Endocrinopathies Diabetes Mellitus

Question 1

Types of DM

Answer 1

Primary DM (Pancreatic disease)

• Autoimmune destruction of islets (dogs)
• islets amyloidosis (cats)
• Pancreatitis (neoplasia)

Secondary DM

• Excess of counterregulatory hormones (Increased GH, increased glucocorticoids)
• obesity (reduced receptor binding of insulin)

Question 2

Consequences of Extracellular glucose excess

- Increased blood glucose leads to:

Answer 2

Glycosuria (polyuria) Dog BG>10mmol/l, Cat BG:
–> Hypokalemia, hyponatremia, hypophosphatemia

Intracellular dehydration:
–> hyperglycemic coma

Glycation of proteins:
–> Lens cataract, retinopathy, peripheral neuropathy, glomerulosclerosis

Question 3

Consequences of intracellular lack of glucose:

- increased lipolysis leads to:

Answer 3

Ketonemia:
–> ketonuria, acidosis, ketoacidotic coma

Weight loss
Hyperlipemia: –> fatty liver

Question 4

Consequences of intracellular lack of glucose:

- increased Gluconeogenesis leads to:

Answer 4

Decreased protein synthesis:

–> weakness, poor wound healing, susceptibility to infections increases

Question 5

DM signalment in dog:

Answer 5

• common diseases
• middle-aged and old dogs
• females are predisposed
• poodle, dachshund, terriers, beagle, puli, labrador, retrivers (english cocker spaniel, rottweiler)

Question 6

Clinical manifestations in uncomplicated DM in dog

Answer 6

• signs may appear 1-2 months after estrus
• history with (possible) pancreatitis +/-
• PU/PD, weight loss, (PP)
• dehydration, hepatomegaly, dull hair coat, flaking skin, cystitis, glycosuria/ketonuria and hyperglycemia
• chronic cases: cataracts/retinopathy, proteinuria +++, (paresis)

Question 7

Clinical manifestations in complicated DM in dog

Answer 7

• same as in uncomplicated + this:
• diabetic ketoacidosis: lethargy, weakness, anorexia, vomiting, coma, Kussmaul´s respiration, odor of acetone in the breath
• hyperglycemic hyperosmolar syndrome (HHS; BG >33mmol/l): restlessness, ataxia, nystagmus, convulsions
• pancreatitis: lethargy, vomiting/diarrhea, abdominal pain
• exocrine pancreatic insufficiency: poorly digested feces, sour smell, flatulence
• signs of cushings, acromegaly

Question 8

Laboratory and instrumental findings in dog:

Answer 8

• Increased: WBC, PCV, ALT, ALKP(SIAP?), BUN/creatinin, amylase/lipase, cholesterol, progesterone, cortisol, GH. K+ increasd/decreased
• metabolic acidosis
• (fructosamine, glycosylated hemoglobin, IV glucose tolerance test)
• Bacteruria: sediment and culture
• Abdominal US: diffuse hepatomegaly, pancreatitis +/-, enlarged adrenals +/-, neprhopathy +/-, cystitis +/-, ovarian/uterine cyst +/-

Question 9

DM signalment in cat:

Answer 9

• relatively rare

- more common in male cats

Question 10

clinical manifestations in cats:

Answer 10

• sudden onset of PU/PD
• (weight loss, PP)
• cataracts are rare
• neuropathy: plantigrade posture of hind legs

Question 11

Laboratory and instrumental findings in cats:

Answer 11

• hepatic lipidosis is more severe: increased TBr

- hypokalemia is common

Question 12

diagnosis in cats

Answer 12

• hyperthyroidism: PP and weight loss dominated, goiter

- stress hyperglycemia is frequently found in healthy cats –> urine glucose at home (or: fructosamine)