Patient evaluation, diagnosis, and treatment of diabetes mellitus will be discussed. Management of concurrent disease along with diabetes mellitus will be a focus of the talk.
- The practitioner will learn how to choose the appropriate insulin for their patient
- The practitioner will learn how to optimally monitor the diabetic patient
- The practitioner will learn how to diagnose and treat diabetics with concurrent disease
- Urine cultures should be performed on all newly-diagnosed diabetics since many have clinically silent urinary tract infections.
- Concurrent disease should be considered if insulin doses are greater than 1.5 U/kg without adequate glucose control.
- Consider changing the type of insulin used if there have been more than 2 dose changes without clinical response.
- When changing insulins, the new insulin can be started the next day without a washout period.
- Decrease the insulin dose by 25% when starting a new insulin.
Q: What diet is optimal for glucose control in the diabetic dog?
A: A high insoluble fiber diet is optimal. However, diet appears to be less important for canine diabetic control than for our feline friends.
Q: What diet is optimal for glucose control in a diabetic cat?
A: Low carbohydrate diets are optimal for controlling diabetes in the cat. Diet is much more important for cats than for dogs.
Q: I have a feline patient who is diabetic and also has chronic kidney disease. Which diet should I choose?
A: Since we don't have much to help us with chronic kidney disease, you should feed for the kidney (low protein, phosphorous diets)
Q: I have a canine patient who has inflammatory bowel disease and needs glucocorticoids for control. How do I handle the diabetic control?
A: Recognize that you will just need to give more insulin since the glucocorticoids are necessary to control the dog's GI disease. You can give increased doses of insulin if needed.
Q: The owner of my feline diabetic patient can only give insulin once per day. Which insulin is the most appropriate for this cat?
A: I would recommend ProZinc (PZI) or glargine. Both need to be given bid in most cats for optimal treatment, but can be given once per day if necessary.
Q: The owner of my canine diabetic patient can only give insulin once per day. Which is the most appropriate for this dog?
A: I would recommend Vetsulin (Lente) or detemir (Levemir) both of which are long lasting in the dog. However, both should be given twice daily for optimal control.
Q: I believe that my canine diabetic patient also has hyperadrenocorticism. Which test should I use for diagnosis?
A: Although the LDDST is usually the "go to" test as it is the most sensitive, i this case the ACTH-stimulation test is the most specific and will result in low number of false positive results.
Q: How do I adjust insulin therapy when starting treatment for hyperadrenocorticism in my diabetic patient?
A: Decrease insulin by 25% to prevent hypoglycemic when the extra glucocorticoids are removed with adrenolytic therapy.
Q: I have just adjusted my diabetic patient's insulin dose. When should I recheck him/her?
A: The body takes around 7 days to adjust to a new insulin dose, so a good time to check how well the new dose is doing is 7-10 days after the dose is changed.
Q: What is a good starting dose for insulin in the cat and dog?
A: For cats 0.25-0.5 U/kg for dogs 0.5 U/kg except for detemir which should be started at 0.25U/kg
Let us know what you think.
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