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Year 4 Small Animal Studies > Internal Medicine: Endocrinology: Endocrine Pancreas > Flashcards

Internal Medicine: Endocrinology: Endocrine Pancreas Flashcards

1
Q

Describe the different aetiologies of diabetes mellitus in dogs?

A

Loss of iselets
* Infection
* Pancreatitis
* Immune mediated disease
* Hormonal/drug antagonism

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2
Q

What predisposes to diabetes mellitus in dogs?

A
  • Obesity
  • Endocrinopathy
  • Hyperlipaemia
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3
Q

What is the aetiology of diabetes mellitus in cats?

A

Insulin reistance ± insulin deficiency

Combined with obesity, growth hormone and pancreatitis

Leads to beta cell dysfunction

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4
Q

What are the effects of insulin deficiency?

A
  • Increased glucagon
  • Increased gluconeogenesis
  • Decreased cellular uptake of glucose
  • Osmotic diuresis
  • Fatty acid mobilisation- ketoacid production
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5
Q

What are the clinical signs of insulin deficiency/diabetes mellitus?

A
  • PUPD
  • Polyphagia
  • Weight loss
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6
Q

With what basic tests can diabetes mellitus be diagnosed?

A
  • History
  • Clinical signs
  • Haematology/Biochemistry
  • Urinalysis
  • Glycosylated Hb and fructosamine
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7
Q

What does haematology and biochemistry show for diabetes mellitus?

A
  • Hyperglycaemia
  • Elevated ALT, ALKP
  • Hypertrigyceridaemia
  • Urinary ketones
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8
Q

What does urinalysis show for diabetes mellitus?

A
  • Low USG
  • Glycosuria
  • Ketonuria
  • Active sediment (WBCs)
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9
Q

How long is diabetes treated in cats and dogs?

A

Dogs- life long
* Life style change
* Insulin, diet, routine

Cats- may go into remission

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10
Q

How is insulin used for treatment in diabetic dogs?

A
  • Twice daily
  • Feed half ration and then administer insulin
  • 6-8hr later
  • Second part of ration- larger portion
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11
Q

What drug is used for insulin in dogs/cats?

A

Caninsulin or Prozinc

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12
Q

When may synthetic insulins be more desirable?

A
  • May provide better control in cats
  • May have more physiological distribution
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13
Q

What dietary therapy is also used for diabetes in dogs and cats?

A

Dogs
* Fibre/complex CHO

Cats
* Low CHO
* High protein

Consistent feeding, consistent excercise

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14
Q

What oral hypoglycaemic drugs can be used for diabetes?

When are they indicated?

A
  • Sulfonylureas (glipizide)

Not first choice- salvage

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15
Q

How should diabetes mellitus be monitored?

A

Clinical signs
* Thirst
* Appetie
* Weight gain

Urine glucose
* Afternoon sample

Glucose curve- 5-7 days for adaption

Fructosamine- 2w
Glycosylates Hb- 2-3m

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16
Q

What happens in an overdose of insulin?

How is it treated?

A

Ataxia, collapse, seizure

Tx
* Give sugary substance under tongue
* Feed ASAP
* Avoid insulin dose if imminent

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17
Q

What should be done for diabetic dogs if they are not eating?

A
  • Basal insulin always needed to control glucose entry into cells
  • If not eating- reduce insulin dose by 50%

DO NOT STOP

18
Q

How should a glucose curve be created in clinic?

A
  • Duplicate diet and timing of home
  • Serial blood samples- 2h
  • Lowest points should be within normal range (4.5 and 9mM)
19
Q

When should insulin not be given based on glucose curve?

A

If not returned to >9mM by 12 hrs

20
Q

Where can a skin prick be done for a side monitor of glucose?

A

Cats- ear
Dogs- lip/ear

21
Q

When do wireless monitors usually stop working?

A

7-14 days

Often precisely inacurate- don’t show exact blood glucose but follow curve

22
Q

What problems can occur with serial blood glucose curves?

A
  • Activity can have effect- inconsistent
  • Poor appetite
  • Stress
23
Q

What may cause recurrence of clinical signs with treated diabetes?

A
  • Administration technique and insulin activity problems
  • Insulin overdose and glucose counter-regulation
  • Short duration of insulin effect
  • Inadequate insulin absorption
  • Circulating insulin binding Abs
  • Concurrent disorders causing resistance
24
Q

What are potential chronic complications of diabetes mellitus?

A
  • Ketoacidosis
  • Infections
  • Lens induced uveitis
  • Diabetic neuropathy
  • Cataracts
  • Diabetic retinopathy
25
Q

If a diabetic patient is unstable what should paid attention on glucose curves?

A
  • Is insulin effective at lowering blood glucose
  • How quickly does the insulin act
  • Glucose nadir- low point
  • Duration of action of insulin
26
Q

When investigating unstable treated diabetes patient what should be ruled out first?

A
  • Is the owner giving injections correctly
  • Correct dose and syringes
  • Handled/stored appropriately
  • Out of date
  • Feeding regime
27
Q

If insulin is not lowering the blood glucose what should be considered?

A
  • Insulin dose < 2IU/kg increase dose
  • If >2IU/kg- insulin resistance?
    UTI/other disease/Insulin Abs
28
Q

What should be done if the glucose nadir is the following for diabetes?:
1. < 4mmol/l
2. > 8-9mmol/l
3. 4-8 mmol/l

A
  1. Decrease insulin dose
  2. Increase insulin dose
  3. Perfect
29
Q

When is longer acting insulin indicated?

A

When duration of action is too fast

30
Q

What is overswing?

A
  • When too much insulin is given- hypoglycaemic
  • Causes- glucagon, adrenaline, cortisol production
  • This then caused hyperglycaemia

Constant hypo/hyperglycaemia

31
Q

What is the aetiology of diabetic ketoacidosis

A
  • Insulin deficiency
  • Insulin resistance

Increased circulating levels of diabetogenic hormones

32
Q

Describe the pathogenesis of diabetic ketoacidosis

A
  • Lipolysis of fat oxidation- insulin not inhibiting
  • Produces ketoacids- causes metabolic acidosis
  • Ketoacids increase ketones in the blood
  • Ketones in urine causes osmotic diruesis
  • Loss of H2O and electrolytes
  • Causes a loss of perfusion to the kidneys
  • Leading to azotaemia
  • Azotaemia increases plasma osmolarity
  • Causes cellular dehydration
33
Q

What are the clinical signs of diabetic ketoacidosis?

A
  • Vomiting
  • Depression
  • Dehydration
  • Weakness
  • Tachypnea
  • Signs of concurrent disease
34
Q

How is diabetic ketoacidosis diagnosed?

A

Diabetes and ketonuria

35
Q

What are the goals of treatment of diabetic ketoacidosis?

A

Goals of therapy:
* Provide adequate amounts of insulin
* Restore water and electrolyte losses
* Correct acidosis
* Identify any concurrent illness
* Provide carbohydrate substrate

36
Q

How is diabetic ketoacidosis treated?

A
  • Potassium supplementation
  • Phosphate supplementation
  • Bicarbonate therapy
  • Insulin therapy
  • Fluid therapy
  • Concurrent illness tx
  • Insulin therapy
37
Q

Describe insulin therapy for diabetic ketoacidosis?

A
  • Initial loading dose- crystalline insulin (fast acting)
  • Measure blood glucose every hour
  • When glucose < 16mmol/l give regular insulin every 4-6 hours
  • Maintain glucose 8.4-16mmol/l
  • Maintain this until the patient is eating

Or

Constant low dose insulin infusion

38
Q

What is an insulinoma?
What are the clinical signs?

A
  • Functional tumour of pancreatic Beta cells producing insulin
  • Causes hypoglycaemia

CS
* Often episodic
* Weakness, trembling, ataxia, seizures
* ± other neurological signs
* May have weight gain

39
Q

How is insulinoma diagnosed?

A
  • Persistent hypoglycaemia
  • Normal glucose does not exclude
  • Elevated insulin
  • Pancreatic mass- can be small
40
Q

How is insulinoma treated?

A
  • IV glucose if needed
  • Avoid excess stimulation of insulin by giving- frequent small meals, avoid simple sugars
  • Prednisolone
  • Oral hyperglycaemics
  • Surgery
41
Q

What is a gastrinoma?

A
  • Pancreatic gastrin-producing tumour
  • Gastric hyperacidity and risk of ulceration
  • GI signs can be very severe
  • Diagnosis: elevated gastrin levels, imaging, endoscopy
  • Can be surgically removed- frequent metastases

Year 4 Small Animal Studies (97 decks)

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