The amended insulin to glucose ratio and diagnosis of insulinoma in dogs

Amended insulin to glucose ratios were calculated from the concentrations of serum insulin and blood glucose measured concurrently during either a glucagon tolerance test or after feeding in healthy dogs. Values greater than 30 microU/mg which are supportive of a diagnosis of insulinoma were obtained at certain times during the test period. Amended insulin to glucose ratios calculated from serum insulin and blood glucose concentrations obtained during a glucagon tolerance test and an oral glucose tolerance test on a dog with an insulinoma were less than 30 microU/mg, or equivocal, at different times during the test period. This indicates that under some circumstances healthy dogs may have elevated amended insulin to glucose ratios, and dogs with insulinoma may have a normal amended insulin to glucose ratio. Care is essential for interpretation of amended insulin to glucose ratios, and a diagnosis of insulinoma using the ratio must be made in conjunction with appropriate clinical signs of hypoglycaemia.     

Effects of pre‐operative administration of medetomidine on plasma insulin and glucose concentrations in healthy dogs and dogs with insulinoma

ObjectiveTo investigate the effect of medetomidine on plasma glucose and insulin concentrations in dogs with insulinoma and in healthy dogs undergoing anesthesia and surgery.AnimalsTwenty–five dogs with insulinoma and 26 healthy dogs.MethodsIn dogs with insulinoma, medetomidine (5 μg kg^?1) was randomly included (n = 12) or omitted (n = 13) from the pre–anesthetic medication protocol, which typically contained an opioid and an anticholinergic. Healthy dogs received medetomidine (5 μg kg^?1; n = 13) or acepromazine (0.04 mg kg^?1; n = 13) plus an opioid (morphine 0.5 mg kg^?1) and an anticholinergic (atropine 0.04 mg kg^?1) as pre–anesthetic medications. Pre–anesthetic medications were given intramuscularly. Plasma glucose and insulin concentrations were measured before (sample 1) and 30 minutes after pre–anesthetic medication (sample 2), and at the end of surgery in dogs with insulinoma or at 2 hours of anesthesia in healthy dogs (sample 3). Glucose requirement to maintain intra–operative normoglycemia in dogs with insulinoma was quantified and compared. Data were analyzed with anova and Bonferroni post–test, t–tests or chi–square tests as appropriate with p < 0.05 considered significant. Data are shown as mean ± SD.ResultsMedetomidine significantly decreased plasma insulin concentrations and increased plasma glucose concentrations in healthy dogs and those with insulinoma. These variables did not change significantly in the dogs not receiving medetomidine. In the dogs with insulinoma, intra–operative glucose administration rate was significantly less in the animals that received medetomidine compared to those that did not.ConclusionsPre–anesthetic administration of medetomidine significantly suppressed insulin secretion and increased plasma glucose concentration in dogs with insulinoma and in healthy dogs undergoing anesthesia and surgery.Clinical relevanceThese findings support the judicious use of medetomidine at low doses as an adjunct to the anesthetic management of dogs with insulinoma.     

Effect of octreotide on plasma concentrations of glucose, insulin, glucagon, growth hormone, and cortisol in healthy dogs and dogs with insulinoma

The inhibitory effect of the somatostatin analogue octreotide on the secretion of insulin could be used in the treatment of insulinoma. However, current information on the effectiveness of octreotide in dogs is conflicting. Therefore, the endocrine effects of a single subcutaneous dose of 50 microg octreotide were studied in healthy dogs in the fasting state (n=7) and in dogs with insulinoma (n=12). Octreotide did not cause any adverse effects. In healthy dogs in the fasting state, both plasma insulin and glucagon concentrations declined significantly. Basal (non-pulse related) GH and ACTH concentrations were not affected. A slight but significant decrease in the plasma glucose concentrations occurred. Dogs with insulinoma had significantly higher baseline insulin concentrations and lower baseline glucose concentrations than healthy dogs in the fasting state. Plasma glucagon, GH, ACTH, and cortisol concentrations did not differ from those in healthy dogs. Baseline plasma insulin concentrations decreased significantly in dogs with insulinoma after octreotide administration, whereas plasma concentrations of glucagon, GH, ACTH, and cortisol did not change. In contrast to the effects in the healthy dogs, in the dogs with insulinoma plasma glucose concentrations increased. Thus, the consistent suppression of plasma insulin concentrations in dogs with insulinoma, in the absence of an suppressive effect on counter-regulatory hormones, suggests that further studies on the effectiveness of slow-release preparations in the long-term medical treatment of dogs with insulinoma are warranted.     

Effects of topical application of amitraz on plasma glucose and insulin concentrations in dogs

Amitraz, a formamidine insecticide, is used topically in the treatment of demodicosis and other ectoparasitic infestations. When 3.78 L (containing 2.1 g) of amitraz (twice the recommended concentration) was applied to 5 dogs 4 hours before glucose (0.6 g/kg of body weight) was administered IV, plasma glucose concentration increased, but the increase in plasma insulin concentration, which usually follows IV administered glucose, was suppressed. The results suggested that amitraz induced hyperglycemia at least partly by inhibiting insulin release.     

Spontaneously obese dogs exhibit greater postprandial glucose, triglyceride, and insulin concentrations than lean dogs

Dogs do not appear to progress from obesity-induced insulin resistance to type 2 diabetes mellitus. Both postprandial hyperglycemia and postprandial hypertriglyceridemia have been proposed to cause or maintain beta cell failure and progression to type 2 diabetes mellitus in other species. Postprandial glucose, triglyceride, and insulin concentrations have not been compared in lean and obese dogs. We measured serum glucose, triglyceride, and insulin concentrations in nine naturally occurring obese and nine age- and gender-matched lean dogs. After a 24-h fast, dogs were fed half their calculated daily energy requirement of a standardized diet that provided 37% and 40% of metabolizable energy as carbohydrate and fat, respectively. Fasting and postprandial glucose and triglyceride concentrations were greater in the obese dogs (P < 0.001), although the mean insulin concentration for this group was five times greater than that of the lean group (P < 0.001). Most of the 0.6 mM (11 mg/dL) difference in mean postprandial glucose concentrations between lean and obese dogs was attributable to a subset of persistently hyperglycemic obese dogs with mean postprandial glucose concentrations 1.0 mM (18 mg/dL) greater than that in lean dogs. Persistently hyperglycemic obese dogs had lower triglyceride (P = 0.02 to 0.04) and insulin (P < 0.02) concentrations than other obese dogs. None of the dogs developed clinical signs of diabetes mellitus during follow-up for a median of 2.6 yr. We conclude that pancreatic beta cells in dogs are either not sensitive to toxicity because of mild hyperglycemia or lack another component of the pathophysiology of beta cell failure in type 2 diabetes mellitus.     

Renal clearance, insulin secretion and glucose tolerance in spontaneous diabetes mellitus of dogs.

A standard intravenous glucose tolerance test (IVGTT) and the insulin response to the glucose loads were studied in 14 cases of diabetes mellitus in dogs. In addition, urinary glucose excretion, and clearances of urea, creatinine and phosphate were also determined in these dogs. All diabetic dogs were characterized by glucose intolerance as expressed by an abnormal half-time (T 1/2) or fractional clearance rate (k-value) and were further classified as Types I, II or III diabetes on the basis of their insulin responses. Renal functional impairment was observed in about 60 percent of the cases and was generally mild. There appeared to be no apparent relationship between advanced chronic renal disease and severity of diabetes in dogs.     

Improved survival in a retrospective cohort of 28 dogs with insulinoma

OBJECTIVES: To determine the survival times for a cohort of dogs with insulinoma and to describe the impact of medical therapy both in non-surgical cases and in surgical cases following relapse. METHODS: A retrospective study of dogs with insulinoma is presented. The Kaplan-Meier method is used to evaluate the survival characteristics of this population. RESULTS: Twenty-eight dogs were included in the study. The median survival time for all dogs was 547 days. Nineteen patients underwent partial pancreatectomy. The median survival time for this group was 785 days and for those subsequently receiving prednisolone therapy on relapse it was 1316 days. Perioperative complications are discussed. CLINICAL SIGNIFICANCE: Survival times in this study exceed those in other studies published previously. In part, this is explained by an improved remission duration following surgery compared with previous reports. More striking though is the longevity of patients following institution of medical therapy. These data give strong objective support to the role of medical therapy in the management of canine insulinoma, including following relapse after surgically induced remission.     

Evaluation of the urinary Cortisol: creatinine ratio in the diagnosis of hyperadrenocorticism in dogs

The diagnostic accuracy of the urinary cortisol:creatinine ratio (CCR), with the cortisol being measured by ELISA, was evaluated by subjecting data from 18 dogs with and 20 dogs without hyperadrenocorticism to recelver operating characteristic (ROC) curve analysis. The area under the ROC curve (W 0–93, SE_w 0–044) was much higher than 045, indicating that the CCR did distinguish between dogs with and without hyperadrenocorticism.A cutoff value of about 60 × 10^-6 was assoclated with the highest sensitivity (1.0)and speciflcity (0–85). At the disease prevalence rate of the present study (0 47), the positive and negative predictive values were 0–87 and 1.0, respectively. These numbers indicate that canine hyperadrenocorticism may be safely excluded when the CCR Is below 60 × 10^-6 but that a test of higher specificlty (eg, the ACTH stimulation test) should be used to confirm the diagnosis of canine hyperadrenocorticism when the CCR Is above 60 × 10^-6.     

Effects of the alpha-glucosidase inhibitor acarbose on postprandial serum glucose and insulin concentrations in healthy dogs.

OBJECTIVE: To determine effects of acarbose on baseline and postprandial serum glucose and insulin concentrations in healthy dogs, if effects of acarbose were dosage related, and if acarbose caused any short-term adverse effects. ANIMALS: 5 healthy dogs fed a high-fiber diet. PROCEDURE: A Latin-square design was used. During each 1-week treatment period, dogs were given a placebo or 25, 50, 100, or 200 mg of acarbose, PO, twice daily immediately prior to feeding. There was a 1-week interval between periods. At the end of each treatment period, serum glucose and insulin concentrations were measured prior to feeding and at 30- to 60-minute intervals for 6 hours after feeding. RESULTS: Baseline serum glucose and insulin concentrations, insulin peak response, and total glucose absorption were not significantly different following treatment with placebo and treatment with acarbose; however, total insulin secretion was significantly decreased when dogs were treated with 100 or 200 mg of acarbose. Four dogs developed soft to watery stools when treated with 200 mg of acarbose, and 2 dogs lost weight during the study. Results of CBC and serum biochemical analyses were within reference ranges throughout the study. CONCLUSIONS: Acarbose did not induce any serious adverse effects and was effective in healthy dogs in reducing total postprandial insulin secretion when administered immediately prior to meals. CLINICAL RELEVANCE: Results suggest that acarbose may help control hyperglycemia in dogs with insulin-dependent diabetes mellitus. Additional studies designed to evaluate the effect of acarbose on postprandial blood glucose concentrations in dogs with diabetes mellitus are indicated.     

Influence of topical dexamethasone applications on insulin, glucose, thyroid hormone and cortisol levels in dogs

The influence of two topical dexamethasone applications (dermal and ototopical) on plasma insulin, glucose, thyroid hormone and cortisol levels was investigated in beagle dogs. Both treatments significantly decreased basal cortisol values, associated with exaggerated rise in insulin (∼50%), together with unchanged serum glucose levels. Dermal dexamethasone quickly decreased plasma thyroxin (T₄) levels; whereas dexamethasone in ear drops gradually inhibited time-dependently T₄ release (18–50%). Both formulations blunted plasma triiodothyronine (T₃) levels but the response induced by dermal dexamethasone was stronger than by dexamethasone ear drops. Upon drug withdrawal, insulin secretion returned to baseline a week after treatment cessation, while cortisol, T₄ and T₃ levels did not reach baseline values. These results suggest that topical glucocorticoids unexpectedly trigger secondary hypothyroidism with concomitant suppression of hypothalamic–pituitary–adrenal axis but sensitize the endocrine pancreas, thus, their application needs careful evaluation for surprisingly different effects on endocrine stress axis activity.     

Dual-phase computed tomographic angiography in three dogs with pancreatic insulinoma.

This article describes the findings in three dogs with histopathologically confirmed pancreatic insulinoma using dual-phase computed tomographic angiography (CTA). In all three dogs, dual-phase CTA findings identified lesions not seen on ultrasonography, including the actual identification of the primary pancreatic neoplasm in two dogs. CTA findings were in agreement with the surgical and histopathological findings. In two dogs, the insulinomas were found to have a strong enhancement during the arterial phase of the study but not at the other phases, which stresses the importance of dual-phase computed tomography for the diagnosis of this type of pancreatic neoplasia, in agreement with current knowledge in humans.     

Maturation of insulin and glucose responses to normal feeding in foals

SUMMARY Postprandial insulin and glucose concentrations were measured in 3 Arabian and 3 Thoroughbred foals at 1 day, 1 week, 1 month and 3 months of age. Prefeeding serum Insulin concentrations were similar in foals at 1 day (25.9 ± 5.1 pmol/L), 1 week (32.4 ± 5.8 pmol/L), and 1 month (38.2 + 7.9 pmol/L), but had Increased significantly to 131.0 ± 20.2 pmol/L at 3 months of age (P < 0.05). There was significantly increased serum Insulin secretion after a feed In foals at 3 months of age (P < 0.05) when compared with that at younger ages. Prefeeding serum glucose concentrations ranged from 6.0 ± 0.7 mmol/L at 1 day, to 5.9 ± 0.9 mmol/L at 1 week, 4.9 ± 1.7 mmol/L at 1 month, and 4.4 ± 1.5 mmol/L at 3 months of age. There were lower postprandial glucose concentrations with advancing age. It appeared that there was a period of maturation in pancreatic β-cell function after birth in foals, which reached adult levels by 3 months of age.     

Characterization of triple-phase computed tomography in dogs with pancreatic insulinoma

Little information is available regarding triple-phase computed tomography (CT) of canine pancreatic insulinoma. A few case reports with small numbers of cases have indicated that hyper-attenuation in the arterial phase was a common finding on multi-phasic CT in dogs with insulinoma. Our purpose was to clarify the characteristic findings of dogs with insulinoma on triple-phase CT. Nine dogs with insulinoma that underwent triple-phase CT were included in the present study. Attenuation patterns in the arterial phase indicated hypo-attenuation in 4 cases and hyper-attenuation in 2 cases. In the remaining 3 cases, 1 case showed hypo-attenuation and 1 case showed hyper-attenuation in the pancreatic phase, and 1 case presented hyper-attenuation in the later phase. Altogether, 5 cases showed hypo and 4 cases showed hyper-attenuation in at least one phase. The enhancement pattern was homogenous in 7 cases and heterogeneous in 2 cases. Tumor margins were well-defined in 5 cases and ill-defined in 4 cases. Capsule formation was present in 5 cases and absent in 4 cases. In conclusion, it is important to note that hypo-attenuation was as common as hyper-attenuation in dogs with insulinoma in triple-phase CT in at least one phase. Additionally, mass lesions were most conspicuous not only in the arterial phase but in the pancreatic and later phases in some cases. Therefore, it is important to perform triple-phase CT and notice about variable findings for the detection of canine pancreatic insulinoma.