Sami Endocrine - Hypoglycemia

Front 1

What is insulin?

Back 1

anabolic hormone that increases fat and protein synthesis, increases hepatic glycogenesis, decreses hepatic glycogensis and stimulate glucose by cells

Front 2

When is insulin increased? inhibited?

Back 2

when blood glucose is greater than 110 mg/dl

when blood glucose decreases below 60mg/dl

Front 3

What are not likely causes of hypoglycemia?

Back 3

starvation
malabsorption
renal glucosuria

Front 4

How does artifact cause hypoglycemia?

Back 4

It doesn't, the animal may appear hypoglycemic if a blood sample is stored without being separated.

blood glucose may decrease up to 10mg/dl/hr in a stored blood sample after collection due to RBC consumption of glucose

Front 5

How do you avoid artifact?

Back 5

separate the sera from blood within the hour

blood glucose is stable in the fridge up to 48 hours

Front 6

How can an animal be iatrogenically hypoglycemic?

Back 6

due to excessive insulin dose

Front 7

What is puppy hypoglycemia?

Back 7

seen in young toy breed dogs that have high energy requirements

precipitated by stress illness or GI upset

caused by limited glycogen and body fat stores or decreased or poorly developed gluconeogenic enzymes?

Front 8

What is glycogen storage disease?

Back 8

rare congenital hepatic enzyme deficiency

animals are unable to convert glycogen to glucose

Front 9

What is hunting dog hypoglycemia?

Back 9

clinical hypoglycemia that occurs in hunting dogs undergoing vigorous exercise

unknown etiology

retire these dogs

Front 10

What hepatic disease cause hypoglycemia?

Back 10

portosystemic shunt
acquired liver disease

Front 11

How can sepsis cause hypoglycemia?

Back 11

WBC and bacteria utilize glucose as an energy source which results in decrease oxygen availability to tissues which increase glycolysis and glucose utilization

there is decreased perfusion and there is a decrease in hepatic glucose production

Front 12

What are growth hormone deficiencies?

Back 12

may decrease in hepatic glucose production and facilitate the peripheral uptake of glucose

GH antagonizes insulin

Front 13

How does hypoadrenocorticism cause hypoglycemia?

Back 13

cortisol deficiency results in impaired hepatic gluconeogenesis and increased peripheral uptake of glucose and hepatic glycogen depletion

seen in 20% of cases

Front 14

How can non neoplastic tumors cause hypoglycemia?

Back 14

due to secretion of polypeptide that has insulin like activity (insulin growth factor)

ex) mesenchymal tumors
-hepatoma
-fibrosarcoma
-hemangiopericytoma

Front 15

What is insulinoma?

Back 15

a tumor of beta cells that causes over excretion of insulin regardless of blood glucose levels

rare but if seen it is most commonly in adult animals

Front 16

What does clinical signs of hypoglycemia depend on?

Back 16

rate of blood glucose fall
blood glucose concentration
duration of hypoglycemia

Front 17

What are neuroglycopenic signs due to hypoglycemia?

Back 17

fatigue
ataxia
confusion
blindness
weakness
collapse
seizures
coma

due to the fact that neurons rely on energy stores solely on glucose

Front 18

What are sympathetic or adrenergic responses to hypoglycemia?

Back 18

hypothalamus recognizes sharp drops in blood glucose

see sympathetic discharge in drop in BG and release epinephrine, glucocorticoids

see signs of hunger, tremors and nervousness

Front 19

What is the signalment of insulinomas?

Back 19

greater than 5 years old
seen more in dogs
reported in cats and ferrets

see seizures as the most common sign

Front 20

How are insulinomas diagnosed?

Back 20

normal or increased insulin when hypoglycemic
CT, ultrasound, possible MRI

Front 21

What is Whipples triad?

Back 21

documentation that hypoglycemia has caused neurological abnormalities is achieved by

-neurologic signs
-occur during hypoglycemia state
-resolves by exogenous glucose administration

Front 22

How to you treat acute cases of insulinomas?

Back 22

give 50% dextrose slowly

give 2.5 - 10% dextrose continuous

karo syrup

do not over correct blood glucose because you might exacerbate insulinoma

Front 23

How do you manage insulinomas?

Back 23

feed small meals ( 4-6) meals with minimal simple sugars

Front 24

What are treatments for insulinomas?

Back 24

partial pancreas removal
drugs
-corticosteroids - antagonist to insulin
-Diaxoide - inhibits insulin secretion
-Streptozoein - cytotoxic to B cells
-Octreotide - Somatostatin analog

Front 25

What is the prognosis of insulinoma?

Back 25

8 months with metastasis
14 months without metastasis