68..............................................................................................................................................................................navc Clinician’s Brief / April 2011 / Diagnostic Tree
1. IV Isotonic Crystalloid Therapy • Shock fluid therapy is warranted if cardiovascular instability is present: Full shock dose of fluids is 90 mL/kg; start with ¼ to 1/3 dose and reassess until stable • Correct dehydration, provide maintenance needs, and replace ongoing losses over 6 to 24 hours: - % dehydration × body weight (kg) × 1000 plus - 20 mL/kg/day (insensible losses) plus - 20 to 40 mL/kg/day (maintenance sensible losses) plus - Account for vomiting, diarrhea, & polyuria (ongoing sensible losses) Alice Huang, VMD, & J. Catharine Scott-Moncrieff, Vet MB, MS, MA, Diplomate ACVIM & ECVIM Purdue University Canine Diabetic Ketoacidosis D i a gno s t i c Tre e / ENDOCRINOLOGY Peer Reviewed Physical Examination • Polyuria • Weight loss • Polydipsia • Vomiting • Polyphagia • Lethargy Patient may have only 1 or more of these signs. Laboratory Results • Blood glucose (BG): Hyperglycemia (> 200 mg/dL) • Blood gas (venous or arterial): Metabolic acidosis • Urine dipstick: Glucosuria; ketonuria or ketonemia Serum ketones can be measured if urine is unavailable. Diabetic Ketoacidosis Treatment 2. Electrolyte Supplementation (see Table 1, page 70) • Monitor serum potassium Q 4–6 H until within reference interval and stable; then Q 12–24 H • Monitor serum phosphorus Q 4–6 H until > 1.5; then Q 6–24 H • When supplementing potassium and phosphorus concurrently, take into account the amount of potassium contained in the potassium phosphate • Consider magnesium supplementation in instances of refractory hypokalemia 3. Regular Insulin • Continuous rate infusion (CRI) protocol:1 - Add 2.2 U/kg of regular insulin to 250 mL of 0.9% saline - Allow 50 Continue reading >>
Update On Insulin Treatment For Dogs And Cats: Insulin Dosing Pens And More
Authors Thompson A, Lathan P, Fleeman L Accepted for publication 19 February 2015 Checked for plagiarism Yes Peer reviewer comments 3 1School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia; 2College of Veterinary Medicine Mississippi State University, Starkville, MS, USA; 3Animal Diabetes Australia, Melbourne, VIC, Australia Abstract: Insulin therapy is still the primary therapy for all diabetic dogs and cats. Several insulin options are available for each species, including veterinary registered products and human insulin preparations. The insulin chosen depends on the individual patient's requirements. Intermediate-acting insulin is usually the first choice for dogs, and longer-acting insulin is the first choice for cats. Once the insulin type is chosen, the best method of insulin administration should be considered. Traditionally, insulin vials and syringes have been used, but insulin pen devices have recently entered the veterinary market. Pens have different handling requirements when compared with standard insulin vials including: storage out of the refrigerator for some insulin preparations once pen cartridges are in use; priming of the pen to ensure a full dose of insulin is administered; and holding the pen device in place for several seconds during the injection. Many different types of pen devices are available, with features such as half-unit dosing, large dials for visually impaired people, and memory that can display the last time and dose of insulin administered. Insulin pens come in both reusable and disposable options. Pens have several benefits over syringes, including improved dose accuracy, especially for low insulin doses. Keywords: diabetes, mellitus, canine, feline, NPH, glargine, porcine lente Introduction Insulin the Continue reading >>
2010 Aaha Diabetes Management Guidelines For Dogs And Cats
Renee Rucinsky, DVM, ABVP (Feline) (Chair) | Audrey Cook, BVM&:S, MRCVS, Diplomate ACVIM-SAIM, Diplomate ECVIM-CA | Steve Haley, DVM | Richard Nelson, DVM, Diplomate ACVIM | Debra L. Zoran, DVM, PhD, Diplomate ACVIM | Melanie Poundstone, DVM, ABVP - Download PDF - Introduction Diabetes mellitus (DM) is a treatable condition that requires a committed effort by veterinarian and client. This document provides current recommendations for the treatment of diabetes in dogs and cats. Treatment of DM is a combination of art and science, due in part to the many factors that affect the diabetic state and the animal's response. Each animal needs individualized, frequent reassessment, and treatment may be modified based on response. In both dogs and cats, DM is caused by loss or dysfunction of pancreatic beta cells. In the dog, beta cell loss tends to be rapid and progressive, and it is usually due to immune-mediated destruction, vacuolar degeneration, or pancreatitis.1 Intact females may be transiently diabetic due to the insulin-resistant effects of the diestrus phase. In the cat, loss or dysfunction of beta cells is the result of insulin resistance, islet amyloidosis, or chronic lymphoplasmacytic pancreatitis.2 Risk factors for both dogs and cats include insulin resistance caused by obesity, other diseases (e.g., acromegaly in cats, hyperadrenocorticism in dogs), or medications (e.g., steroids, progestins). Genetics is a suspected risk factor, and certain breeds of dogs (Australian terriers, beagles, Samoyeds, keeshonden3) and cats (Burmese4) are more susceptible. Regardless of the underlying etiology, diabetic dogs and cats are hyperglycemic and glycosuric, which leads to the classic clinical signs of polyuria, polydipsia (PU/PD), polyphagia, and weight loss. Increased fat mobi Continue reading >>
Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is an emergency. DKA develops due to: Long standing undiagnosed diabetes mellitus Insufficient insulin dose in treated diabetics Reduced insulin action - caused by obesity , concurrent illness or drugs. This is the cause of more than two-thirds of cases of DKA. What causes DKA? Due to a lack of insulin , glucose cannot be used by the body cells as an energy source. Instead fat is broken down to provide energy. When fat is used as an energy source, acids known as ketones are produced. Ketones circulating in the blood cause signs of DKA - anorexia, nausea and lethargy. Diagnosis The diagnosis of DKA is based on detecting ketones in the urine and sometimes in the blood along with signs of illness. See Urine Monitoring for more information. Treatment DKA is an emergency and treatment must be started as soon as possible. Your veterinary surgeon will administer intravenous fluids and insulin and correct any underlying disorders to stabilise your cat. Once your cat is stabilised it will be started on long term insulin therapy again. Continue reading >>
An Individual Approach To Feline Diabetes Care: A Case Report And Literature Review
Go to: Case presentation A five-year-old female neutered Burmese (Swedish and UK origin) was started on a management strategy for allergic dermatitis consisting of short course of 5 mg prednisolone twice daily, rapidly tapering and withdrawn after 3 weeks. This programme was repeated five times over the next 6 years until at 11 years of age the cat received a single injection of methylprednisolone (Depo-Medrol 20 mg i.m.) and, within 5 days, was observed to have polydipsia and polyuria. Home urinalysis (Keto-Diastix, Bayer) revealed glucose (2+) without ketonuria and, at initial veterinary assessment 2 days later the cat weighed 3.2 kg (last recorded weight was 3.5 kg 18 months previously) and had a body condition score of 4 (on a 9 point scale [23]) with no other significant abnormalities detected on physical examination. Routine serum biochemistry revealed marked hyperglycemia (blood glucose concentration 29.8 mmol/L (reference range 3.9–8.8) and increased fructosamine concentrations (481 µmol/L, 190–340). All other measured parameters were within normal limits. Initial management consisted of a high protein, low carbohydrate diet (Purina DM wet and dry food, fed ad libitum in a ratio of at least 3:1) and twice daily porcine lente insulin (Caninsulin, MSD Animal Health), starting with 1 unit q12 h, started immediately (on day seven after the injection of methylprednisolone). Capillary blood monitoring from the pinna of the ear was commenced using a blood glucose meter calibrated for human blood that is used in cats (Accu-Chek Aviva, Roche UK; feline reference range 2.8–5.5 mmol/L for meter [14]). Blood glucose was taken prior to insulin injection. On some days glucose was also measured more frequently between insulin injections; for example every 3 h or when hy Continue reading >>
Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)
Unfortunately, we veterinarians are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). So, if you just had a dog or cat diagnosed with diabetes mellitus, what do you do? First, we encourage you to take a look at these articles for an explanation of the disease: Diabetes Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it! What is DKA? When diabetes goes undiagnosed, or when it is difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells -- resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body. Symptoms of DKA Clinical signs of DKA include the following: Weakness Not moving (in cats, hanging out by the water bowl) Not eating to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab Continue reading >>
Feline Diabetic Ketoacidosis
Fall 2008 Ketoacidosis is a metabolic imbalance that is most commonly seen as a sequel to unmanaged or poorly regulated diabetes mellitus. It is caused by the breakdown of fat and protein in a compensatory effort for the need of more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product in the form of ketones. As ketones build up in the blood stream, pH and electrolyte imbalances proceed. This condition is a potentially life-threatening emergency that requires immediate medical attention. Diabetes mellitus is a common endocrine disease in geriatric felines. It is caused by a dysfunction in the beta cells of the exocrine pancreas resulting in an absolute or relative deficiency of insulin. Insulin has been called the cells' gatekeeper. It attaches to the surface of cells and permits glucose, the cells' primary energy source, to enter from the blood. A lack of insulin results in a build up of glucose in the blood, physiologically causing a state of cellular starvation. In response to this condition the body begins to increase the mobilization of protein and fat storage. Fatty acids are released from adipose tissue, which are then oxidized by the liver. Normally, these fatty acids are formed into triglycerides. However, without insulin, these fatty acids are converted into ketone bodies, which cannot be utilized by the body. Together with the increased production and decreased utilization an abnormally high concentration of ketone bodies develop. These fixed acids are buffered by bicarbonate; however, the excessive amounts overwhelm and deplete the bicarbonate leading to an increase in arterial hydrogen ion concentration and a decrease in serum bicarbonate. This increase in hydrogen ions lowers the body's pH, leading to a metabolic ac Continue reading >>
Managing Diabetes Complicated By Ketoacidosis
Go to site For Pet Owners Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus that must be swiftly and aggressively treated. Diagnosis Diagnosis is based on the presence of ketonuria with clinical signs. Management guidelines Goals of treatment for diabetic ketoacidosis include correcting fluid deficits and acid-base and electrolyte imbalances, reducing blood glucose and ketonuria, initiating insulin therapy, and treating concurrent diseases. The use of intravenous fluid therapy with isotonic fluids to correct fluid deficits and acid-base and electrolyte imbalances is recommended. Many protocols for treatment of DKA exist but IV fluids and rapid-acting insulin (regular) must be administered first to quickly decrease hyperglycemia. Once the blood glucose has decreased to 250 mg/dL using regular insulin, it is important to add dextrose to the fluids and continue with regular insulin until the cat is no longer vomiting, is eating, and no longer has ketones in the urine. At this point, the regular insulin along with the dextrose in the fluids can be discontinued and Vetsulin® (porcine insulin zinc suspension) therapy can be initiated. Evaluation of treatment When evaluating the regulation of insulin therapy, it is important to consider several areas including the evaluation of glycemia, urine monitoring, routine rechecks and glycated protein evaluations. Evaluation of the glycemia Creating a blood glucose curve is the most accurate way to evaluate glycemia to adjust the Vetsulin dose. Indications for creating a blood glucose curve are: First, to establish insulin dose, dosing interval, and insulin type when beginning regulation. Second, to evaluate regulation especially if problems occur. Third, when you suspect rebound hyperglyc Continue reading >>
Care Of Diabetic And Diabetic Ketoacidotic Patients (proceedings)
Diabetes mellitus is the condition of hyperglycemia (high blood glucose) and glucosuria (glucose in the urine) caused by absence of the hormone insulin, or failure of the cells of the body to be able to respond to insulin. Diabetes mellitus is the condition of hyperglycemia (high blood glucose) and glucosuria (glucose in the urine) caused by absence of the hormone insulin, or failure of the cells of the body to be able to respond to insulin. Diabetes mellitus in veterinary patients can most often be compared to human adult onset diabetes (type 2), and juvenile onset diabetes is rare in veterinary patients. Patients may present with few clinical signs, in relatively good health (uncomplicated diabetes mellitus), or may be weak and dehydrated with severe electrolyte abnormalities (ketoacidotic diabetes mellitus). The most common clinical signs include weight loss, polyuria/polydipsia, increased or decreased appetite, unkempt hair coat, dandruff, sudden onset blindness (in dogs from cataract formation secondary to diabetes), and hind limb weakness (from diabetic neuropathy in cats) . In dogs and cats that have progressed to diabetic ketoacidosis, vomiting, anorexia, and lethargy are common complaints. Physical examination findings can reveal thin body condition, cataracts (dogs), dehydration, and mental dullness. Animals with recent onset diabetes mellitus can have a relatively normal examination. Laboratory testing to diagnose diabetes mellitus is relatively straightforward, and diagnosis can be confirmed at the time of evaluation in some cases with in-house testing. Elevated blood glucose is the mainstay of diagnosis; however keep in mind that hyperglycemia may be from diabetes, or secondary to a stress response, especially in cat. Handheld glucometers that are used by h Continue reading >>
Monitoring Methods For Dogs And Cats With Diabetes Mellitus
Go to: Abstract Effective monitoring is essential for the management of dogs and cats with diabetes mellitus. However, methods for evaluating glycemic control must be tailored to meet both the needs of the patient and the expectations of the owner. This article discusses the philosophies that drive blood glucose monitoring in veterinary diabetics and review common practices. The advantages and limitations of the various options are presented. Keywords: cat, diabetes mellitus, dog, glucometer, monitoring Diabetes mellitus is a common endocrinopathy in dogs and cats. Although the underlying etiologies differ for the two species, both are treated with exogenous insulin and require regular monitoring to ensure appropriate therapy.1 Successful patient management is widely defined by the maintenance of a stable body weight and mitigation of clinical signs such as excessive thirst, urination, and hunger, along with the avoidance of ketosis or hypoglycemia. The latter is particularly important for veterinary diabetics, as these patients cannot assist themselves if blood glucose (BG) concentrations drop precipitously. Achieving euglycemia (BG approximately 60–130 mg/dl) is not the goal of insulin therapy because dogs and cats are spared many of the complications associated with sustained hyperglycemia in human diabetes patients, such as retinopathy, vascular disease, and renal injury.1 Consequently, most canine and feline diabetics experience only short periods of euglycemia in the course of the day and instead live with mild to moderate hyperglycemia. The frequency of monitoring for diabetic dogs and cats is variable, although some form of evaluation is generally recommended every 4–12 weeks.1 Newly diagnosed patients are monitored more frequently, often every 7–14 days, Continue reading >>
Diabetic Ketoacidosis (dka)
Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>
Glycemic Control Of Hospitalized Diabetic Patients
Thomas Schermerhorn, VMD, Diplomate ACVIM (Small Animal Internal Medicine) Kansas State University Glycemic control in diabetic dogs and cats may be jeopardized by hospitalization for treatment of diabetic or nondiabetic disorders or routine health care interventions, such as minor surgical procedures or dental prophylaxis. Thus, a major challenge for veterinarians caring for established diabetics in the hospital is to provide needed care while avoiding significant disruption of glucose control. This article provides useful strategies and techniques for in-hospital glucose management in established stable diabetics. GLUCOSE REGULATION Glucose homeostasis is subject to complex physiologic regulation.1 Glucose in the blood has 3 major sources. Digestion of dietary carbohydrates, which produces glucose that is absorbed into the blood following a meal. Glycogenolysis biochemically breaks down glycogen, a stored form of glucose. Hepatic gluconeogenesis produces glucose from precursors, such as amino acids and glycerol. The latter 2 processes occur between meals or during fasting. Each process is subject to physiologic regulation at multiple steps, which maintains blood glucose within precise physiologic limits. Regulation in Healthy Animals In healthy animals, euglycemia is maintained by interplay between hormones that adjust glucose levels in the blood. Insulin is released from pancreatic beta cells, and is the principal hormone responsible for lowering blood glucose. Precise coupling between changes in portal vein glucose concentration and insulin secretion permits exquisite minute-to-minute glycemic regulation. The rate and amount of insulin release is modulated by a myriad of physiologic substances, including neurotransmitters, paracrine factors, and hormones. The incret Continue reading >>
The Latest Management Recommendations For Cats And Dogs With Nonketotic Diabetes Mellitus
A new type of insulin is well-suited for cats, and the advent of at-home glucose monitors for dogs and cats can help owners become more involved in the care of their diabetic pets. Underlying causes of diabetes mellitus, a common endocrinopathy in dogs and cats, include chronic pancreatic inflammation, pancreatic atrophy, and immune-mediated destruction of the insulin-producing beta cells. Chronic insulin resistance with subsequent beta cell exhaustion and pancreatic amyloidosis are primarily described in cats.1 In dogs, diabetes mellitus is generally a permanent condition, although transient diabetes may occur in pregnant and diestrus females. In cats, diabetes may go into remission, but recurrence is likely.2 A range of insulin choices and management strategies are available for our veterinary patients. Recently, a new type of insulin, glargine, has become available, and many owners are now able to monitor blood glucose concentrations at home. This article reviews these options and provides guidelines for starting therapy in stable, nonketotic dogs and cats. Persistent fasting hyperglycemia is the hallmark of diabetes mellitus. In dogs, you can confidently diagnose diabetes mellitus if a patient has a fasting serum glucose concentration > 200 mg/dl. As the threshold for glucose resorption from the glomerular filtrate is 180 to 220 mg/dl, concurrent glycosuria will be present.1 Cats can become transiently hyperglycemic (serum glucose concentration > 300 mg/dl) when stressed, so a single elevated serum glucose concentration, even with concurrent glycosuria, is not enough to diagnose diabetes mellitus. Supportive clinical signs such as weight loss, polyuria, and polydipsia must be documented. In equivocal cases, measuring the serum fructosamine concentration (which refle Continue reading >>
Spilleautomater Dka Diabetes Cats
Feline diabetic ketoacidosis is a buildup of ketones in the bloodstream of a cat's body. Ketoacidosis is a result of diabetes that has worsened or hasn't. The Secret of Nature treatment of dka in cats, Stop Searching Official ADA recommendation for someone with diabetes: Less than treatment of dka in cats. Stop Searching About dka treatment in cats! Stop wasting your time with unanswered searches. Diabetes is diagnosed by any one of the following. Now, what should your normal ranges be? As I have always recommended you (and it is dka cats also the recommendation of ADA for diabetes management), every diabetic. Diabetes Care Dka: : The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. DIABETES CARE DKA The REAL cause of Diabetes (and. AAHA guidelines for Diabetes management in dogs and cats 2010 AAHA Diabetes Management Guidelines for Dogs Dogs and cats with DKA may show very elevated. Diabetic ketoacidosis (DKA) is a lifethreatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy. Now, what should your normal ranges be? As I have always recommended dka treatment in cats you (and it is also the recommendation of ADA for diabetes management. The Secret of Nature. You can print your sugar chart and present it to your doctor to undertake the most appropriate actions for the best dka treatment in cats diabetes management. It solves the problem for you quickly. Is this what you are looking dka treatment cats? Stop Searching About dka diabetes cat! We collect what you are looking for here. Feline Diabetes: : Pre Diabetes Diabetic Dka Read Cats on the opposite hands have to have someone near the as well as family responsible to. If you want to take care of your health. You Want Something Special Ab Continue reading >>
Diabetes In Cats
This article is about diabetes mellitus in cats. For other uses, see Diabetes (disambiguation). Diabetes mellitus is a chronic disease in cats, whereby either insufficient insulin response or insulin resistance lead to persistently high blood glucose concentrations. Diabetes could affect up to 1 in 230 cats,[1] and may be becoming increasingly common. Diabetes mellitus is less common in cats than in dogs. 80-95% of diabetic cats experience something similar to type-2 diabetes, but are generally severely insulin-dependent by the time symptoms are diagnosed. The condition is treatable, and treated properly, the cat can experience a normal life expectancy. In type-2 cats, prompt effective treatment may lead to diabetic remission, in which the cat no longer needs injected insulin. Untreated, the condition leads to increasingly weak legs in cats, and eventually malnutrition, ketoacidosis and/or dehydration, and death. Symptoms[edit] Cats will generally show a gradual onset of the disease over a few weeks or months, and it may escape notice for even longer.[citation needed] The first outward symptoms are a sudden weight loss (or occasionally gain), accompanied by excessive drinking and urination; for example, cats can appear to develop an obsession with water and lurk around faucets or water bowls. Appetite is suddenly either ravenous (up to three-times normal) or absent. These symptoms arise from the body being unable to use glucose as an energy source. A fasting glucose blood test will normally be suggestive of diabetes at this point. The same home blood test monitors used in humans are used on cats, usually by obtaining blood from the ear edges or paw pads. As the disease progresses, ketone bodies will be present in the urine, which can be detected with the same urine stri Continue reading >>
