Hypoglycemia

Question 1

Beta cells secrete __ when __ is above 100mg/dL

Answer 1

Beta cells secrete insulin when glucose is above 100mg/dL

Question 2

alpha cells synthesize __ while delta cells synthesize __

Answer 2

alpha cells synthesize glucagon while delta cells synthesize somatostatin

Question 3

what organ is the MOST responsible for regulating blood glucose levels?

Answer 3

the endocrine pancreas

Question 4

Glucagon is glucose __ because its __ and secreting from alpha cells in a __ state

Answer 4

Glucagon is glucose elevating because its catabolic and secreting from alpha cells in a fasted state

Question 5

describe what the liver would do in a fasted state related to blood glucose

Answer 5

the liver stores and releases glucose so in a fasted state the pancreas would release glucagon that would travel through the bloodstream and stimulate gluconeogenesis, glycogenolysis and glycogenesis

Question 6

describe gluconeogenesis (what is it and what lowers/increases it)

Answer 6

This is the formation of glucose that occurs mostly in the liver and sometimes in the kidneys. The release of glucagon and cortisol will cause gluconeogenesis to increase while insulin will inhibit it and cause a lowering of glucose

Question 7

describe glycogenesis

Answer 7

Glycogenesis is the formation of glycogen. Its inhibited by glucagon which causes the conversion to glucose thus glucose to be elevated. Insulin stimulated glycogenesis which lowers glucose (promoting storage)

Question 8

glycogen v glucagon

Answer 8

Glucagon is a hormone that signals the liver to convert glycogen into glucose, while glycogen is a stored form of glucose

Question 9

hypoglycemia is glucose < __mg/dL and in this state what stops being secreted?

Answer 9

60 mg/dL, insulin

Question 10

what role does cortisol play in hypoglycemia?

Answer 10

A deficiency in cortisol can cause hypoglycemia since cortisol plays a role in gluconeogenesis, antagonizes insulin and can be used to treat hypoglycemia

Question 11

list some clinical signs of hypoglycemia

Answer 11

lethargy, ataxia, bizarre behavior, weakness, seizures, coma, low glucose concentration

Question 12

what are the top 4 differentials when diagnosing hypoglycemia?

Answer 12

Liver disease
Addisons
Tumors (insulinomas)
Sepsis

Question 13

whats the typical workup for a hypoglycemic patient?

Answer 13

Ultrasound (insulinomas in the pancreas) , Bile acids (liver dz) , Basal cortisol (addisons), insulin/glucose concentrations

Question 14

what BG/Insulin indicate an insulinoma? whats a maybe?

Answer 14

BG <60 mg/dL with insulin > normal or in the upper 50% of the reference range

It might be an insulinoma if the BG <60 mg/dL and the insulin is in the lower 55% of the reference range

Question 15

what are the basics to treating insulinomas?

Answer 15

1. Diet: give small frequent meals with high fat, protein and complex carbs to prevent high releases of insulin
2. prednisone
3. Diazoxide (prevents pancreas from releasing insulin)
4. surgery to remove the tumor

Question 16

An emergency case arrives at the clinic and you determine it to be hypoglycemic with a BG of 40mg/dL, how should you treat this patient right now?

Answer 16

IV 50% dextrose at 1ml/kg diluted to a 1:4 ratio and/or karo syrup on the gums if the animal isn’t seizing

Question 17

If a hypoglycemic patient has an insulinoma how would that change your initial treatment?

Answer 17

They’ll be stabilized with IV dextrose slowly so not to further insulin release and then placed on a 2-2.5% dextrose CRI once stabilized. Then IV dexmethasone can also be administered to help the insulinoma

Question 18

what is the treatment of choice for insulinomas?

Answer 18

surgery, its diagnostic and therapeutic

Question 19

whats the prognosis like for an insulinoma?

Answer 19

the short term prognosis is good but long term is guarded to poor since almost 100% metastasize