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🥖Diabetes Mellitus🥖, Hyperglycemia despite >1.5U/kg per dose - Coggle…

- - - - Low carb/high protein
      - Correct obesity
      - Feed Rec:
        
        Meal feedings :dog: > :cat:
        
        Strategy
        
        Canned ideal/Kibble for grazing
        
        Offer main meals @ insulin times
    - - Weight-loss in obese patients
      - Health BMI = any diet
      - Low GI
        
        Fermentable fibres
        
        Soluble/insoluble fibres
      - Low fat content (unless weight gain)
  - - - Mild signs
      - No ketosis/systemic illness
      - O. request
    - - Stim. insulin secretion from :fish: cells
      - Side effects
        
        Hepatopathy
        
        Cholestasis
        
        Vomiting
        
        Hypoglycemia
    - - Inhibit GI :baguette_bread: absorption
  - - - 3-6m clinic life
      - Refrigerate
      - Shaking (caninsulin) v rolling (others)
  - - - :dog: 12mmol/L
      - :cat: 14-17mmol/L
- - - - Serum 🥖 incr 10min after stress
      - Mild-Moderate Hyperlgycemia 🐱
      - Serum elevate for >3hr
  - - - Neuropathy (🐱)
        
        Hx + PE
      - UTI (🐶>🐱)
        
        Hx, UA+ culture
      - Cataracts (🐶)
        
        Hx & PE
    - - Diabetogenic Medications (HX)
      - Obesity (Lipase measurement/biochem)
      - Pancreatitis (PE)
    - - Renal dz (Biochem) :cat:>:dog:
      - Hyperthyroidism 🐱 (TT4)
      - Intact/diestrus (Hx + PE) :dog::cat:
      - Cushing's, hypothyroidism 🐶 (endocrine test)
      - Dental dz :dog::cat:
      - Infection :dog::cat:
      - Hypertriglyceridema :dog:
      - Acromegaly :cat:
      - Pancreatitis :dog:>:cat:
- - - - When :question:
        
        ~3m w/ well regulated
        
        Relapse/CS
        
        7-14d after dosing changes
      - Where :question:
        
        :house_buildings:
        
        :two: Measure every 2hr
        
        :three: Note time of injections/meal/snaks
        
        :one: BG prior to meal/insulin
        
        :hospital:
        
        Measure curve in clinic ASAP
        
        :warning: stress hyperglycemia
        
        Picky eater (Feed home)
      - How :question:
        
        :one: Look at NADIR (5-8mmol/L)
        
        :two: NADIR adjustment
        
        Low -> reduce by 25-50%
        
        High
        
        Increase 10-20%
        
        stress, techincal problems, somogyi, resistance
        
        :three: Assess insulin duration (<14mml/L :dog: ; <17mmol/L :cat:)
    - - Reflect BG levels for last 1-3wks
      - Compare to normal (mild elevation = :check:)
  - - - CS gone
      - Negative glucosuria
      - BG normal to low
    - - :arrow_down: insulin dose
      - Recheck 1-2wks after dose change
      - Monitor at home