Hypoglycemia and Insulinoma

Question 1

When is an animal considered hypoglycemic?

Answer 1

<70 mg/dl

Question 2

When do you start to see clinical signs with hypoglycemia?

Answer 2

<50 or <30

Question 3

Hypoglycemic coma?

Answer 3

sustained seizures for over 30 minutes leads to necrosis of the brain lamina and major brain dz

affects brain stem and cortex - consciousness affected

Question 4

Hypoglycemia causes?

Answer 4

1. Insulinoma
2. extrapancreatic tumors
3. addison’s
4. liver dz (lowered gluconeogenesis and glycolysis)
5. sepsis
6. Insulin OD - most common cause!
7. starvation (pediatric)

Question 5

Hypoglycemia clinical signs?

Answer 5

Anxiety
Tachycardia
bizzare behavior 
weakness/ataxia
muscle twitching
dementia
seizures

Question 6

Insulin overdose Rx?

Answer 6

give glucose asap!!! 
Dextrose 50%*
Glucose
Glucagon
Karo syrup

Question 7

Dose for dextrose 50%?

Answer 7

1 ml/kg IV

Question 8

Natural body mechanisms to raise blood glucose?

Answer 8

Adrenals make glucocorticoids and GH (slow) and Epi (fast)
Epi —> liver –> glycolysis within minutes
Pancreatic alpha cells –> glucagon –> liver –> gluconeogenesis

Question 9

What is insulinoma?

Answer 9

Functional beta cell (malignant) tumor (hyperpigmented)

Usually a beta cell adenocarcinoma

Question 10

adenocarcinoma common in what species?

Answer 10

dogs, cats, ferrets

Question 11

adenoma common in what species?

Answer 11

humans

Question 12

Age and incidence of insulinoma?

Answer 12

middle aged or older

no breed predilection

Question 13

What is the primary site of metastasis for an insulinoma?

Answer 13

liver

Question 14

Clinical signs of insulinoma?

Answer 14

episodic neuroglycopenia

neuro manifestation of hypoglycemia, levels can fluctuate depending on the secretory pattern of the tumor

Question 15

dx of insulinoma?

Answer 15

inappropriate hyperinsulinemia
concurrent hypoglycemia
imaging unreliable
amended insulin/glucose ratio >50 (unless + sepsis)

Question 16

Why do you get post-op hyperglycemia with insulinoma resection?

Answer 16

normal beta cells are on vacation because the tumor was making all the insulin
takes time for them to kick back into action
can become permanent insulin-dependent diabetics

Question 17

What can cause a complicated recovery from insulinoma resection other than post-op hyperglycemia?

Answer 17

acute pancreatitis
usually see vomiting, fever, tender belly
check amylase and lipase - 5x above normal = most likely pancreatitis

Question 18

What happens if animal has recurrent hypoglycemia some time (a year?) after the surgery?

Answer 18

Treat with glucose supplementation until become resistant and die

Will most likely find insulinoma regrowth/metastasis on necropsy

Question 19

insulinoma medical treatment?

Answer 19

Frequent feeding
diazoxide
prednisone

also octeotride (somatostatin), propanolol, phenytoin, amlodipine, and verapamil

Question 20

Hypoglycemia in sepsis

Answer 20

gram - bacteria and endotoxins

hypoxia –> lowered ATP –> inhibits gluconeogenesis –> hepatic glycogen depletion –> shift to anaerobic metabolism

Question 21

What is paraneoplastic (extrapancreatic) Hypoglycemia usually associated with?

Answer 21

A tumor that produces IGF-2 (mimics insulin)

peripheral lymphadenopathy?

Question 22

hypoglycemia of pregnancy reason and rx?

Answer 22

no idea why, just give dextrose and maintain until birth (usually happens at late term)

Question 23

What percent of addison’s cases have Hypoglycemia?

Answer 23

20%

Question 24

What causes Hypoglycemia in addison’s?

Answer 24

absence of glucocorticoids –> decreased gluconeogenesis

Question 25

Addison's Hypoglycemia ECG?

Answer 25

atrial standstill

Question 26

missing p waves + bradycardia = ?

Answer 26

atrial standstill