Endocrine pancreas (Yr 4)

Question 1

what are some causes of diabetes mellitus in dogs?

Answer 1

infection, pancreatitis, immune mediated disease, hormones/drugs causes loss of islets

Question 2

what are some predisposing factors for diabetes mellitus in dogs?

Answer 2

obesity
endocripnopathy
hyperlipaemia

Question 3

what is the pathogenesis of diabetes mellitus in cats?

Answer 3

insulin resistance (type II diabetes) with possible insulin deficiency

Question 4

what can exacerbate diabetes mellitus in cats?

Answer 4

obesity
growth hormone
pancreatitis

Question 5

what biochemical processes will be influenced by lack of insulin?

Answer 5

increased glucagon
increased gluconeogenesis
decrease cellular uptake of glucose
osmotic diuresis
fatty acid metabolism (ketoacids produced)

Question 6

what are the main clinical signs of diabetes mellitus?

Answer 6

PUPD
polyphagia
weight loss

Question 7

what are the findings on haematology and biochemistry that indicate diabetes mellitus?

Answer 7

hyperglycaemia
elevated ALT, ALKP
hypertriglycidaemia
urinary ketones

Question 8

what findings on urinalysis are indicative of diabetes mellitus?

Answer 8

low USG
glycosuria
ketonuria
sediment

Question 9

how is diabetes mellitus diagnosed?

Answer 9

clinical signs with persistant fasting hyperglycaemia and glycosuria

Question 10

how is diabetes mellitus treated?

Answer 10

lifelong insulin, diet and routine
(cats can go into remission)

Question 11

how much insulin should a dog be given for diabetes mellitus?

Answer 11

twice daily (give half daily ration of food then a dose of insulin)

Question 12

how are cats with diabetes mellitus treated?

Answer 12

twice daily injections of insulin (can go into remission)

Question 13

what are the features of a diabetes mellitus diet for dogs?

Answer 13

high fibre and complex carbohydrates
with consistent feeding/exercise

Question 14

what are the features of a diabetes mellitus diet for cats?

Answer 14

low carbohydrates and high protein
with constant feeding/exercise

Question 15

what should be monitored in diabetes mellitus cases?

Answer 15

clinical signs (thirst, appetite, weight gain)
urine glucose
glucose curves and fructosamine (weekly)

Question 16

what are the signs of an insulin overdose in diabetes mellitus patients?

Answer 16

ataxia, collapse, seizures

Question 17

how are insulin overdoses of diabetes mellitus patients treated?

Answer 17

feed immediately and give sugar substance under tongue

Question 18

should therapy for diabetes mellitus be continued if an animal isn’t eating?

Answer 18

yes as basal insulin is always needed to control glucose entry into cells
give a half dose (don’t stop!!)

Question 19

what is the nadir of a glucose curve?

Answer 19

the lowest point on the curve

Question 20

what should the nadir of the glucose curve stay between?

Answer 20

4.5-9mM

Question 21

how is blood glucose measured to get a glucose curve?

Answer 21

skin prick on lip/ear then glucose monitor
can also use wireless monitoring using a patch

Question 22

what are some problems that may effect the accuracy of a blood glucose curve?

Answer 22

depends how active the animal is being
depends on appetite of patient
depends how stressed the patient is

Question 23

what are some chronic complications of untreated diabetes mellitus?

Answer 23

ketoacidosis
infections
lens induced uveitis
diabetic neuropathy
cataracts
diabetic retinopathy

Question 24

what is type 1 diabetes mellitus?

Answer 24

patients pancreas doesn’t make enough insulin meaning they have very high blood glucose

Question 25

what causes overswing of glucose curves in diabetes mellitus patients?

Answer 25

insulin causes massive drop (too low) in blood glucose this trigger glucagon, epinephrine and cortisol which causes a massive increase in blood glucose (too high)

Question 26

why do patients with diabetes mellitus get ketoacidosis?

Answer 26

insulin deficiency/resistance causes an increase in lipolysis and fat oxidation (not being inhibited by insulin) leading to increased ketones in blood which get into urine and cause an osmotic diuresis
osmotic diuresis leads to loss of water/sodium and reduced kidney perfusion which causes an azotaemia and cells become dehydrated

Question 27

what are the clinical signs of ketoacidosis from diabetes mellitus?

Answer 27

vomiting
depression
dehydration
weakness
tachypnoea

Question 28

how can diabetic ketoacidosis be diagnosed?

Answer 28

ketonuria along with being a diagnosed diabetic

Question 29

how is diabetic ketoacidosis treated?

Answer 29

provide adequate insulin
restore water/electrolyte loss (potassium, phosphate, bicarbonate)
correct acidosis
treat concurrent illnesses (pancreatitis…)

Question 30

should you always hospitalise patients with diabetic ketoacidosis?

Answer 30

if patient is clinically well they can be managed at home

Question 31

what is an insulinoma?

Answer 31

insulin producing tumour of pancreatic beta cell (leads to hypoglycaemia)

Question 32

what are the clinical signs of an insulinoma?

Answer 32

weakness, trembling, ataxia, seizures
weight gain
neurological signs
often episodic
(all signs of hypoglycaemia)