. Bexacat (bexagliflozin tablets)

d. Chromium picolinate

e. Troglitazone (rezulin)

f. Senvelgo (velagliflozin oral solution)

a. Senvelgo (velagliflozin oral solution)

meaning this is the ONLY hypoglycemic which you can use instead of insulin

Which SGLT2 receptor inhibitor oral hypoglycemic is the first FDA approved oral liquid medication for diabetes in cats:

a. Senvelgo (velagliflozin oral solution)

b. Bexacat (bexagliflozin tablets)

1. insulin similar between puppies, pigs, and people

2. insulin similar between cats and cows

Name the species for which insulins are really similar between them

Separate into onset/duration of action AND protein source

What are the two broad categories for insulin?

1. Immediate: Regular crystalline insulin

2. Intermediate: NPH (isophane protamine) insulin

3. Longest acting: PZI (protamine zinc) insulin

One broad category of insulin encapsulates duration. Name the lengths of duration for insulin and an insulin type that fits in each category:

c. Regular crystalline

Which type of insulin has immediate onset, peaking at 2 hours and only lasting about 2-4 hours:

a. PZI

b. NPH

c. Regular crystalline

b. NPH

Which type of insulin has intermediate 2-6 hour onset, 4-14 hour peak, 12-18 hour duration, considered a twice a day insulin:

a. PZI

b. NPH

c. Regular crystalline

a. PZI

Which type of insulin is the longest acting, with 4-8 hour onset, 12-14 hour peak, with up to a 24 hour duration:

a. PZI

b. NPH

c. Regular crystalline

1. porcine insulin

2. cats and dogs

3. intermediate (zinc lente)

4. U40

Describe Vetsulin in terms of:

1. protein source

2. animals it can be used in

3. how long is acts

4. U40 or U100?

1. human recombinant insulin

2. dogs and cats

3. longest acting (protamine zinc)

4. U40

Describe Prozinc (PZI) in terms of:

1. protein source

2. animals it can be used in

3. how long is acts

4. U40 or U100?

1. human recombinant insulin

2. typical go to for dog insulin

3. intermediate (protamine)

4. U100

Describe NPH in terms of:

1. protein source

2. animals it can be used in

3. how long is acts

4. U40 or U100?

1. human analog insulin

2. typical go to for cat insulin

3. longest lasting

4. U100

Describe glargine in terms of:

1. protein source

2. animals it can be used in

3. how long is acts

4. U40 or U100?

Because it increases chance of remission

Why is glargine considered the go to insulin for feline diabetes?

U100 is 2.5x more concentrated than U40 concentration insulin. This means if you accidentally give a U100 syringe to a U40 patient, you will MASSIVELY OD them

Why is it important to know that Vetsulin and Prozinc are U40, but NPH and Glargine are U100?

Human source

Which are the more common types of insulin protein sources in animals now, humans or animals source insulin?

2x per day

How many times a day do you have to give glargine insulin?

Glargine

Lantus is the trade name for which insulin?

Glargine

Which insulin type is considered "peakless" in terms of it's glucose utilization rate?

Glargine

Which insulin type can be administered as a vial or a pen, allowing you to give small amounts of insulin?

FALSE: diabetic cats treated with twice daily GLARGINE insulin have better glycemic control and higher probability of remission than cats treated with twice daily PZI or porcine lente insulin

TRUE OR FALSE: diabetic cats treated with twice daily PZI or porcine lente insulin have better glycemic control and higher probability of remission than cats treated with twice daily glargine insulin

Detemir

This type of insulin is not a first wave insulin and is new to the vet med scene, but is known to be good in dogs and cats where other insulins aren't working, used twice daily (human analog insulin)

Degludec

This type of insulin is not a first wave insulin and is new to the vet med scene, but is longer acting, though there is little information known on its' use in cats