Diabetes mellitus manual merck

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Common Veterinary Topics. Videos Figures Images Quizzes. Thousands of topics in all veterinary fields. Information that is clear and easy to understand on thousands of veterinary topics. Free, and always will be. The Merck Manuals are offered as a free public service to the general public and veterinary professionals. In the presence of elevated glucagon and other counter-regulatory hormones, free fatty acids are broken down into ketoacids.

As ketoacids and glucose accumulate in the blood, metabolic disturbances occur, which can be profound and life threatening. These include dehydration, hypovolemia, elevated anion gap, metabolic acidosis, electrolyte disturbances, azotemia, elevated liver enzymes, hyperlactatemia, and clinical signs of vomiting and anorexia.

Treatment involves rehydration and the use of short- and long-acting insulins to reduce ketone production and establish euglycemia. Hyperosmolar hyperglycemic state is another syndrome of decompensated diabetes mellitus. It is less common than diabetic ketoacidosis. In the classical form animals are not ketotic or acidotic, however, mixed forms occur with severe hyperosmolality compounded by ketoacidosis. A diagnosis of diabetes mellitus is based on persistent fasting hyperglycemia and glycosuria.

In cats, stress-induced hyperglycemia is a frequent problem, and multiple blood and urine samples may be required to confirm the diagnosis. Measurement of serum fructosamine can assist in differentiating between stress-induced hyperglycemia and diabetes mellitus. In cases of stress-induced hyperglycemia, the fructosamine concentrations are normal.

In all cases, a search should be made for drugs or diseases that predispose to diabetes. Longterm success depends on the understanding and cooperation of the owner.

Treatment involves a combination of weight reduction, diet, insulin, and possibly oral hypoglycemics. Intact females should be neutered. In cats, recent evidence has supported the use of high-protein, low-carbohydrate diets. In dogs, diets high in fiber and complex carbohydrates are preferred. Diet and weight reduction alone will not control the disease, so initial therapy with insulin is required. Most dogs require two doses of insulin a day.

In general, NPH or lente is the initial insulin of choice at a dose of 0. With twice daily injections, two meals of equal calories are given at the time of insulin administration.

Diets high in simple sugars semi-moist foods should be avoided. Clinical signs and serial blood glucose determinations are used to monitor therapy after initial stabilization at home for 5—7 days.

Blood glucose testing is best performed at home to avoid changes in the pet's routine and to minimize the stress of in-hospital testing. Studies both in dogs and cats have shown that at-home monitoring improves glycemic control and increases the likelihood of obtaining remission in diabetic cats. In dogs with poor glycemic control being given NPH or lente insulin, use of the basal insulin detemir should be considered.

Because of its potency, the starting dosage of detemir is 0. In cats, high-protein diets along with insulin therapy are initiated, with reevaluation in 5—7 days. In newly diagnosed cats, insulin glargine is the insulin of choice.

Glargine is a long-acting basal insulin. NPH, lente, or PZI insulins may also be used in cats, with starting dosages ranging from 1 to 3 units, twice daily. However, these insulins are not associated with high rates of diabetic remission. The use of oral hypoglycemic agents glipizide has been evaluated in diabetic cats. Glipizide should not be used in thin or ketonuric cats when absolute insulin deficiency is likely and exogenous insulin administration is required.

Glipizide is administered at an initial dose of 2. Clinical response is seen at 3—4 wk. Ketoacidosis is a serious complication of diabetes mellitus and should be regarded as a medical emergency. Therapy includes correcting dehydration by administration of IV fluids, such as 0. Numerous insulin regimens have been used in treatment of ketoacidotic diabetes mellitus. In the intermittent insulin regimen, regular insulin at 0.

El ejercicio puede disminuir considerablemente la glucemia. Algunos dispositivos permiten que la muestra de sangre se obtenga de otros lugares, como la palma de la mano, el antebrazo, el brazo, el muslo o la pantorrilla. El sensor mide los niveles de glucosa en sangre cada pocos minutos. Por lo general, se aprende a ajustar la dosis de insulina por cuenta propia cuando sea necesario.

Estas alteraciones son directamente proporcionales a la glucemia durante un periodo prolongado. Se suele recomendar que la hemoglobina A1C se mida cada 3 a 6 meses.

Este procedimiento puede permitir que las personas con diabetes mellitus tipo 1 mantengan niveles normales de glucosa. Se pueden tener problemas al manejar la jeringa, ya sea por artritis, por enfermedad de Parkinson o porque se ha sufrido un accidente cerebrovascular ictus, infarto cerebral, derrame cerebral.

Muchas personas mayores tienen dificultad para seguir una dieta saludable y equilibrada, que les permita controlar la glucemia y el peso. Sin embargo, es posible incorporar el ejercicio en la rutina habitual. Por ejemplo, pueden caminar en vez de conducir o subir las escaleras en lugar de tomar el ascensor.

Si las dosis de insulina que se inyectan son estables, se pueden adquirir jeringas precargadas. Pero se pueden usar monitores especiales.

La diabetes tipo 2 se puede prevenir con cambios en el estilo de vida.