Hypoglycaemia Flashcards
What are the clinical signs of hypoglycaemia in dogs and cats?
- Hunger
- restlessness
- shivering
- ataxia
- disorientation
- convulsions
- coma
What factors might make a blood glucose result for hypoglycaemia unreliable in a veterinary practice?
- Stress
- if they’ve just eaten
- storage of sample (no anti-coagulants)
- bacteria etc.
What are the main differentials for hypoglycaemia in a puppy?
- GDV
- Liver disease
- hypoadrenocorticism
- insulinoma
- sepsis
- neuro
What important steps would you include in your diagnostic plan for hypoglycaemia?
- Urinalysis
- bloods
- general exam
- neuro exam
- radiographs
Give at least one likely clinical example to illustrate the following causes of hypoglycaemia:
Excessive uptake of glucose by normal or neoplastic cells?
Insulinoma, Cancers
Give at least one likely clinical example to illustrate the following causes of hypoglycaemia:
Impaired hepatic gluconeogenesis or glycogenolysis?
Liver failure
Give at least one likely clinical example to illustrate the following causes of hypoglycaemia:
A deficiency in diabetogenic hormones?
Pancreatitis,
hyperadrenocorticism
There are several reasons why a diabetic dog or cat might present with a low blood sugar. How many can you think of?
- Not eaten
- Overdose of insulin
- Relative insulin overdose (vom, exercise)
- Increased use of glucose (infection, preggers etc.)
- Decreased glucose production
A client calls because their 6 month old Labrador pup has just stolen a multi pack of sugar free chewing gum from her handbag.
What advice you would need to give to the owner?
Xylitol is quickly absorbed –> large insulin release –> dangerous hypoglycaemia (in nonprimates)
Advice: Hospitalise, monitor, give glucose CRI?, (maybe induce vomiting)
A 15 week old ME Yorkshire Terrier puppy presents collapsed and twitching.
His owners noticed he was having difficulty passing urine a couple of days ago. His bladder is tense and painful and you can’t pass a urethral catheter beyond the level of his os penis.
His blood glucose is 1.5mmol/l.
What is your top differential for this clinical situation?
Bladder stones
You have been treating an obese diabetic cat with diet management and low dose insulin for the last 4 weeks. His owners call to say they have found him cold and collapsed in the garden. He is able to lift his head but is yowling and his pupils are dilated. He staggers and falls if he tries to walk.
He had his usual insulin dose (1 unit) 4 hours ago and ate his breakfast as normal.
What advice will you give?
JAM (or jam substitute)
Bring to vets for discussion after
A 10 year old FN cross breed is rushed in as an emergency. She has been slowing up on walks recently but has still been eating well. She has put on some weight in the last couple of months. Her owners assumed she has arthritis and the weight gain was due to reduced exercise.
She went out in the garden half an hour ago and her owners then found her outside having a seizure which seems to have stopped but she is still vacant, unable to stand and twitching. A vet nurse has checked her blood glucose which is 1.3mmol/l
How will you manage this situation and what will you do first?
IV glucose, followed by blood tests and urine samples
You need to think about how to reach a diagnosis
History, Blood, urine, radiographs
What possible complications are associated with giving more concentrated glucose solutions in to a peripheral vein?
- Vein irritation and damage
- Embolus
- Circulatory overload
What is an insulinoma?
Beta cell cancer
Is insulinoma more likely in dogs or cats?
Dogs
What are the early clinical signs of insulinoma and why are they often missed?
Exercise intolerance, lethargy etc. very easy to fob off
What is the definitive test for insulinoma?
High insulin with low glucose
What is the imaging modality of choice for staging an insulinoma?
Thoracic and abdominal radiograph looking for metastases
In people insulinoma is often a benign condition with a good cure rate- is the same true for our patients?
No usually malignant, often metastasises
What factors determine the prognosis and treatment options for a dog with insulinoma?
Surgery has best prognosis, but still not great (approx survival time from 2 –> 4 years with adjunctive medical)
- Stage 2 –> 18 months
- Stage 3 –> 6 months
What are the risks associated with surgical removal of an insulinoma?
- Persistent hypoglycaemia (probably metastases)
- Pancreatitis or diabetes mellitus
- Polyneuropathy
- Duodenal necrosis and perforation
What feeding regime would you suggest for an elderly dog with insulinoma where her owners have decided against any invasive procedures?
- Small and frequent meals
- Exercise restriction
- Glucocorticoids (^ hepatic gluconeogenesis and decrease cellular uptake)
- Diazoxide, inhibits pancreatic insulin secretion, and decrease tissue uptake
- Prognosis usually 6-18 months
