Endocrine Flashcards
4 hormone that are antagonistic to insulins effects
1 - Glucocorticoids 2 - Inflammation (cause of deregulation) 3 - Epinephrine 4 - Growth Hormone (acromegaly) 5 - Progesterone (pregnancy)
Cells that secrete insulin
Beta cells
List 5+ causes of transient hyperglycemia
1 - Stress
2 - Excitement
• glucosuria possible
3 - Post-prandial
4 - Xylozin
5 - Ketamine3 causes of persistent hyperglycemia
1 - DM
• glucosuria
2 - hyperadrenocorticism
• NO glucosuria
3 - Hyperglucoagonemia / acromegaly (less common)
• Repeat sample to be sure it was one of these
How is DM differentiated from other causes of hyperglycemia?
1 - Hyperglycemia + glucosuria & ketonuria
2 - Persistant hyperglycemia
Cautious interpretation:
- Single measurement w/ hyperglycemia + glycosuria
Regulating:
- Glucose tolerance test
Electrolyte changes that can be assoc’d w/ insulin admin
• What would be the complications if you didn’t think about it?
Potassium & Phosphorus
5 secondary changes commonly assoc’d w/ diabetes
1 - Fluid, e-lyte, acid-base 2 - Lipemia 3 - UTI 4 - Pancreatitis 5 - Fatty liver (endocrine hepatopathy)
9 causes for hypoglycemia
1 - Insulinoma
2 - Hepatic insufficiency
3 - Addison’s
4 - Hypothyroidism
• low metabolic rate –> ↓ consumption
5 - Juvenile hypoglycemia (toy/mini dogs)
• immature liver + high metabolism
6 - Extreme exertion
7 - Gram Neg sepsis
• cytokines, ↓ liver fxn, consumption
8 - Pregnancy ketosis
• fetal consumption (esp twins)
9 - Sample mishandling
• 8% ↓ per hr – if RBC’s left w/ serum
When is it appropriate to test for hyperinsulinism? Why?
Measure Insulin & glucose simultaneously
• Glucose < 60 –> measure insulin levels
• Glucose > 60 –> fast (monitor closely) –> measure if < 60
Bc if glucose is high & insulin is high, this is not an abnormal response.
Abnormal is when insulin remains elevated.
Clinical presentation of DM
• signalment
• classic clinical signs
Middle-aged - Dog ~8 - Cat ~11 Females PU / PD / PP / Weight loss
** may see anorexia if patient feels ill (mentally dull)
= medical emergency!!
Why is hyperglycemia + ketonuria pathoneumonic for DM?
Ketones are only produced in negative energy state.
- If there is hyperglycemia, there is not need for a negative energy state.
- must not be getting into the cells
Diabetes in the horse
may not have glucosuria
?
Species differences assoc’d w/ Epinephrine causing hyperglycemia
Cat
• > 300 mg/dl in agonal state
When would doing a glucose tolerance test (GTT) be indicated?
Persistant hyperglycemia
+ NO glucosuria
Mechanism for fluid / e-lyte /acid base abnormalities assoc’d w/ DM
• Osmotic diuresis –> progressive e-lyte loss (panE-lyte depletion)
• Potassium
- Early: ↓ insulin & acidosis –> Hyperkalemia
- Later: osmotic diuresis –> depletion
** masked by acidosis & dehydration
• Hyperosmotic dilution
- VERY high glucose
–> pulls H2O in vascular space
–> values appear lower than they are
• Titrational Acid-base
- Ketoacidosis
- Lactic acidosis – if perfusion is poor
