30 Questions
Which insulin is NOT typically administered at home every 12 hours?
regular crystalline insulin
When administered every 12 hours, which insulin has the greatest likelihood of causing hypoglycemia due to the next dose occurring before the prior dose's effects have ended?
glargine insulin
Which statement about at-home treatment during a hypoglycemia-induced seizure is correct?
Treat initially at-home with sugar solution rubbed on gums.
You are caring for a cat that has been taking another drug for a prior condition unrelated to its new diagnosis today of diabetes mellitus. Which concurrent drug would you be most concerned about in terms of complicating treatment of his new diagnosis?
prednisolone
Which insulin preparation can be administered IV to affect a rapid response under emergency conditions (e.g., a DKA patient)?
regular crystalline insulin
Which drug is a teratogen and has been associated with hypersensitivity reactions that can lead to dermatitis, vasculitis, and blood-cell dyscrasias?
methimazole
Which drug inhibits the formation of functional T3 and T4?
methimazole
Which drug COMMONLY causes adrenocortical cell death?
mitotane
The primary goal of diabetes mellitus therapy is:
Eliminating client-observed clinical signs.
In the pre-work reading from Nelson-Couto, which drug is recommended as a first-choice diabetes mellitus drug in dogs?
lente insulin
What is the treatment of choice for large pituitary tumors?
RT
What medication should be dispensed to patients taking mitotane in case they develop severe adverse effects?
prednisone
What frequency of dosing has been shown to BEST control clinical signs in dogs with hyperadrenocorticism? (trilostane)
q12hrs
True or false: Mitotane can cause necrosis of the adrenal cortex but trilostane cannot.
False
Which antifungal drug inhibits glucocorticoid and androgen synthesis and can be used to treat hyperadrenocorticism?
ketoconazole
When do you tell the owner to stop administering mitotane during the induction phase?
When the patient starts showing signs of decreased appetite.
True or false: Compounded trilostane is equivalent to the brand name trilostane product, Vetoryl, and can be used interchangeably to save the client money.
False
What medication is most commonly used to treat hyperadrenocorticism in cats
trilostane
If a dog with a functional adrenal tumor is not a surgical candidate, what is the treatment of choice?
trilostane
A ferret is hospitalized for hypoglycemia, intermittent ataxia, lethargy and tremors. You suspect insulinoma as the top differential for this ferret. Which treatment is the preferred choice for ferrets with insulinomas?
Partial pancreatectomy
In general, which describes the best nutritional recommendation for diabetic dogs?
The diet should optimize body condition and minimize postprandial hyperglycemia and this may vary based on the individual dog.
What does a spot blood glucose of 356 in a diabetic dog indicate, regarding how well the diabetes is regulated?
This spot blood glucose does not tell you how well the diabetes is regulated.
What is the most important manageable risk factor for diabetes mellitus in cats?
obesity
What is the foundation of treatment for diabetic dogs?
Insulin therapy and dietary modification.
How does exercise affect blood glucose?
Exercise helps with weight loss and obesity, leading to better glycemic control and lowers glucose.
Which clinical sign is an indication of poorly controlled diabetes mellitus?
unplanned weight loss
What does diabetic remission mean?
Blood glucose levels can be managed by diet alone without insulin that previously required treatment to control diabetic signs.
What is the most important complication associated with insulin therapy?
hypoglycemia
True or false: Regarding insulin dosing, it is always better to error on the side of giving too low of a dose rather than too high of a dose.
True
Which nutritional recommendation describes the best option for diabetic cats?
Feed a diet that is high in protein and restricted in carbohydrates, ad lib or multiple small meals each day.
Study Notes
Insulin Administration
- NPH insulin is NOT typically administered at home every 12 hours.
- NPH insulin has the greatest likelihood of causing hypoglycemia due to the next dose occurring before the prior dose's effects have ended.
Hypoglycemia-Induced Seizure
- During a hypoglycemia-induced seizure, at-home treatment involves providing glucose orally or intravenously, without attempting to restrain the patient.
Concurrent Medications
- Concurrent administration of beta blockers with insulin can complicate treatment of diabetes mellitus.
Insulin Preparations
- Regular insulin can be administered IV to affect a rapid response under emergency conditions (e.g., a DKA patient).
Teratogenic Drugs
- Streptozotocin is a teratogen and has been associated with hypersensitivity reactions that can lead to dermatitis, vasculitis, and blood-cell dyscrasias.
Thyroid Inhibitors
- Methimazole inhibits the formation of functional T3 and T4.
Adrenocortical Death
- Mitotane commonly causes adrenocortical cell death.
Diabetes Mellitus Therapy
- The primary goal of diabetes mellitus therapy is to control blood glucose, alleviate clinical signs, and prevent complications.
Canine Diabetes Mellitus
- Insulin is the first-choice diabetes mellitus drug in dogs.
Pituitary Tumors
- The treatment of choice for large pituitary tumors is surgical removal.
Mitotane Therapy
- Hydrocortisone should be dispensed to patients taking mitotane in case they develop severe adverse effects.
- The owner should be instructed to stop administering mitotane during the induction phase when the patient's clinical signs resolve or improve.
Hyperadrenocorticism
- Trilostane is used to treat hyperadrenocorticism.
- Twice daily dosing of trilostane has been shown to best control clinical signs in dogs with hyperadrenocorticism.
Antifungal Drugs
- Ketoconazole inhibits glucocorticoid and androgen synthesis and can be used to treat hyperadrenocorticism.
Feline Diabetes Mellitus
- Glipizide is the most commonly used medication to treat hyperadrenocorticism in cats.
Insulinoma
- Streptozotocin is the preferred treatment choice for ferrets with insulinomas.
Nutritional Recommendations
- The best nutritional recommendation for diabetic dogs is to feed a high-fiber, low-fat diet.
- The foundation of treatment for diabetic dogs is diet.
- Exercise decreases blood glucose.
Blood Glucose Monitoring
- A spot blood glucose of 356 in a diabetic dog indicates poorly regulated diabetes.
Diabetic Remission
- Diabetic remission means the absence of clinical signs of diabetes mellitus, with normal blood glucose levels, without insulin therapy.
Complications of Insulin Therapy
- Hypoglycemia is the most important complication associated with insulin therapy.
- It is better to err on the side of giving too low of an insulin dose rather than too high of a dose.
Week 5 iRATs
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