Endocrine pancreas Flashcards
What is the aetiology of diabetes mellitus in dogs? Predisposing factors?
- Loss of Islets =
-Infection
-Pancreatitis
-Immune mediated disease
-Hormonal/drug antagonism - Predisposing =
-Obesity
-Endocrinopathy
-Hyperlipaemia
What is aetiology of diabetes mellitus in cats? Predisposing factors?
- Type-2-like Insulin resistance +/- relative insulin deficiency =
-Beta Cell Dysfunction (Glucotoxicity, Amyloid, ROS) - Predisposing =
-Obesity
-Growth Hormone
-Pancreatitis
What does insulin deficiency cause?
- Increased Glucagon
- Increased Gluconeogenesis
- Decreased cellular uptake
- Osmotic diuresis
- Fatty acid mobilisation = Ketoacid production
What are features of insulin deficiency?
- Polyuria
- Polydipsia
- Polyphagia
- Weight loss
How is diabetes mellitus diagnosed?
- History
- Clinical signs
- Haematology/ Biochemistry
- Urinalysis
- Glycosylated Hb and fructosamine
What would be seen on bloods?
- Hyperglycaemia
- Elevated ALT, ALKP
- Hypertrigyceridaemia
- Urinary Ketones
What would be seen on urinalysis?
- Low USG
- Glycosuria
- Ketonuria
- Active sediment
What is treatment of diabetes mellitus?
- Dogs = life long - lifestyle change for dog + owner
= Insulin , diet + routine - Cats = may go into remission
= bexagliflozin SGLT 2 inhibitor
What is insulin Tx of diabetic dogs + cats?
- Twice daily feeding + Twice daily insulin
- 0.25-0.5iu/Kg insulin
(Caninsulin + Prozinc)
What is dietabry therapy of diabetes mellitus?
- Dietary composition
- Dogs - Fibre/Complex CHO
- Cats - Low CHO, High Protein
- Caloric intake
- CONSISTENT FEEDING
- Consistent exercise
What is oral hypoglycaemic drugs?
- Sulfonylureas (glipizide)
- Not first choice (Salvage)
- Bexagliflozin (SGLT-2 blocker - prevents hyperglycaemia - may still be ketotic
How would you monitor diabetes treatment?
i. Clinical Signs = thirst, Appetite, Weight Gain
ii. Urine Glucose = Afternoon sample, Do not adjust insulin based on this
iii. Glucose Curve - NB 5-7 days for adaptation
iv. Fructosamine (~2wks)
v. Glycosylated Hb (2-3months)
What are signs of insulin overdose? What is treatment?
- Signs = ataxia, collapse, seizure
- Tx = treat hypoglycaemia = give sugary substance under tongue, feed ASAP, avoid insulin dose
What should you do with insulin treatment if not eating?
- Basal insulin always needed to control glucose entry into cells
- If not eating (ill or requiring procedure such as GA)
- Reduce insulin dose by 50%
- Do not stop insulin
When reading glucose curve, what should the reading be?
- Within 4.5 -9mM
- If glucose not returned to >9mM by 12hs do not inject insulin
- feed + continue monitoring until reaches >14mM to asses duration of action of insulin
What are reasons for recurrence of clinical signs?
- 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
What are chronic complications of diabetes?
- Ketoacidosis
- Infections
- Lens induced uveitis
- Diabetic neuropathy
- Cataracts
- Diabetic retinopathy
What is diabetic ketoacidosis?
- Insulin deficiency
- Insulin resistance
- Increased circulating levels of diabetogenic hormones
What are clinical features of ketoacidosis?
- Vomiting
- Depression
- Dehydration
- Weakness
- Tachypnoea
- Signs of concurrent disease eg pancreatitis, infection, etc
How is diabetic ketoacidosis diagnosed?
- Diabetes + Ketonuria = DKA
How do you treat diabetic ketoacidosis?
- Provide adequate amounts of insulin
- Restore water and electrolyte losses
- Correct acidosis
- Identify any concurrent illness
- Provide carbohydrate substrate
What is insulinoma?
- Functional tumour of pancreatic B-cells = produce insulin = hypoglycaemia
What are clinical signs of insulinoma?
- Often episodic (fasting, exercise, excitement)
- Weakness, trembling, ataxia, seizures
- +/- other neurological signs
- May have weight gain
How are insulinomas diagnosed?
- Persistent hypoglycaemia
- Normal glucose does not exclude
- Elevated insulin - fast till patient becomes hypoglycaemic + measure insulin (normal/high insulin = insulinoma)
- Pancreatic mass
What is Tx of insulinoma?
- 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
What is gastrinoma? Dx? Tx?
- Pancreatic gastrin-producing tumour
- Gastric hyperacidity and risk of ulceration
- GI signs can be very severe
- Dx = elevated gastrin levels, imaging, endoscopy
- Tx = Can be surgically removed but frequent metastases
