Endocrine Pancreatic Disorders 3

Question 1

Does canine DM remiss?

Answer 1

No remission unless not really a type 1 (eg. d/t diestrus, steroids, hyperA - then possible)

Question 2

Does feline DM remiss? Confounding factors?

Answer 2

25-50% (maybe more)

• confounding factors: disease, phenotype
• ^ remission rate if diabetic

Question 3

How can remission be controlled in cats?

Answer 3

• • dont be in a hurry
• reduce by 0.5 - 1 IU q few days
• then SID 1IU/cat/24hourss
• check glucose >12hrs post insulin
• only stop insulin if euglycaemia at >12hrs
• low carb diet and continue regular checks
  > WILL ALWAYS BE DIABETIC, WILL NOT ALWAYS REQUIRE INSULIN

Question 4

Summary of tx for DM

Answer 4

• BID lente
• 2 meals roughly 12 hrs
• dietary manipulation
• monitoring
• dynamic problem ( will change throughout life)

Question 5

Summary dogs DM

Answer 5

• absolute insulin deficiency
• islet number v or absent
• variable insulin requirement
• dose tends to increase
• ~0.75 unit/kg/12hrs
• caloric intake CONSISTENET (no evidence for carbs)

Question 6

Summary cats DM

Answer 6

• relative insulin deficiency
• islet numbers same or decreased
• insulin odse varies
• dose may decrease or increase
• ~2 units/cat/12hrs
• consistent caloric intake with LOW CARBS

Question 7

Ketoacidosis

Answer 7

-

Question 8

What endocrine panreatic disorder can cause episodic weakness, neuromuscular problems, seizures and metabolic pertubations?

Answer 8

-

Question 9

What is the immediate treatmeent of a generalised tonic clonic seizuring dog? What about 2nd seizure in a row?

Answer 9

• catheter and give midazolam or diazepam
• rectal diazepam at home (not that useful)
• KBr and phenobarb better long term not short term
  > 2nd
• give midazolam diazepam and take bloods

Question 10

What biochem changes may be seen following generalised tonic clonic sezires?

Answer 10

• Hypoglycaemia (But only if for a very long period of time so if only had one seizure then more likely the cause of the seziure not the result)
• CK ^

Question 11

Most common cause of hypoglycaemia induced seziureing in a 8yo FN springer with no previous hx ? How would you r/o other options?

Answer 11

• liver disease (liver have to be in FAILURE, which would -> v urea, cholesterol, albumin)
• insulinoma *
• Addison’s (stress leucogram present)
• puppy/toy breed (wrong signnalment)
• other paraneoplastic syndrome *
• sepsis (too well)
• iatrogenic insulin overdose (not on insulin)
• other dz
• NOT FASTING (can fast for a long time before becoming hypoglycaemic)

Question 12

If insulin 80 (35-140pmol/l) with hypoglycaemia, can you tell if the dog has an insulinoma?

Answer 12

YES

- pathologically high, with hypoglycaemia should be very low!

Question 13

Diagnosis of insulinoma

Answer 13

• hypoglycaemia
• hyperinsulinaemia (or innappropriatly normal with hypoglycaemia)
• ultrasound?

Question 14

Tx insulinoma

Answer 14

• surgical removal BEST (even if mets can combine with medical)
• diazoxide (inhibit insulin secretion)
• freq small meals (low carb, complex - dont anger the B cells!!)
• GCs
• streptozo(to)cin (chemo targets B cells)
• pasireotide (inhibtis pituitary and pancreas)