Flashcards in Endocrinology - Diabetes Management Deck (32)
When should diabetic monitoring occur?
1-2 weeks after diagnosis and implementation of insulin
1-2 weeks after insulin changes
Every 3-6 months in stable diabetics
Whenever the owner observes clinical signs
What diagnostics should be done for diabetic monitoring?
Urinalysis and glucose monitoring +/- full blood work
How is a blood glucose curve done?
BG is recorded every 2 hours after insulin administration ideally for 12 hours
What are the parameters of the blood glucose curve?
Pre-insulin BG, Nadir, duration of insulin effect, highest BG, and average BG
What is important to remember when interpreting the blood glucose curve?
Must interpret the curve in light of other clinical parameters before making decisions regarding insulin administration
When is a glucose curve indicated?
1-2 weeks after any change in insulin dose or formulation, any patient with poor control of clinical signs, and routine monitoring in any patient every 3-6 months
What are the pitfalls to the glucose curve?
Day-to-day variability, effect of stress hyperglycemia, expense, and potential to miss hypoglycemia
What does fructosamine measurement reflect?
The mean BG for the past 2 weeks
What is the use of fructosamine measurement?
It eliminates confounding effect of stress hyperglycemia
What are the limitations of fructosamine measurement?
Can be normal in recent-onset DM and reduced in cases of hypoproteinemia and hyperthyroidism
A good control of fructosamine is associated with a low/high number.
The presence of high fructosamine supports poor glycemic control but does not help do what?
identify the underlying problem
What are the benefits to home monitoring?
Stress hyperglycemia is not as common, glucose curves are time consuming and expensive, and frequent glucose curves required following diagnosis
What is the freestyle libre?
A disposable 14-day flash glucose monitoring system that can be used to monitor glucose as often as every minute
What are the reasons for poor glycemic control (clinical signs are not resolving)?
Poor owner compliance, insulin underdose, insulin resistance, insulin-induced hypoglycemia, and problems with insulin metabolism/duration of effect
How do you 'diagnose' poor owner compliance?
History, observe how they administer insulin, and take blood glucose (from their administration and yours)
What may be the cause of an insulin underdose?
The initial dose when starting insulin therapy is too low for most and/or they may have increased sensitivity to insulin after starting treatment
Most diabetis will have glycemic control with __unit/kg insulin BID or lower.
1 - occasionally up to 1.5 U/kg
What generally is the cause of insulin resistance?
There is a concurrent disease process that impairs insulin activity
What common diseases can lead to insulin resistance?
Obesity, infection, acromegaly (cats), hyperadrenocorticism (dogs), pancreatitis, and neoplasia
Insulin resistance can be a source of sudden loss of ______ control, or can be a precipitating cause of ____ (especially in _____).
Glycemic, diabetes, cats
When should you be suspicious of insulin resistance?
When doses exceeding 1-1.5 units/kg are needed for glycemic control and other problems such as owner compliance is ruled out
What is the approach to determine insulin resistance?
fulll blood work, search for infection:urine culture, imaging, +/- advanced endocrine diagnostics
What is the somogyi effect?
It is when insulin induces hyperglycemia
What is the etiology of the somogyi effect?
Hypoglycemia brought on by an insulin overdose causes the stimulation of diabetogenic hormones which then increases BG levels and results in rebound hyperglycemia
The somogyi effect can induce insulin resistance for how long?
Up to 72 hours
What clinical signs are associated with the somogyi efect?
Clinical signs of hyperglycemia dominate and glucosuria is common
What is required to document the somogyi effect and what will you see?
BG curve is required to document - you will see hypoglycemia or a rapid drop in BG followed by profound hyperglycemia
What is inadequate insulin duration due to?
Rapid metabolism of insulin - the duration is less than 8-10 hours