Bryan - Sa Med - Endocrine Pancreas - Final Exam - Fall 3Rd Year

Front 1

What are the major types of diabetes mellitus affecting small animals? Which animals are in each group?

Back 1

Type 1 (insulin dependent; DOGS)
Type 2 (insulin deficient/resistant; CATS)
Type 3 (transient; either, rare)

Front 2

What are some disease processes leading to insulin resistance?

Back 2

Acromegaly
Hyperadrenocorticism
Hyperthyroidism

Front 3

What are the 4 classic signs of diabetes mellitus?

Back 3

Polydipsia
Polyuria
Polyphagia
Weight Loss

Front 4

How does the cellular hypoglycemia in diabetes mellitus lead to PU/PD?

Back 4

Low glucose in cells stimulates epinephrine/glucagon release which increases glucose, leading to glucosuria and osmotic diuresis.

Front 5

How does DM cause ketoacidosis?

Back 5

Lack of insulin stimulates lipolysis, resulting in more FFAs which are oxidized into ketones.

Front 6

What effect does ketoacidosis have on electrolytes?

Back 6

Ketones get in urine, act as an osmotic diuretic, and pull Ca, K, Mg, and Na into the urine. (Although you don't get hypocalcemia)

Front 7

What is the formula for anion gap?

Back 7

Anion gap = (K + Na) – (Cl + HCO3)

Front 8

T or F:
Glucose concentration is a major contributor to plasma osmolarity.

Back 8

False! Na and K are 40x more potent!
Osmolality (mOsm/kg) = 2(Na + K) + 0.05(glucose in mg/kg)
However, in hyperosmolar syndrome, glucose IS the biggest contributor 'cause it can exceed 1000 mg/dl

Front 9

If a diabetic gets all dehydrated for some reason, what may occur? What signs would be seen?

Back 9

Hyperosmolar DM;
Neuro signs and no ketoacidosis!

Front 10

Why do cats get pancreatic amyloidosis?

Back 10

Amylin is secreted along with insulin

Front 11

Which of the following is NOT thought to commonly contribute to diabetes mellitus in dogs?
a) genetics
b) amyloid
c) adipokines
d) glucose toxicity
e) diet

Back 11

b) amyloid
e) diet (the "carnivore connection")

Front 12

What is the typical signalment for diabetes mellitus in the dog? The cat?

Back 12

Dog (older female terrier, poodle, & etc)
Cat (older male Burmese)

Front 13

In addition to the 4 major signs of DM, what else might be commonly seen (there is a hint here....SEEN...like EYES) in the dog? What is the pathogenesis of this?

Back 13

CATARACTS!!!
Fructose and sorbitol get stuck in the lens!

Front 14

In addition to the 4 major signs of DM, what else might be commonly seen in the cat? What is the pathogenesis of this?

Back 14

Polyneuropathy
Fructose and sorbitol surround nerves, pull in water and cause demyelination

Front 15

Why doesn't ketosis occur with hyperosmolar diabetes mellitus?

Back 15

Pancreas produces a small amount of insulin

Front 16

T or F:
Ketonuria doesn't necessarily mean that there is ketoacidosis.

Back 16

True!

Front 17

What is the target glucose level for a patient in diabetic ketoacidosis? How is this achieved?

Back 17

Shoot for 75-250 mg/dl glucose
(1st stabilize pt w/fluids, start regular insulin and lower glucose 50mg/dl/hr until goal is reached)

Front 18

What are the three components of monitoring DM therapy?

Back 18

Clinical signs
Glucose curves
Serum fructosamine

Front 19

If you're using a human glucometer on a dog, what fudge factor should you add or subtract?

Back 19

add 30mg/dl to the measured value

Front 20

What serum analyate can give an indication of glucose levels irregardless of stress levels?

Back 20

Fructosamine levels! (normal values <350 mg/dL)

Yeah I said irregardless! I know its not a real word but who cares!?

Front 21

T or F:
Glucose has little effect on urine specific gravity.

Back 21

True!
4+ glucose only raises USG by 0.01.

Front 22

T or F:
Diabetic remission rates are much greater in cats than in dogs.

Back 22

True! 25 to 90% remission in cats (depending on the study and timeline)

Front 23

T or F:
Some DM dogs can be treated by diet management only.

Back 23

False! All dogs need insulin therapy!

Front 24

Which of the following would be best used in sick patients?
a) humulin R
b) Lente insulin
c) PZI insulin
d) Glargine
e) Detemir

Back 24

a) humulin R (short-acting insulin)

Front 25

What are the ultra long-acting analogues? How are the dosages different?

Back 25

Glargine
Insulin detemir (30% dosage of glargine)

Front 26

T or F:
Dosing of insulin should be made on ideal, not actual body weight.

Back 26

Tru dat!

Front 27

When treating a stabilized dog for diabetes mellitus, which drug would probably be the best to start off with?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr

Back 27

a) NPH; good to start off in the mid-range; may want to try Glargine/Detemir or PZIr later

Front 28

When treating a stabilized cat for diabetes mellitus, which drug would probably be the best to start off with?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr

Back 28

d) Glargine (or detemir)
Maybe PZIr

Front 29

Which of the following is primarily used in cats?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr

Back 29

d) Glargine (or detemir)
e) PZIr

Front 30

Which of the following is least potent?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr

Back 30

d) Glargine

Front 31

Which of the following is insoluble at neutral pH?
a) NPH
b) Lente
c) Biguanides
d) Glargine
e) PZIr

Back 31

d) Glargine

Front 32

What is a dangerous possible side effect to adjusting insulin dosages too rapidly?

Back 32

Samogyi phenomenon

Front 33

What occurs in the Samogyi phenomenon?

Back 33

Glucose gets REALLY low and cortisol, glucagon, epinephrine, and GH all ramp up, causing a compensatory hyperglycemia (often over 400 mg/dL)

Front 34

What is the signalment for insulinomas?

Back 34

Ferrets!!!
Also medium/large breed older dogs.
Rare in cats

Front 35

Which of the following are congruent with insulinomas?
a) seizures
b) weakness/ataxia
c) hypoglycemia
d) vomiting
e) hypomagnesemia

Back 35

a) seizures
b) weakness/ataxia
c) hypoglycemia
d) vomiting

Front 36

What is the most consistent lab finding with an insulinoma?

Back 36

HYPOGLYCEMIA

Front 37

How can an insulinoma be diagnosed?

Back 37

high insulin:glucose ratio
+ clinical signs;
Exploratory laparotomy

Front 38

T or F:
A BAR animal shows high insulin and low glucose. Thus, insulinoma is very likely.

Back 38

False!
insulin:glucose ratio has a poor specificity and this animal has no clinical signs.

Front 39

Which hormones play major effects in the pathophysiology of insulinomas?

Back 39

Insulin
Catecholamines
Glucagon

Front 40

Which electrolytes are important to supplement when treating DKA and why?

Back 40

K and P; insulin reduces K and P (remember refeeding syndrome???)

Front 41

Describe the dextrose and insulin protocol in a patient with >250 mg/dl glucose.

Back 41

Give insulin
No Dextrose

Front 42

Describe the dextrose and insulin protocol in a patient with 75-250mg/dl glucose.

Back 42

Give insulin
2.5% dextrose

Front 43

Describe the dextrose and insulin protocol in a patient with <75 mg/dl glucose.

Back 43

no insulin
5% dextrose

Front 44

Describe the dextrose and insulin protocol in a patient with <50 mg/dl glucose.

Back 44

no insulin
BOLUS dextrose

Front 45

What are the regulatory cut-off points for beta cell excretion of insulin?

Back 45

Glucose >110mg/dl (EXCRETE INSULIN)
Glucose <65mg/dl (STOP EXCRETION)

Front 46

T or F:
Most insulinomas are malignant.

Back 46

True!

Front 47

What are some major differentials you should rule-out first before looking into an insulinoma in a dog?

Back 47

Paraneoplastic effects (leiomyoma, hepatic cancer, HSA)
Artifacts
Iatrogenic
Liver failure (CPSS or cirrhosis)
Sepsis

Front 48

Why might a dog with an insulinoma and blood glucose of 40mg/dl not have clinical signs?

Back 48

Due to upregulated CNS glucose receptors and increased sensitivity

Front 49

What are medical management options for insulinomas?

Back 49

Prednisone + diet
(Diazoxide or streptozocin if they don't work)