Endocrine pancreas

Question 1

What is the aetiology of diabetes mellitus in dogs? Predisposing factors?

Answer 1

• Loss of Islets =
  -Infection
  -Pancreatitis
  -Immune mediated disease
  -Hormonal/drug antagonism
• Predisposing =
  -Obesity
  -Endocrinopathy
  -Hyperlipaemia

Question 2

What is aetiology of diabetes mellitus in cats? Predisposing factors?

Answer 2

• Type-2-like Insulin resistance +/- relative insulin deficiency =
  -Beta Cell Dysfunction (Glucotoxicity, Amyloid, ROS)
• Predisposing =
  -Obesity
  -Growth Hormone
  -Pancreatitis

Question 3

What does insulin deficiency cause?

Answer 3

• Increased Glucagon
• Increased Gluconeogenesis
• Decreased cellular uptake
• Osmotic diuresis
• Fatty acid mobilisation = Ketoacid production

Question 4

What are features of insulin deficiency?

Answer 4

• Polyuria
• Polydipsia
• Polyphagia
• Weight loss

Question 5

How is diabetes mellitus diagnosed?

Answer 5

• History
• Clinical signs
• Haematology/ Biochemistry
• Urinalysis
• Glycosylated Hb and fructosamine

Question 6

What would be seen on bloods?

Answer 6

• Hyperglycaemia
• Elevated ALT, ALKP
• Hypertrigyceridaemia
• Urinary Ketones

Question 7

What would be seen on urinalysis?

Answer 7

• Low USG
• Glycosuria
• Ketonuria
• Active sediment

Question 8

What is treatment of diabetes mellitus?

Answer 8

• Dogs = life long - lifestyle change for dog + owner
  = Insulin , diet + routine
• Cats = may go into remission
  = bexagliflozin SGLT 2 inhibitor

Question 9

What is insulin Tx of diabetic dogs + cats?

Answer 9

• Twice daily feeding + Twice daily insulin
• 0.25-0.5iu/Kg insulin
  (Caninsulin + Prozinc)

Question 10

What is dietabry therapy of diabetes mellitus?

Answer 10

• Dietary composition
• Dogs - Fibre/Complex CHO
• Cats - Low CHO, High Protein
• Caloric intake
• CONSISTENT FEEDING
• Consistent exercise

Question 11

What is oral hypoglycaemic drugs?

Answer 11

• Sulfonylureas (glipizide)
• Not first choice (Salvage)
• Bexagliflozin (SGLT-2 blocker - prevents hyperglycaemia - may still be ketotic

Question 12

How would you monitor diabetes treatment?

Answer 12

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)

Question 13

What are signs of insulin overdose? What is treatment?

Answer 13

• Signs = ataxia, collapse, seizure
• Tx = treat hypoglycaemia = give sugary substance under tongue, feed ASAP, avoid insulin dose

Question 14

What should you do with insulin treatment if not eating?

Answer 14

• 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

Question 15

When reading glucose curve, what should the reading be?

Answer 15

• 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

Question 16

What are reasons for recurrence of clinical signs?

Answer 16

• 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

Question 17

What are chronic complications of diabetes?

Answer 17

• Ketoacidosis
• Infections
• Lens induced uveitis
• Diabetic neuropathy
• Cataracts
• Diabetic retinopathy

Question 18

What is diabetic ketoacidosis?

Answer 18

• Insulin deficiency
• Insulin resistance
• Increased circulating levels of diabetogenic hormones

Question 19

What are clinical features of ketoacidosis?

Answer 19

• Vomiting
• Depression
• Dehydration
• Weakness
• Tachypnoea
• Signs of concurrent disease eg pancreatitis, infection, etc

Question 20

How is diabetic ketoacidosis diagnosed?

Answer 20

• Diabetes + Ketonuria = DKA

Question 21

How do you treat diabetic ketoacidosis?

Answer 21

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

Question 22

What is insulinoma?

Answer 22

• Functional tumour of pancreatic B-cells = produce insulin = hypoglycaemia

Question 23

What are clinical signs of insulinoma?

Answer 23

• Often episodic (fasting, exercise, excitement)
• Weakness, trembling, ataxia, seizures
• +/- other neurological signs
• May have weight gain

Question 24

How are insulinomas diagnosed?

Answer 24

• Persistent hypoglycaemia
• Normal glucose does not exclude
• Elevated insulin - fast till patient becomes hypoglycaemic + measure insulin (normal/high insulin = insulinoma)
• Pancreatic mass

Question 25

What is Tx of insulinoma?

Answer 25

• 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

Question 26

What is gastrinoma? Dx? Tx?

Answer 26

• 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