Endocrine pancreas 1 + 2 Flashcards

Question

Describe the use of pin prick glucose monitors

Answer 1

Some owners can be trained to perform glucose monitoring at home using patient side glucometers, sampling using ear or lip-prick. This may provide a more representative measure of the performance of the insulin treatment in any given animal.

Answer 2

- Prolonged insulin antagonistic eﬀects of counter-regulatory hormones - Poor appetite - Stress

Answer 3

- Administration technique and insulin activity problems - Insulin overdose and glucose counter-regulation - Short duration of insulin eﬀect - Inadequate insulin absorption - Circulating insulin binding antibodies - Concurrent disorders causing insulin resistance

Answer 4

Ketoacidosis Infections Lens induced uveitis Diabetic neuropathy Cataracts Diabetic retinopathy

Answer 5

Is insulin eﬀective at lowering blood glucose? How quickly does the insulin act What is the glucose nadir? What is the duration of insulin action?

Answer 6

- Is the owner giving the injections correctly? - Is the owner using the correct dose and syringes? - Is the insulin being handled/stored appropriately? - Is the insulin out of date? - What is the feeding regime?

Answer 7

The Somogyi phenomenon occurs when there is hypoglycaemia (<3.5 mmol/l) followed by hyperglycaemia (>17 mmol/l) within 24 hours of insulin injection

Answer 8

When insulin requirements exceed 2 U/kg and clinical signs persist or when the animals show clinical signs of hypoglycaemia in the afternoon. The diagnosis of the Somogyi phenomenon is done with blood glucose curves

Answer 9

The dose of insulin should be reduced by 25-50%.

Answer 10

This occurs when the duration of the insulin eﬀect is less than 18 hours. Diagnosed by performing a blood glucose curve and identifying hyperglycaemia (>14 mmol/l) within 18 hours of insulin injection WITHOUT previous hypoglycaemia. Indicated to switch to a longer acting insulin (if administering insulin once daily) or to administer insulin twice daily

Answer 11

The presence of hyperglycaemia (>17 mmol/l) throughout the day, despite insulin dosages > 2 U/kg

Answer 12

Hyperadrenocorticism Steroid or progestagen administrationdiestrus or pregnancy Acromegaly Concurrent illness Infection Hypothyroidism (dogs), hyperthyroidism (cats).

Answer 13

Insulin overdose

Answer 14

Weakness, shaking, ataxia or seizures at the time of the peak eﬀect of the insulin The owners should be warned about these clinical signs and asked to feed the patient as soon as possible

Answer 15

- Medical emergency - Occurs as a consequence of imbalance between insulin and counter- regulatory hormones -> increase in lipolysis and free fatty acids (FFA). - The FFA are metabolized in the liver to ketone bodies. - When the ketone production exceeds peripheral utilization of ketones, ketonemia results - Ketone bodies are acidic and the build-up of ketones in the body causes metabolic acidosis

Answer 16

The presence of severe academia, electrolyte imbalances and dehydration lead to vomiting, diarrhoea and anorexia, which contributes to the water and electrolyte loss.

Answer 17

Cause an increase in plasma osmolarity which leads to cellular dehydration

Answer 18

Diabetes + ketonuria

Answer 19

Provide adequate amounts of insulin Restore water and electrolyte losses Correct acidosis Identify any concurrent illness Provide carbohydrate substrate

Answer 20

Urinalysis Haematocrit Plasma protein concentration Blood glucose concentration Urea and creatinine Serum electrolytes

Answer 21

Fluids are the most crucial aspect to treating DKA. Rehydration alone will lower blood glucose concentrations. Often beneﬁcial therefore to start patients on ﬂuids for a few hours prior to giving insulin Dehydration should be corrected over 24 hours

Answer 22

Potassium and phosphate Most DKA's are moderately to severely hypokalaemic, due to urinary and gastro- intestinal potassium loss As treatment begins to correct the acidosis, the serum K+ concentration will drop. Insulin also causes K+ to move intracellularly

Answer 23

1. Intermittent intramuscular regime - Initial loading dose of regular crystalline insulin im, measure glucose every hour - Maintained until glucose levels are normal and patient has started eating 2. Constant low dose insulin infusion

Answer 24

Functional tumour of pancreatic islet β-cells. Produce insulin resulting in hypoglycaemia

Answer 25

Often episodic: include lethargy, weakness, trembling, ataxia, collapse, seizures, or bizarre behaviour. Signs often precipitated by fasting, exercise, or excitement. Episodes can be short. Physical exam may be normal, there may be weight gain as insulin is anabolic. May have neurological deﬁcits if hypoglycaemic at the time.

Answer 26

- Hypoglycaemia (persistent: beware of lab error) - Normal glucose doesn’t rule it out: can ﬂuctuate. Sometimes need to fast the patient for a few hours under observation, with hourly samples. - Elevated insulin at a time of low blood glucose - Pancreatic mass +/- metastasis – detected by palpation, radiography, ultrasound, exploratory laparotomy. Can be very small: easily missed.

Answer 27

- IV glucose if needed - Avoid excess stimulation of insulin by giving: Frequent small meals - Avoid simple sugars, Use diet high in complex carbohydrates, protein and fat - Prednisolone - Oral hyperglycaemics (expensive, not licensed) - Surgery (pancreatitis)

Answer 28

Long-term prognosis is guarded, as metastasis is common leading to eventual recurrence of signs

Answer 29

Functional pancreatic islet α2 or δ- cell tumour producing gastrin This results in gastric hyperacidity and risk of ulceration

Answer 30

Vomiting, haematemesis, diarrhoea, melaena, pain, anorexia, weight loss, pallor, pyrexia, cranial abdominal pain, dehydration, shock and tachycardia