Lecture – Customizing Care For The Diabetic Care

Dr. Margie Scherk

A 9 year old, neutered male cat with diabetes is presented for poor control on insulin. Oral examination reveals calculus and gingivitis. You suspect also that there are resorptive lesions as the cat appears painful when you touch his gums. The next best approach to improve this cat’s glycemic control is to:

increase his insulin dose

perform a blood glucose curve

initiate feeding a dental diet

anaesthetize to provide dental care

initiate a course of antibiotics

In general, when anaesthetizing a cat with diabetes:

Fast the cat for 12 hours and administer 2 units of insulin

Fast the cat for 4 hours and administer 2 units of insulin

Fast the cat for 12 hours and administer his full dose of insulin

Fast the cat for 4 hours and administer his full dose of insulin

Fast the cat for 12 hours and administer 1/2 of his dose of insulin

Fast the cat for 4 hours and administer 1/2 of his dose of insulin

In order to make a diagnosis of diabetes, persistence of hyperglycemia must be verified. Which of the following is the best way to do this?

Measure a serum fructosamine

Repeat the blood glucose measurement

Repeat a urine glucose measurement

This is not necessary when both blood and urine glucose are elevated

The main goals of treating a cat with diabetes are to eliminate clinical signs and avoid insulin-induced hypoglycemia as well as complications associated with not treating the condition.

True

False

Which of the following is the most important component for the initial management of the newly diagnosed diabetic cat?

Switch to feeding a low carbohydrate, high protein diet

Increase exercise and interaction

Monitor urine glucose daily

Initiate a weight loss program

Start twice daily insulin therapy

The purpose of performing a blood glucose curve is to determine:

Whether the insulin has been damaged

The dose, type and frequency of insulin needed

Client comprehension and compliance

Those cats for whom monitoring fructosamine is sufficient

How often and when spot-checking should be performed

The nadir:

Predicts duration of insulin effect

Provides information to adjust frequency of insulin administration

Screens for Somogyi overswing

Helps identify time until, and degree of, maximum effect of the insulin

Occurs 4-6 hours after insulin administration

Identification of the glucose differential helps to:

Determine whether insulin type is appropriate for the individual

Identify the ideal frequency of insulin administration

Predict whether Somogyi overswing will occur

Establish how often BG curves should be performed

Define whether only monitoring fructosamine is adequate

Defining the duration of effect of insulin is required in order to:

Identify the time of day that urine glucose should be measured

Know how often and when spot-checking should be performed

Recommend the frequency of insulin administration

Prescribe feeding frequency

Determine how often fructosamine should be evaluated

The reason to measure the blood glucose every hour is to

Give staff practice performing BG measurements

Give the client a sense of involvement

Provide revenue for the practice

Improve accuracy determining time and level of nadir BG

Average out irregularities due to stress-induced BG values

The most common cause for Somogyi overswing is:

Insulin dose too low

Insulin dose too high

Concurrent pancreatitis

Concurrent inflammatory bowel disease

Inappropriate insulin handling

Too long of an interval between insulin doses

Which of the following is the preferred approach?

Minimize risk of hypoglycemia while tolerating periods of hyperglycemia

Minimizing periods of hyperglycemia while tolerating risk of hypoglycemia