https://www.vetsurgeon.org/f/clinical-questions/29442/canine-dm-with-poss-hac Hi All I hope you are all well. I have some questions to ask re a new DM case. He is an 11yo JRT who is owned by a lovely elderly lady. He had bloods done at his recent booster due to PU/PD signs. Biochem: glu 27.4, ALKP&gt;2000, ALT 365, GGT 49, Naen-USTelligent Community 10https://www.vetsurgeon.org/thread/226358?ContentTypeID=1Mon, 02 Nov 2020 15:44:10 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:ec70a4c6-643c-4f0c-b808-39a92d00e6e1Anthony Dennison<p>Hi,</p> <p></p> <p>Some patients with DM can have really high ALKP levels. It&#39;s possible there is a degree of HAC but as Beats says, focus on stabilising the DM and only worry about anything else if there is some serious insulin resistance.&nbsp;</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/226205?ContentTypeID=1Mon, 26 Oct 2020 17:34:47 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:31b30dff-564c-4ceb-910e-ccfbdc620655Beats<p>What makes you suspicious of HAC?</p> <p>For me, there&#39;s nothing here other than DM, unless get to 2iu/kg caninsulin twice daily and still not stabilising (or there are some highly suggestive signs specific to HAC such as calcinosis cutis).</p> <p>My answer to (4) would be &quot;yes&quot; this dog likely has just DM causing this magnitude of ALKP increase.&nbsp;</p><div style="clear:both;"></div>