Approach to diabetic patient and hypoadrenocorticism

Question 1

Summarise cause of DKA

Answer 1

Primarily caused by a severe deficiency of insulin in the body, most commonly associated with type 1 diabetes. In the absence of sufficient insulin, cells are unable to use glucose, leading to a reliance on fat metabolism for energy production.

This metabolic shift results in the release of ketones, acidic byproducts of fat breakdown, into the bloodstream. Accumulation of ketones leads to ketosis and an increase in the acidity of the blood,

Question 2

Functions of insuline

Answer 2

Glucose Uptake: It promotes the movement of glucose from the bloodstream into cells, where it can be used for energy.

Glycogen Synthesis: Insulin stimulates the conversion of excess glucose into glycogen in the liver and muscle cells.

Inhibition of Glucose Production: Insulin inhibits the liver’s production of glucose. This helps prevent excess glucose release into the bloodstream, maintaining blood sugar levels within a normal range.

Protein and Fat Synthesis: Insulin promotes the synthesis of proteins and the storage of fats. It encourages cells to take up amino acids for protein formation and facilitates the storage of fatty acids in adipose tissue.

Question 3

Clinical signs of ketoacidosis

Answer 3

Dehydration
Tachycardia
Vomiting
Haemorrhagic diarrhoea
Poor peripheral perfusion
Acidotic respiration
Collapse
Death

Question 4

Complications of ketoacidosis

Answer 4

Urinary tract infections
Pancreatitis
Gastro-intestinal haemorrhage
Bacteraemia / septicaemia
Acute renal failure
Disseminated intravascular coagulation
Pulmonary thromboembolism

Question 5

Confirmatory tests for ketoacidosis

Answer 5

Urinalysis
Biochemistry

Question 6

What results do you expect to see from a urinalysis of a patient with ketoacidosis

Answer 6

Glucosuria
Ketonuria

Question 7

What results do you expect to see from a Biochemistry test of a patient with ketoacidosis

Answer 7

Hyperglycaemia- Not in cats on SGLT2 inhibitors
Hypokalaemia
Hypophosphataemia
Azotaemia
Hepatopathy

Question 8

What to do for a patient with ketoacidosis

Answer 8

Fluid therapy
Soluble insulin injections
Glucose supplementation needed if not eating and glucose low

Question 9

Outline fluid therapy for a ketoacidosis patient

Answer 9

Give intravenously
K+ supplementation
PO4- supplementation
Calculate requirement for 24 hours taking into account: % dehydration, continuing losses , maintenance
20% of requirement in first hour

Question 10

Outline Soluble insulin injections for a ketoacidosis patient

Answer 10

Little and often!

Intramuscular:
Initial dose = 0.2 IU/kg
Subsequent doses = 0.1 IU/kg every 2 to 4 hours
Monitor glucose hourly

IV:
0.03 units /kg/hour
Run 50 ml of solution through tubing before starting
Monitor glucose hourly

Question 11

Treatment of hypokalaemia

Answer 11

10 mmol KCl per 500 ml fluids
do not exceed 0.5 mmol/kg/hr

Question 12

Signs of hypophosphataemia

Answer 12

Haemolysis
Severe weakness,
Rhabdomyolysis
Stupor, seizures

Question 13

Why can DKA cause hypophosphataemia

Answer 13

Insulin therapy, a key component of DKA treatment, promotes the movement of phosphate into cells, leading to a decrease in blood phosphate levels. Additionally, the loss of fluids through frequent urination, which is common in DKA, can contribute to the depletion of electrolytes, including phosphate.

Question 14

Which route of injection is best to administer insulin for a ketoacidosis patient

Answer 14

Intramuscular

Question 15

What is a common side effect of acute/chronic insulin overdose

Answer 15

Hypoglycaemia

Question 16

Onset of hypoglycaemia after insulin overdose

Answer 16

rapid onset 6-8 hours after insulin

Question 17

Signs of hypoglycaemia

Answer 17

Hunger
Hyperaesthesia, trembling,
Ataxia
Fitting
Collapse

Question 18

Most common source of infection of Septicaemia

Answer 18

Urinary tract

Question 19

Outline how diabetes impair immune function

Answer 19

Impaired neutrophil function
Decreased prostaglandin production

Question 20

What to do if a diabetic patient is seizuring

Answer 20

Stop insulin
Feed ASAP
Sugar solution / Hypostop- NOT IF SEIZURING
Urgent check required
Subsequent dose reduction

Question 21

Treatment for septicaemia

Answer 21

Fluid therapy
Antibacterials
Anti-pyretics?

Question 22

What is insulinomas

Answer 22

Pancreating tumour originating from islet cells causing excessive production of insulin causing hypoglycaemia

Question 23

Signalment of insulinomas

Answer 23

RARE- One or two per year in a referral practice
Older dogs
Sexes equally affected
No confirmed breed association
Larger breeds predisposed ?

Question 24

Clinical signs of insulinomas

Answer 24

General weakness
Episodic collapse
Inco-ordination
Depressed
Apparent blindness
Muscle tremours
Seizures
Weight gain
Neuropathies

Question 25

What is whipple’s triad

Answer 25

Set of three criteria used to diagnose insulinoma. The triad includes symptoms of hypoglycemia (low blood sugar), documented low blood glucose levels during symptoms, and relief of symptoms after glucose administration.

Question 26

Outline 2 Treatment for insulinomas

Answer 26

1. Medical
   Frequent feeding
   Prednisolone
   Diazoxide

2.Surgical
Stabilise medically
Administer glucose before, during and after surgery
Complications = pancreatitis, diabetes (permenant or temporary)
Starve for 24 hours after surgery

Question 27

Insulinomas can also present like what other conditions?

Answer 27

Epilepsy
Brain tumours
Congestive heart failure
Osteoarthritis
Hypoadrenocorticism