Effect of sodium-glucose cotransporter 2 inhibitor canagliflozin on interstitial glucose concentration in insulin-treated diabetic dogs

BACKGROUND

The utility of sodium-glucose cotransporter 2 inhibitors (SGLT2i) has not been reported in insulin-treated diabetic dogs.

HYPOTHESIS

Canagliflozin, a PO-administered SGLT2i, decreases interstitial glucose concentration (IG) in insulin-treated diabetic dogs.

ANIMALS

Five insulin-treated diabetic dogs.

METHODS

Uncontrolled open label longitudinal study. Canagliflozin (2-4 mg/kg/day PO) was added to an unchanged insulin dose for 7 days. Fractional excretion of glucose was calculated by dividing the product of urine glucose and serum creatinine concentrations by the product of serum glucose and urine creatinine concentrations. Hypoglycemia was defined as IG <60 mg/dL.

RESULTS

Median IG in 2869 measurements obtained while dogs were treated with insulin and canagliflozin was 87 mg/dL (range, 40-500 mg/dL) and was significantly lower than median IG in 1426 measurements obtained while dogs were treated with insulin alone (212 mg/dL; range, 41-500 mg/dL; P < .001). Median fractional excretion of glucose when dogs were treated with insulin and canagliflozin was 1.1% (range, 0.9%-2.0%), significantly higher than when dogs were treated with insulin alone (0.3%; range, 0.01%-1.0%; P = .04). The frequency of hypoglycemia was higher in dogs treated with insulin and canagliflozin (544 of 2869 IG measurements, 19%) compared with the frequency of hypoglycemia in dogs treated with insulin alone (52 of 1426 IG measurements, 4%; P < .001).

CONCLUSIONS AND CLINICAL IMPORTANCE

Canagliflozin may have a role in improving glycemic control in insulin-treated diabetic dogs, but the dose of insulin should be decreased when adding canagliflozin to insulin treatment.

Bayesian evaluation of sensitivity and specificity of blood culture media and hypoglycemia in sepsis-suspected calves

BACKGROUND

Sepsis is a life-threatening condition for which critically important antimicrobials are often indicated. The value of blood culture for sepsis is indisputable, but appropriate guidelines on sampling and interpretation are currently lacking in cattle.

OBJECTIVE

Compare the diagnostic accuracy of 2 blood culture media (pediatric plus [PP] and plus aerobic [PA]) and hypoglycemia for bacteremia detection. Estimate the contamination risk of blood cultures in critically ill calves.

ANIMALS

One hundred twenty-six critically ill calves, 0 to 114 days.

METHODS

Retrospective cross-sectional study in which the performance of PP, PA and hypoglycemia to diagnose sepsis was assessed using a Bayesian latent class model. A Cox proportional hazards model was used to compare time to positivity (TTP). Potential contamination was descriptively analyzed. Isolates were considered relevant when they were; member of the Enterobacterales, isolated from both blood cultures vials, or well-known, significant bovine pathogens.

RESULTS

The sensitivities for PP, PA, and hypoglycemia were higher when excluding assumed contaminants; 68.7% (95% credibility interval = 30.5%-93.7%), 87.5% (47.0%-99.5%), and 61.3% (49.7%-72.4%), respectively. Specificity was estimated at 95.1% (82.2%-99.7%), 94.2% (80.7%-99.7%), and 72.4% (64.6%-79.6%), respectively. Out of 121 interpretable samples, 14.9% grew a presumed contaminant in PA, PP, or both. There was no significant difference in the TTP between PA and PP.

CONCLUSIONS AND CLINICAL IMPORTANCE

PA and PP appear to outperform hypoglycemia as diagnostic tests for sepsis. PA seems most sensitive, but a larger sample size is required to verify this. Accuracy increased greatly after excluding assumed contaminants. The type of culture did not influence TTP or the contamination rate.

Hypothermia, anemia, hyperglycemia, and severe hypoglycemia are significant prognostic indicators of death in client-owned ferrets (Mustela putorius furo)

OBJECTIVE

To determine whether rectal temperature, Hct, or blood glucose at presentation were associated with all-cause mortality in ferrets (Mustela putorius furo).

ANIMALS

321 client-owned ferrets.

METHODS

A medical record database was searched for ferrets from January 2012 through September 2022. Records from 1,189 individual examinations were evaluated. Inclusion criteria were rectal temperature, Hct, and/or blood glucose measured at presentation and data on survival status 7 days postpresentation. Data were included from 321 ferrets from 571 examinations. Rectal temperature in 244 ferrets from 346 examinations, Hct in 181 ferrets from 277 examinations, and blood glucose in 260 ferrets from 420 examinations were available.

RESULTS

The odds of death for hypothermic ferrets (< 37.8 °C) were 3.72 times (OR, 3.72; 95% CI, 2.30 to 6.01) the odds of death for normothermic ferrets (37.8 to 40 °C). For every 0.56 °C below normal rectal temperature, the odds of death increased 1.49 times (OR, 1.49; 95% CI, 1.21 to 1.90). The odds of death for anemic ferrets (Hct < 33%) were 4.74 times (OR, 4.74; 95% CI, 1.70 to 13.21) the odds of death for ferrets with a normal Hct (33% to 57%). The odds of death for hyperglycemic ferrets (> 152 mg/dL) were 2.61 times (OR, 2.61; 95% CI, 1.29 to 5.30) the odds of death for normoglycemic ferrets (74 to 152 mg/dL). The odds of death for severely hypoglycemic ferrets (< 40 mg/dL) were 9.45 times (OR, 9.45; 95% CI, 3.18 to 28.12) the odds of death for normoglycemic ferrets.

CLINICAL RELEVANCE

Hypothermia, anemia, hyperglycemia, and severe hypoglycemia were significant prognostic indicators of death in ferrets. Further investigation into the causes and management of these derangements is warranted.

Nesidioblastosis and Subsequent Diabetes Mellitus in a Dog with Hyperinsulinemic Hypoglycemia Treated with Partial Pancreatectomy

A 6.5 yr old castrated male mixed-breed dog was presented for clinical signs associated with hypoglycemia. Hyperinsulinemic hypoglycemia was diagnosed as the cause of the persistent hypoglycemia. No obvious pancreatic mass was seen on abdominal computed tomography and exploratory laparotomy. A partial pancreatectomy was performed with the suspicion of an insulinoma-causing hyperinsulinemic hypoglycemia. Nesidioblastosis was diagnosed based clinical, biochemical, and histopathologic findings. There was beta cell hyperplasia and no evidence of neoplasia. The dog was euglycemic postoperatively after a partial pancreatectomy. Long-term follow-up after 2 yr revealed that the dog was diagnosed with diabetes mellitus.

Diabetes Mellitus Following Resection of a Hepatocellular Carcinoma in a Dog Presented with Hypoglycemia

A 5 yr old male neutered Labradoodle presented for an episode of acute collapse. Point-of-care blood work showed hypoglycemia and abdominal ultrasonography revealed a liver mass arising from the caudate liver lobe. The dog underwent a partial liver lobectomy, and histopathology confirmed a fully resected hepatocellular carcinoma. Blood glucose levels normalized initially after surgery, but 1 wk later, the patient was diagnosed with diabetes mellitus based on the development of polyuria, polydipsia, hyperglycemia, and glucosuria. Appropriate treatment with insulin was initiated, and 1 yr following the diagnosis, the dog was still requiring administration of insulin twice daily. This case describes the uncommon development of diabetes mellitus in a dog following surgical resection of a hepatocellular carcinoma initially associated with hypoglycemia. Although very unusual, this should be considered as a potential complication of surgical treatment of such tumors, and affected patients may require long-term medical management.

Hepatic abscessation in dogs: A multicenter study of 56 cases (2010-2019)

OBJECTIVE

To investigate the clinical findings, treatment strategies, and outcomes in dogs with confirmed hepatic abscessation.

DESIGN

Retrospective cohort study from 2010 to 2019.

SETTING

Multicenter study.

ANIMALS

Fifty-six client-owned dogs with hepatic abscessation confirmed by culture, cytology, or histopathology.

MEASUREMENTS AND MAIN RESULTS

Dogs were presented for lethargy (39/56), hyporexia (31/56), and vomiting (26/56). Abnormal physical examination findings included increased temperature (41/56) and abdominal pain (22/54). CBCs revealed neutrophilia (31/49), toxic changes (25/49), anemia (28/49), and thrombocytopenia (23/49). Biochemical analyses revealed increased alkaline phosphatase (45/50), increased alanine aminotransferase (40/50), hypoalbuminemia (25/48), and hyperbilirubinemia (19/49). Hypoglycemia was found in 13 of 49 dogs. Hepatic abscesses ranging from 0.5 to 15 cm in diameter were identified ultrasonographically in 37 of 48 dogs; 19 of 37 had solitary abscesses, and 18 of 37 had multifocal abscessation. Escherichia coli was the most commonly cultured organism, isolated in 18 of 42 cases. Histopathology revealed underlying hepatic neoplasia in 10 of 47 dogs. Surgical management was performed in 41 of 49 dogs, and 35 of 41 survived to discharge. Medical management was performed in 8 of 49 dogs, and 5 of 8 survived to discharge. With univariate analysis, hypoglycemia and multifocal abscessation were associated with decreased odds of survival (odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.03-0.9, P = 0.04; OR: 0.07, 95% CI: 0.01-0.6, P = 0.02, respectively). With multivariate analysis, only multifocal abscessation was associated with decreased odds of survival (OR: 0.09, 95% CI: 0.01-0.87, P = 0.04).

CONCLUSIONS

Hepatic abscessation, although rare, should remain a differential diagnosis for dogs presenting with nonspecific clinical signs and increase liver enzyme activities, especially with concurrent increased temperature and neutrophilia. Rate of survival to discharge for dogs in this study was consistent with previously reported survival rates, with 40 of 56 (71%) of the total population surviving to discharge. No variables assessed were able to predict survival to discharge; however, hypoglycemia and multifocal abscessation should be assessed in larger populations to determine prognostic significance.

Assessment of the FreeStyle Libre 2 interstitial glucose monitor in hypo- and euglycemic cats

BACKGROUND

Continuous glucose monitoring systems have been validated for eu- and hyperglycemic cats. The FreeStyle Libre 2 (FSL2) is sufficiently accurate in people during hypoglycemia to guide critical treatment decisions without confirmation of blood glucose concentration (BG).

OBJECTIVES

Assess FSL2 accuracy in cats with hypoglycemia.

ANIMALS

Nine healthy, purpose-bred cats.

METHODS

Hyperinsulinemic-hypoglycemic clamps were performed by IV infusion of regular insulin (constant rate) and glucose (variable rate). Interstitial glucose concentration (IG), measured by FSL2, was compared to BG measured by AlphaTrak2. Data were analyzed for all paired measurements (n = 364) and separately during stable BG (≤1 mg/dL/min change over 10 minutes). Pearson's r test, Bland-Altman test, and Parkes Error Grid analysis respectively were used to determine correlation, bias, and clinical accuracy (P < .05 considered significant).

RESULTS

Overall, BG and IG correlated strongly (r = 0.83, P < .0001) in stable glycemia and moderately at all rates of change (r = 0.69, P < .0001). Interstitial glucose concentration underestimated BG in euglycemia, but the BG-IG difference was progressively smaller as BG decreased (12.9 ± 12.2, 8.8 ± 11.2, -3.2 ± 7.4, and -7.8 ± 5.2 mg/dL in the ranges of 80-120 [n = 64], 60-79 [n = 29], 50-59 [n = 71], and 29-49 mg/dL [n = 53], respectively).

CONCLUSIONS

Although IG underestimates BG throughout most of the hypo-euglycemic range, IG generally overestimates BG in marked hypoglycemia (<60 mg/dL). It is therefore imperative to evaluate FSL2 results in this critical range with caution.

Phenibut toxicosis in a dog

OBJECTIVE

To describe the successful treatment of severe neurological and cardiovascular abnormalities in a dog following ingestion of the neuropsychotropic drug, phenibut.

CASE SUMMARY

A 2-year-old neutered male Weimaraner was found unresponsive and laterally recumbent in his urine after ingesting approximately 1600 mg/kg of phenibut. On presentation to an emergency clinic, the dog was neurologically inappropriate, tachycardic, hypertensive, and exhibiting a profoundly decreased respiratory rate. Because of progressive clinical signs, electrolyte abnormalities, increased hepatic enzyme activity and bilirubin concentrations, and the development of pigmenturia, referral to specialist care was sought. On presentation, the dog was intermittently somnolent and then maniacal. Sinus tachycardia persisted, and hyperthermia was documented. Hospitalization for supportive care was undertaken, and the dog was administered IV fluids, flumazenil, antiepileptics, and IV lipid emulsion therapy. The dog developed hypoglycemia and treated with dextrose supplementation. Progressive increases in liver enzyme activities as well as pronounced increase in creatine kinase activity, consistent with rhabdomyolysis, were noted. Over the course of 48 hours, the hypoglycemia resolved, and clinical signs significantly improved. Ultimately, the dog was discharged with improved clinical signs, with the owner reporting that 1 week after discharge, a full recovery had been made, and no residual clinical signs persisted.

NEW INFORMATION PROVIDED

To the authors' knowledge, there are no previous reports of phenibut intoxication in small animals. The growing availability and use of this drug by people in the past several years highlight the need for a greater understanding of its effects in companion animals.

Clinical utility of serum fructosamine in long-term monitoring of diabetes mellitus in dogs

BACKGROUND

Serum fructosamine (sFA) is used to assess glycaemic control in dogs with diabetes mellitus (DM). Nevertheless, its interpretation is hindered by several limitations.

METHODS

This retrospective study evaluates the long-term diagnostic performance of sFA for monitoring clinical control of DM. sFA, bodyweight, appetite, presence of polyuria/polydipsia and clinical scores (CS; well-controlled DM, CS-0; uncontrolled DM, CS-1) were recorded.

RESULTS

The study included 75 dogs (321 visits; median 3 visits/dog; range 1-19). Mean sFA was higher (p < 0.001) on visits with CS-1 (584 μmol/L; 95% confidence interval [95% CI] 561-608) than on visits with CS-0 (506 μmol/L; 95% CI 484-528). Increases in sFA increased   the odds ratio for CS-1 (1.37; 95% CI 1.24-1.52, p < 0.001). sFA was moderately predictive of the CS (area under receiver operating characteristic curve = 0.75; 95% CI 0.70-0.80; p < 0.0001), with a 486 μmol/L cutoff yielding 80% sensitivity and 59% specificity. Mean sFA was lower (p = 0.005) when hypoglycaemic episodes were suspected (496 μmol/L; 95% CI 450-541) than in their absence (572 μmol/L; 95% CI 548-596). sFA is moderately accurate for classifying CS in diabetic dogs. Decreasing sFA over follow-ups indicates improved CS but might suggest occurrence of hypoglycaemic episodes.

LIMITATIONS

Retrospective design, variable treatments and comorbidities are limitations of this study.

CONCLUSION

sFA has a moderate clinical utility in the long-term monitoring of diabetic dogs, but may serve as a first-line, accessible diagnostic tool. Discordant CS and sFA evaluation, or decreased sFA, warrants additional monitoring (i.e., continuous glucose monitoring).

A randomized controlled trial examining the effects of treatment with propylene glycol and injectable cyanocobalamin on naturally occurring disease, milk production, and reproductive outcomes of dairy cows diagnosed with concurrent hyperketonemia and hypoglycemia

The objective of this study was to assess the effects of treatment with propylene glycol (PG) and cyanocobalamin (B12) on health, milk production, and reproductive outcomes of cows diagnosed with hyperketonemia (HK), hypoglycemia (HG), or concurrent HKHG. Glucose and β-hydroxybutyric acid (BHBA) concentrations were assessed in whole blood using a handheld device in lactating dairy cows (n = 2,418) between 3 and 9 d postpartum. Cows categorized as HK (n = 232, BHBA ≥1.2 mmol/L), HG (n = 161, glucose ≤2.2 mmol/L), and concurrent HKHG (n = 204, BHBA ≥1.2 mmol/L, and glucose ≤2.2 mmol/L) were randomized to receive treatment or to remain untreated (control). Treatment consisted of a single dose of B12 (10 mg, intramuscularly) and 300 mL of PG orally for 5 d, starting on the day of cow-side testing. Milk production, health, and reproductive outcomes were analyzed according to groups. Statistical analysis was carried out using SAS version 9.4 (SAS/STAT, SAS Institute Inc.). Treatment in HG cows decreased clinical ketosis, increased milk production in the fifth week of lactation for multiparous cows, and tended to increase 305-d mature-equivalent milk yield (305ME) for primiparous cows compared with untreated cows with the same metabolic profile. For cows with HKHG, treatment increased 305ME in multiparous cows and tended to increase 305ME in primiparous cows. No differences were found for treatment among any of the metabolic groups regarding reproductive outcomes, nor were any treatment effects found among HK cows. Glycemic status may help identify metabolically challenged early postpartum dairy cows, which may have differential response to PG and B12 treatment.

Prognostic value of packed cell volume and blood glucose concentration in 954 client-owned chelonians

OBJECTIVE

To evaluate the prognostic value of PCV and blood glucose concentration in chelonians presented for veterinary care and to develop risk categories on the basis of the interaction of these analytes.

ANIMALS

954 client-owned chelonians (34 genera).

PROCEDURES

Medical records of 1,059 client-owned chelonians presented to 2 veterinary institutions between 2014 and 2018 were reviewed. Logistic regression models were developed to evaluate factors associated with death, including PCV and blood glucose concentrations.

RESULTS

There were 954 chelonians (34 genera) for which the data required to be included in the analysis were available. Both PCV and blood glucose concentration were significant prognostic indicators of death. Odds of death for chelonians with severe anemia (PCV, < 10%) and moderate anemia (PCV, 11% to 20%) were 6.8 times (adjusted odds ratio [aOR], 6.8; 95% CI, 3.8 to 12.3) and 1.6 times (aOR, 1.6; 95% CI, 1.01 to 2.7), respectively, the odds of death for chelonians with PCV within reference range. Odds of death for chelonians with severe hypoglycemia (< 30 mg/dL), moderate hyperglycemia (91 to 150 mg/dL), and severe hyperglycemia (> 181 mg/dL) were 5.3 times (aOR, 5.3; 95% CI; 2.4 to 11.4), 3 times (aOR, 3.0;95% CI, 1.4 to 6.3), and 4.3 times (aOR, 4.3; 95% CI, 2.4 to 7.6), respectively, the odds of death for chelonians with blood glucose concentration within reference range. Five risk categories were identified on the basis of PCV and blood glucose concentration.

CONCLUSIONS AND CLINICAL RELEVANCE

Derangements in PCV and blood glucose concentration in client-owned chelonians were associated with increased odds of death. On the basis of these results, more aggressive diagnostic testing and treatments may be indicated in chelonians with similar alterations.

Resolution of hyperinsulinemic hypoglycemia following partial pancreatectomy in a dog with nesidioblastosis

CASE DESCRIPTION A 6-year-old castrated male Australian Shepherd was evaluated because of a recent onset of persistent hypoglycemia. CLINICAL FINDINGS Physical examination results were generally unremarkable. No abnormalities were detected on thoracic radiographs, and abdominal ultrasonography revealed no obvious pancreatic lesion. Hematologic analysis revealed hypoglycemia with a high serum insulin-to-glucose concentration ratio. TREATMENT AND OUTCOME Insulinoma was suspected; medical treatment with prednisone was initiated, and exploratory laparotomy was performed. No pancreatic lesions or masses were observed. Partial left pancreatectomy and hepatic and local lymph node biopsies were performed. Histologic examination revealed islet cell hypertrophy and hyperplasia, with no evidence of neoplasia. Results of a PCR assay of the pancreatic tissue for Bartonella infection were negative. Clinical, biochemical, and histopathologic findings were compatible with nesidioblastosis. The clinical signs, including hypoglycemia, resolved after surgery. On follow-up examination 8 months later, the dog was apparently healthy and results of a CBC and serum biochemical analysis, including blood glucose concentration, were within respective reference ranges. CLINICAL RELEVANCE To our knowledge, this is the first report of nesidioblastosis in a dog for which clinical signs and clinicopathologic abnormalities resolved after partial pancreatectomy. Although extremely rare, nesidioblastosis should be considered a differential diagnosis in dogs with signs suggestive of insulinoma.

Presumed Neuroglycopenia Caused by Severe Hypoglycemia in Horses

BACKGROUND

Neuroglycopenia refers to a shortage of glucose in the brain resulting in neuronal dysfunction and death if left untreated. Presumed neuroglycopenia has not been described in horses.

OBJECTIVE

To report neurological signs in horses with presumed neuroglycopenia as the result of severe hypoglycemia.

ANIMALS

Ninety horses (hours to 28 years of age) diagnosed with hypoglycemia (blood glucose concentration < 75 mg/dL [< 4.2 mmol/L]).

METHODS

Retrospective study. Electronic medical records were searched. Signalment, history, complaint, clinical signs, laboratory findings including CSF analysis, electroencephalogram, clinical or definitive diagnosis, and outcome were recorded. Kruskal-Wallis analysis of variance and logistic regression were used to investigate association between blood glucose concentration and data extracted. Statistical significance was set at P < 0.05.

RESULTS

Thirty-eight and 52 horses had mild (50-74 mg/dL [2.8-4.1 mmol/L]), and severe hypoglycemia (< 50 mg/dL [< 2.8 mmol/L]), respectively. Most common causes of hypoglycemia included liver and gastrointestinal (40%) disease, sepsis (33%), neoplasia (7%), and insulin-induced (4%). Most common neurologic deficits included obtundation (100%), seizures (42%), and disorientation (22%). CSF-glucose was severely low (mean 2.5 mg/dL [0.1 mmol/L], median 0 mg/dL). Paroxysmal discharges in support of seizures were identified in the occipital (visual) and parietal (closest to temporal-auditory) cortical regions upon EEG examination (8/8 horses).

CONCLUSIONS AND CLINICAL IMPORTANCE

Neuroglycopenia is presumed to occur in horses as the result of severe hypoglycemia. Subclinical seizures, and intermittent blindness and deafness of cortical origin can occur. Severe altered state of consciousness and seizures can be observed at a blood glucose cut-off value of < 42 mg/dL (< 2.3 mmol/L).

Hypoglycemia in dogs: Causes, management, and diagnosis

Hypogylcemia in dogs is defined as a blood glucose concentration of less than 3.3 mmol/L (60 mg/dL) and is a relatively common problem encountered in veterinary practice. This metabolic disorder can have an array of clinical signs, ranging from subtle abnormalities to a life-threatening emergency. Hypoglycemia can be due to several physiological processes or etiologies. It is imperative that the clinician is astute in diagnosing hypoglycemia, proficient in providing rapid symptomatic treatment (if indicated) and has a clear diagnostic plan to elucidate the underlying cause. This article reviews the pathophysiology, most common etiologies, and emergency management of hypoglycemia, and presents a diagnostic approach for this problem.

Acute, Fatal, Presumptive Xylitol Toxicosis in Cape Sugarbirds ( Promerops cafer)

Twenty-nine wild Cape sugarbirds ( Promerops cafer) died acutely after ingestion of a homemade xylitol nectar solution from a bird feeder. The most aggressive feeders were first affected. Most birds showed clinical signs within 15 minutes of nectar ingestion, including incoordination, weakness, falling from perches, collapse, and death. A few birds showing clinical signs seemed to spontaneously recover and fly away. Full necropsy examinations done on 27 birds were hampered by freezing artifact and autolysis, but results indicated death was caused by the consequences of acute hypoglycemia. A presumptive diagnosis of xylitol toxicity was made based on the history, clinical signs, and absence of other obvious causes of death. This is potentially the first record of xylitol toxicity in wild birds.

Estimating glucose requirements of an activated immune system in growing pigs

Activated immune cells become obligate glucose utilizers, and a large i.v. lipopolysaccharide (LPS) dose causes insulin resistance and severe hypoglycemia. Therefore, study objectives were to quantify the amount of glucose needed to maintain euglycemia following an endotoxin challenge as a proxy of leukocyte glucose requirements. Fifteen fasted crossbred gilts (30.3 ± 1.7 kg) were bilaterally jugular catheterized and assigned 1 of 2 i.v. bolus treatments: control (CON; 10 mL sterile saline; = 7) or LPS challenge + euglycemic clamp (LPS-Eu; 055:B5; 5 μg/kg BW; 50% dextrose infusion to maintain euglycemia; = 8). Following administration, blood glucose was determined every 10 min and dextrose infusion rates were adjusted in LPS-Eu pigs to maintain euglycemia for 8 h. Pigs were fasted for 8 h prior to the bolus and remained fasted throughout the challenge. Rectal temperature was increased in LPS-Eu pigs relative to CON pigs (39.8 vs. 38.8°C; < 0.01). Relative to the baseline, CON pigs had 20% decreased blood glucose from 300 to 480 min postbolus ( = 0.01) whereas circulating glucose content in LPS-Eu pigs did not differ ( = 0.96) from prebolus levels. A total of 116 ± 8 g of infused glucose was required to maintain euglycemia in LPS-Eu pigs. Relative to CON pigs, overall plasma insulin, blood urea nitrogen, β-hydroxybutrate, lactate, and LPS-binding protein were increased in LPS-Eu pigs (295, 108, 29, 133, and 13%, respectively; ≤ 0.04) whereas NEFA was decreased (66%; < 0.01). Neutrophils in LPS-Eu pigs were decreased 84% at 120 min postbolus and returned to CON levels by 480 min ( < 0.01). Overall, lymphocytes, monocytes, eosinophils, and basophils were decreased in LPS-Eu pigs relative to CON pigs (75, 87, 70, and 50%, respectively; ≤ 0.05). These alterations in metabolism and the large amount of glucose needed to maintain euglycemia indicate nutrient repartitioning away from growth toward the immune system. Glucose is an important fuel for the immune system, and data from this study established that the glucose requirements of an intensely and acutely activated immune system in growing pigs are approximately 1.1 g/kg BW/h.

Inositol 1,4,5-Triphosphate Receptor Protein Immunohistochemistry of Cerebellar Purkinje Cells in Two Dogs with Hypoglycemia

Immunohistochemical study was performed on cerebellar Purkinje cells of two dogs with hypoglycemia using an antibody against the inositol 1,4,5-triphosphate receptor that is identical to the cerebellar Purkinje cell glycoprotein P400 (P400/InsP3R). In the cerebellar neocortex of an acute case of hypoglycemia, the P400/InsP3R staining of hypoglycemic Purkinje cells was heterogeneous: some peripheral dendrites, including spiny branchlets, were negative and others were stained with various intensities, although Purkinje cells were morphologically intact by hematoxylin and eosin (HE) stain. In a chronic case of hypoglycemia, almost all the dendrites of Purkinje cells of both the neo- and archicortex of the cerebellum were not stained with the P400/InsP3R antibody. This is in contrast to the normal dog where Purkinje cell bodies, axons, and dendrites, including spiny branchlets, are intensely stained by the P400/InsP3R antibody. These results suggest that P400/InsP3R immunolabeling of Purkinje cells decreased, despite their morphology being preserved by HE stain, and that the function of P400/InsP3R, especially in spiny branchlets that receive inputs originating from axon terminals of parallel fibers, may be impaired in hypoglycemia.

Prenatal tolbutamide treatment alters plasma glucose and insulin concentrations and negatively affects the postnatal performance of chickens

To examine the relationship of insulin and glucose, broiler embryos were subjected to acute or prolonged hypoglycemia during the late embryonic phase by, respectively, injecting once (at embryonic day [ED] 16 or 17) or on 3 consecutive days (ED 16, 17, and 18) with tolbutamide (80 μg/g embryo weight), a substance that stimulates insulin secretion from the pancreas. After 1 tolbutamide injection, a prolonged (32 h) decrease of plasma glucose and a profound acute increase in plasma insulin were observed. The 3 consecutive tolbutamide injections induced hypoglycemia for 4 days (from ED 16 to ED 19). The postnatal performance after 3 consecutive tolbutamide injections in broiler embryos was also investigated. Body weight was lower in tolbutamide-treated chickens from hatch to 42 d compared with sham (P = 0.001) and control (P < 0.001) chickens. Feed intake was lower in the tolbutamide group from hatch to 42 d as compared with sham (P = 0.007) and control (P = 0.017) animals. In addition, at 42 d, plasma glucose concentrations, after an insulin injection challenge (50 μg/kg body weight), were higher in tolbutamide-treated chickens compared with the sham and the control group as were their basal glucose levels (P value of group effect <0.001). In conclusion, tolbutamide treatment during the late embryonic development in broilers resulted in prolonged hypoglycemia in this period and negatively influenced the posthatch performance.

Comparison of a human portable glucometer and an automated chemistry analyzer for measurement of blood glucose concentration in pet ferrets (Mustela putorius furo)

This study compared blood glucose concentrations measured with a portable blood glucometer and a validated laboratory analyzer in venous blood samples of 20 pet ferrets (Mustela putorius furo). Correlation and agreement were evaluated with a Bland-Altman plot method and Lin's concordance correlation coefficient. Blood glucose concentrations measured with the laboratory analyzer and the glucometer ranged from 1.9 to 8.6 mmol/L and from 0.9 to 9.2 mmol/L, respectively. The glucometer had a poor agreement and correlation with the laboratory analyzer (bias, -0.13 mmol/L; level of agreement, -2.0 to 3.6 mmol/L, concordance correlation coefficient 0.665). The relative sensitivity and specificity of the portable blood glucometer for detection of hypoglycemia were 100% (95% CI: 66% to 100%) and 50% (95% CI: 20% to 80%), respectively. Positive and negative predictive values were 67% (95% CI: 39% to 87%) and 100% (95% CI: 46% to 100%), respectively. Based on these results, clinicians are advised to be cautious when considering the results from this handheld glucometer in pet ferrets, and blood glucose concentrations should be determined with a laboratory analyzer validated for this species.

Oxyntomodulin attenuates exendin-4-induced hypoglycemia in cattle

Oxyntomodulin (OXM), glucagon, glucagon-like peptide-1 (GLP-1), and exendin-4 (Ex-4) are peptide hormones that regulate glucose homeostasis in monogastric and ruminant animals. Recently, we reported that the insulin-releasing effects of OXM and glucagon in cattle are mediated through both GLP-1 and glucagon receptors. The purpose of this study was to examine the mechanisms of the glucoregulatory actions induced by Ex-4, GLP-1, OXM, and glucagon and the interrelationships among these hormones in cattle. Two experiments were performed in Holstein cattle. In Experiment 1, we initially assessed the effects of intravenous (iv) bolus injection of 0, 0.25, 1, and 2 μg/kg body weight (BW) of Ex-4, GLP-1, and OXM on insulin and glucose concentrations in 3-mo-old intact male Holstein calves. In Experiment 2, we studied insulin and glucose responses to iv coinjection of 0.25 μg of Ex-4 or GLP-1/kg BW with 2 μg of OXM or glucagon/kg BW in 4-mo-old Holstein steers. Administration of peptides and blood sampling were done via a jugular catheter. Plasma was separated and the concentrations of peptides and glucose in plasma were analyzed using radioimmunoassay and enzymatic methods, respectively. Results showed that the potent glucoregulatory action of Ex-4 in 4-mo-old steers was delayed and attenuated when Ex-4 was coinjected with OXM. The decline in plasma glucose concentrations began at 5 min in the Ex-4-injected group (P < 0.05) vs 15 min in the Ex-4 + OXM-injected group (P < 0.05). Plasma concentrations of glucose at 30 min were reduced 26% from basal concentrations in the Ex-4-injected group and 13% in the Ex-4 + OXM-injected group (P < 0.001). Results also showed that the glucose concentrations initially increased in the Ex-4 + glucagon-treated group, but declined to a relatively hypoglycemic condition by 90 to 120 min. In contrast, the glucose concentrations at specific time points between the GLP-1 + OXM-injected group and the OXM-injected group did not differ. Similarly, the glucose concentrations in the GLP-1 + glucagon-injected group did not differ from those in the glucagon-injected group. Because OXM and glucagon mediate glucose concentrations via the glucagon receptor, it is suggested that the potent glucose-lowering action of Ex-4 might include the glucagon receptor antagonistic action of Ex-4.

Xylitol toxicity in dogs

Xylitol, a sugar substitute used in sugar-free gum, oral care products, and baked goods, is gaining popularity in the United States. Xylitol consumption is considered harmless to people but is known to cause life-threatening toxicoses in dogs. Dogs that ingest doses of >0.1 g/kg of xylitol are at risk for developing hypoglycemia, while dogs that ingest >0.5 g/kg may develop acute liver failure. Treatment includes dextrose supplementation for hypoglycemia and aggressive monitoring, treatment, and supportive care for dogs experiencing hepatotoxicosis. The prognosis for dogs with uncomplicated hypoglycemia is good, whereas the prognosis for dogs that develop severe hepatotoxicosis is guarded to poor.

Twin-pregnancy increases susceptibility of ewes to hypoglycaemic stress and pregnancy toxaemia

Pregnancy toxaemia is a metabolic disorder with a high mortality rate and occurs in twin-bearing ewes in late gestation. Maternal hypoglycaemia is a characteristic symptom of the disease and has been attributed to an increase in glucose uptake by the twin-bearing uterus. The possibility that a reduced maternal glucose production rate might cause hypoglycaemia, has received little attention in the past. It was the aim of this study to investigate this explanation as a possible alternative. Six ewes were sequentially subjected to two types of hypoglycaemic stress, firstly by fasting for 14 h and secondly through induction of moderate hyperketonaemia. Glucose kinetics were assessed in each animal during the dry non-gestational period, during late gestation, and during early lactation. Application of these stress factors was associated with variation of plasma glucose concentration from 4.9 to 0.87 mmol L(-1). The plasma glucose concentration was always significantly related to the glucose production rate. The greatest stress-induced reductions in glucose concentration and glucose production rate were seen during late gestation in twin-bearing ewes. The decline in the glucose production rate after an overnight fast and during induced hyperketonaemia was greater in twin-bearing ewes than in single-bearing ewes (59% and 43%, respectively, p<0.05). The stress conditions resulted in the lowest levels of glucose concentration and glucose turnover rates in the stressed, hyperketonaemic, late gestation twin-bearing ewes. This illustrates that the glucose homoeostatic system of ewes bearing twins is significantly more susceptible to hypoglycaemic stress than that of ewes bearing single lambs. These findings also show that the primary cause of hypoglycaemia in late gestation twin-pregnant ewes is an increased susceptibility to a stress related reduction in glucose production rate. This metabolic condition leaves the twin-pregnant ewe predisposed for the development of pregnancy toxaemia.

Metabolic adaptations associated with irreversible glucose loss are different to those observed during under-nutrition

In this study the hypothesis that irreversible glucose loss results in an 'uncoupling' of the somatotrophic axis (increasing plasma GH levels and decreasing plasma IGF-I) was tested. During periods of negative energy balance the somatotrophic axis respond by increasing plasma GH and decreasing plasma IGF-I levels. In turn, elevated GH repartitions nutrient by increasing lipolysis and protein synthesis, and decreases protein degradation. Irreversible glucose loss was induced using sub-cutaneous injections of phloridizin. Seven non-lactating cows were treated with 8g/day phloridizin (PHZ) and seven control animals (CTRL, 0g/day), while being restricted to a diet of 80% maintenance. PHZ treatment increased urinary glucose excretion (P<0.001), resulting in hypoglycemia (P<0.001). As a response to this glucose loss, the PHZ treated animals had elevated plasma NEFA (P<0.005) and BHBA (P<0.001) levels. Average plasma insulin concentrations were not altered with PHZ treatment (P=0.059). Plasma GH was not different between the two groups (P>0.1), whereas plasma IGF-I levels decreased significantly (P<0.001) with PHZ treatment. The decline in plasma IGF-I concentrations was mirrored by a decrease in the abundance of hepatic IGF-I mRNA (P=0.005), in addition the abundance of hepatic mRNA for both growth hormone receptors (GHR(tot) and GHR(1A)) was also decreased (P<0.05). Therefore, the irreversible glucose loss resulted in a partial 'uncoupling' of the somatotrophic axis, as no increase in plasma GH levels occurred although plasma IGF-I levels, hepatic IGF-I mRNA declined, and the abundance of liver GH receptor mRNA declined.

Insulinoma in a cat

A 14-year-old domestic shorthair cat was presented with hypoglycaemia and seizures of several weeks duration. Bloodwork revealed hypoglycaemia (1.83 mmol/l; reference range 4.22-8.05 mmol/l) with concurrent normal insulin levels (171 pmol/l; reference range 72-583 pmol/l). An insulinoma was suspected and medical and dietary management were attempted with minimal success. An exploratory laparotomy was performed and a single, well-defined mass was found within the left lobe of the pancreas. The mass was removed and histologically classified as an islet cell carcinoma, consistent with an insulinoma. The cat had an episode of presumed postoperative pancreatitits, but recovered with appropriate treatment. The cat has had no clinical signs of recurrence of greater than 32 months postsurgery. There are only four cases of insulinoma in cats reported in the literature. All prior insulionomas reported were in older cats and were malignant in character, which is similar to the reports in the dog. This case is unique because of the apparent lack of local recurrence and development of metastatic disease, leading to the prolonged survival.

Insulinoma in a Dog With Pre-existing Insulin-Dependent Diabetes Mellitus

A 10-year-old golden retriever with a 3-year history of insulin-dependent diabetes mellitus was presented with recurring episodes of hypoglycemia and seizures. A presumptive diagnosis of an insulinoma was made based on hypoglycemia with concurrent endogenous hyperinsulinemia and unremarkable radiographic and ultrasonographic images of the chest and abdomen. A beta cell carcinoma of the pancreas with metastasis to the liver and a mesenteric lymph node was confirmed by surgery and histopathology.

Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs

CASE DESCRIPTION

8 adult dogs were evaluated for treatment of lethargy and vomiting after ingestion of xylitol, a sugar alcohol used as a sweetener in various products.

CLINICAL FINDINGS

In addition to vomiting and lethargy, 5 of the dogs had widespread petechial, ecchymotic, or gastrointestinal tract hemorrhages. Common clinicopathologic findings included moderately to severely high serum activities of liver enzymes, hyperbilirubinemia, hypoglycemia, hyperphosphatemia, prolonged clotting times, and thrombocytopenia. Necropsies were performed on 3 dogs and severe hepatic necrosis was found in 2. In the third dog, histologic examination revealed severe hepatocyte loss or atrophy with lobular collapse.

TREATMENT AND OUTCOME

Treatments varied among dogs and included IV administration of fluids; plasma transfusions; and, if indicated, administration of dextrose. Three dogs were euthanatized, 2 dogs died, 2 dogs made a complete recovery, and 1 dog was recovering but was lost to follow-up.

CLINICAL RELEVANCE

Although xylitol causes hypoglycemia in dogs, hepatic failure after ingestion has not previously been reported. Because an increasing number of consumer products contain xylitol, clinicians should be aware that ingestion of xylitol can have serious, life-threatening effects.

Diabetes mellitus after resection of hepatocellular carcinoma with hypoglycemia in a dog

A 10-year-old male beagle was referred to us with seizure related to hypoglycemia and a large intraabdominal mass. Based on various types of imaging and a laparoscopic biopsy, the intraabdominal mass was diagnosed as a hepatocellular carcinoma (HCC) of the quadrate lobe. The hypoglycemia was suspected to be associated with the HCC. After lobectomy of the quadrate lobe was performed, blood glucose levels continued to increase to higher than normal values and sugar was detected in the urine. The dog was diagnosed as diabetes mellitus (DM) and was treated with insulin for over two years after the surgery.

Hypoglycaemic bradycardia and circulatory collapse in a dog and a cat

Hypoglycaemia was accompanied by sinus bradycardia and circulatory collapse in a dog and a cat. In each case, when the hypoglycaemia was corrected by intravenous infusion of a glucose solution the bradycardia and circulatory failure were soon abolished, indicating that these abnormalities were caused by the hypoglycaemia. Similar observations have been made in human patients. To the author's knowledge, this is the first report documenting hypoglycaemic bradycardia in veterinary medicine.

Enhanced non-esterified fatty acids and corticosterone in blood plasma of chickens treated with insulin are significantly depleted by reverse T: minor changes in hypoglycaemia

Previously, it has been observed that dexamethasone or adrenaline-induced hyperlipaemia in blood of chicken was significantly reduced after administration of reverse triiodothyronine (rT3). The present experiment was performed on chicken to determine the altered circulating non-esterified fatty acids (NEFA) induced by physiologically enhanced endogenous corticosterone and catecholamines may also be influenced by rT3. Rise of both hormones were induced by insulin administration. Changes in circulating glucose, corticosterone and catecholamines were additionally measured. Following insulin injection blood glucose fell on the average by 32.7% below control at 2 h of the experiment. Additional treatment with rT3 (rT3 + insulin group) gradually attenuated this decrease and at 4 and 6 h of the experiment it was 17.1% and 12.9% below control, respectively, suggesting on slight inhibition by rT3 of insulin-stimulated glucose utilization. Exposure to insulin significantly increased NEFA levels to about 670% above control group. Additional treatment with rT3 reduced this increase to 309% of control, suggesting inhibition of lipolysis by rT3. Similar alterations were observed in plasma corticosterone levels. Insulin treatment peaked the corticosterone levels maximally by 507.6% above control. Additional treatment with rT3 abolished this rise in the averages to 194.2% above control, possibly by interaction of rT3 with hypothalamo-adrenal axis. Insulin injection increased plasma catecholamines on the average by 21.5% and 53.4% for adrenaline and noradrenaline respectively. Supplementary treatment with rT3 intensified this rise by 55.6% and 71.6% respectively. The obtained results suggest on inhibitory effect of rT3 on hypoglycaemia, hyperlipaemia and plasma corticosterone concentrations in chickens treated with insulin. Contrary to this, rT3 enhanced the rise of plasma catecholamines due to insulin treatment. The obtained data favour the assumption that hypometabolic properties of rT3 depends mainly upon reduced supply of NEFA as a result of restricted lipolysis and to a lesser extent upon the supply of glucose.

Measurement of plasma chromogranin A concentrations for assessment of stress responses in dogs with insulin-induced hypoglycemia

OBJECTIVE

To determine whether cross-reactivity exists between canine chromogranin A (CgA) and anti-human CgA antibody and investigate the usefulness of plasma CgA concentration measurements as an index of acute stress responses in dogs.

ANIMALS

12 healthy Beagles.

PROCEDURE

Canine CgA was extracted and purified from canine adrenal glands of cadaver dogs for studying cross-reactivity with anti-human CgA antibody. Western blotting with anti-human CgA antibody was performed. Blood samples were collected from dogs at 0, 10, 20, 30, 40, 60, 120, and 180 minutes after IV administration of saline (0.9% NaCl) solution or insulin. Canine plasma CgA concentrations were determined by use of a CgA ELISA kit with rabbit antiserum against the carboxy-terminal fragment of human CgA. Plasma cortisol and catecholamine (ie, norepinephrine and epinephrine) concentrations were measured by use of an ELISA and a high-performance liquid chromatography method, respectively.

RESULTS

Purified canine CgA was specifically detected by use of western blot analysis and an ELISA with anti-human CgA antibody. An increase in plasma CgA concentrations was observed in insulin-induced hypoglycemic dogs. Changes in plasma CgA concentration were correlated with changes in plasma cortisol or catecholamine concentrations of hypoglycemic dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

Use of the CgA ELISA kit for determination of human plasma CgA concentrations is applicable to the measurement of canine plasma CgA concentrations. Canine plasma CgA concentrations, along with measurements of plasma cortisol and catecholamine concentrations, correctly reflect insulin-induced hypoglycemic stressed conditions in dogs. Measurement of canine plasma CgA concentrations may provide a useful index for evaluation of an acute stress response.

Acute Insulin-induced Hypoglycaemia does not alter IGF-1 and LH Release in Cyclic Mares

Lactation in the mare is associated with changes in the release of metabolic as well as reproductive hormones. Plasma glucose concentration is constantly reduced in lactating compared with non-lactating mares. Several metabolic signals have been proposed to link nutrition and somatic metabolism with reproductive function. The following experiment was performed to study the effect of acute hypoglycaemia on the release of insulin-like growth factor-1 (IGF-1) and luteinizing hormone (LH) in cyclic mares. Different doses of insulin (0.1 and 0.2 IU/kg body weight) were given to induce a decrease in plasma glucose concentration, as existent in lactating mares. All horses treated with insulin developed a hypoglycaemia over a time period of nearly 10 h. The IGF-1 and LH were analysed before and after insulin administration. At no point of time, a significant difference between the two insulin treatments and the control treatment was observed. Therefore, the hypoglycaemic horse is apparently able to provide the brain with sufficient glucose. Short-term hypoglycaemia does not affect the hypothalamo-pituitary-ovarian axis, and concentrations of IGF-1 and LH remained stable during insulin-induced hypoglycaemia. An acute change in plasma glucose concentration is thus not or at least not the only metabolic signal that links nutrition and somatic metabolism with reproductive function in the horse mare.

Glucose, lactate, and pyruvate concentrations in dogs with babesiosis

OBJECTIVE

To document changes in glucose, lactate, and pyruvate concentrations in dogs with severe or complicated babesiosis; assess relationships among glucose, lactate, and pyruvate concentrations in those dogs; and compare clinical and laboratory variables in dogs with and without hypoglycemia and hyperlactatemia.

ANIMALS

20 dogs with naturally developing severe or complicated babesiosis.

PROCEDURE

Samples and measurements were obtained before treatment was initiated. Babesiosis was diagnosed by examination of blood smears. Arterial blood pressure measurement, parasite quantification, CBC count, serum biochemical analysis, urinalysis, venous blood gas analysis, and acid-base determination were performed. Glucose, lactate, and pyruvate concentrations were measured in samples of venous blood.

RESULTS

We detected a significant negative correlation between glucose and lactate concentrations. Glucose, lactate, and pyruvate concentrations all differed significantly between dogs that died and those that survived. Three of 5 dogs that died had concurrent hypoglycemia, hyperlactatemia, and hyperpyruvatemia. Hypoglycemic dogs differed significantly from normoglycemic dogs with regard to lactate, urea, and bicarbonate concentrations; lactate-to-pyruvate ratio; percentage parasitemia; and PCO2. Dogs with hyperlactatemia differed significantly from normolactatemic dogs with regard to clinical collapse; alanine transaminase activity; concentrations of bilirubin, urea, creatinine, and bicarbonate; percentage parasitemia; and PCO2.

CONCLUSIONS AND CLINICAL RELEVANCE

Abnormal carbohydrate metabolism is commonly evident in dogs with severe or complicated babesiosis and is often associated with changes in other clinical and laboratory variables. Significant differences were found between survivors and nonsurvivors. Hypoglycemia should be assessed and aggressively treated in dogs with babesiosis. Lactate concentration can be used as an indicator of disease severity.

Artifactual hypoglycemia associated with hemotrophic mycoplasma infection in a lamb

BACKGROUND

A 35-day-old male lamb with Mycoplasma ovis infection (previously Eperythrozoon ovis) was evaluated because of severe hypoglycemia (serum glucose 4 mg/dL, Hitachi 704 automated chemistry analyzer) inconsistent with the animal's condition. Whole blood glucose concentration measured with a glucometer was 74 mg/dL.

OBJECTIVE

The purpose of this study was to investigate this discrepancy through in vitro evaluation of the patient's blood.

METHODS

Blood was incubated alone, with increasing concentrations of plasma, or with equine serum of known glucose concentration for 0, 15, 30, and 60 minutes at room temperature; end-point glucose concentrations were compared with blood from a control sheep handled similarly.

RESULTS

A rapid decline in glucose concentration was observed in heparinized or EDTA anticoagulated whole blood from the infected lamb incubated alone or with the equine serum. Glucose concentrations in incubated samples from a control sheep remained stable. Incubation of increasing concentrations of heparinized blood with autologous plasma resulted in decreased glucose concentrations in patient, but not control, blood. As parasitemia decreased after treatment, serum glucose concentration increased, serum lactate concentration decreased, and in vitro glucose concentration stabilized.

CONCLUSIONS

These findings are consistent with parasite-associated in vitro glucose consumption. An increase in the lamb's plasma glucose concentration associated with reduction of parasite load suggested excess glucose consumption also may have occurred in vivo.

Prevalence and risk factors of hypoglycemia in virulent canine babesiosis

Hypoglycemia is a common complication of virulent canine babesiosis. A study was conducted to determine the prevalence of and potential risk factors for hypoglycemia in canine babesiosis from Babesia canis rossi. Plasma glucose concentration was measured at presentation in 250 dogs with babesiosis, of which 111 were admitted to hospital. The prevalence of hypoglycemia (<60 mg/dL) was 9% (23/250). Twenty-two hypoglycemic dogs required admission, making the prevalence of hypoglycemia in admitted dogs 19.8%. Sixteen dogs had severe hypoglycemia (<40 mg/dL), of which 5 had glucose < 18 mg/dL. Hyperglycemia (>100 mg/dL) was present in 38 dogs, of which 21 were admitted. Risk factors for hypoglycemia identified by univariate analysis were collapsed state (P < .00001), severe anemia (P = .0002), icterus (P = .003), age < 6 months (P = .02), and vomiting (P = .03). After logistic regression analysis, collapsed state (odds ratio [OR] = 18; 95% CI, 1.9-171; P = .01) and young age (OR = 2.8; 95% CI, 0.8-9.7; P = .1) remained significantly associated with hypoglycemia. Toy breeds and pregnant bitches were not at higher risk for hypoglycemia than other dogs. Blood glucose concentration should ideally be measured in all dogs requiring inpatient treatment for babesiosis but is mandatory in collapsed dogs; puppies; and dogs with severe anemia, vomiting, or icterus. Many dogs have probably been misdiagnosed with cerebral babesiosis in the past, and hypoglycemia should be suspected in any dog with coma or other neurological signs.

Hypoglycemia following canine ingestion of xylitol-containing gum

A 9-mo-old neutered male Labrador Retriever developed severe hypoglycemia, collapse, and seizures after consuming a large quantity of sugar-free gum sweetened with the sugar-alcohol xylitol. The dog was treated with i.v. boluses and continuous infusion of dextrose; its condition improved rapidly, but the dog remained mildly hypoglycemic for 11 hours before recovering fully. In humans, xylitol has little to no effect on plasma insulin or glucose levels, but in dogs xylitol is a strong promoter of insulin release and can cause severe hypoglycemia with ataxia, collapse and seizures. With the increased appearance of xylitol-sweetened products in the US, xylitol toxicosis in dogs may become more common.

Hypoglycemia and irreversible neurologic complications in a cat with insulinoma

A 14-year-old spayed female domestic shorthair cat was evaluated for weakness, lethargy, decreased appetite, diarrhea, weight loss, and seizures. On physical examination, the cat appeared disoriented and had an inconsistent menace response. An insulinoma was diagnosed on the basis of normal serum insulin activity in conjunction with profound hypoglycemia and histologic examination (with immunohistochemical staining for chromogranin A and insulin) of a pancreatic mass that was removed surgically. Blood glucose concentration was within reference limits after surgery. However, neurologic abnormalities persisted, and the cat was euthanatized. Chronic hypoglycemia, associated with insulinomas, can cause irreversible neuronal changes in cats; therefore, rapid diagnosis and treatment of hypoglycemic conditions are of critical importance.

Pancreatic islet cell tumor in a domestic ferret

A 5-year-old castrated male ferret began to exhibit signs of episodic lethargy, hindlimb weakness, and ataxia along with mild to moderate weight loss. Serial blood glucose measurements revealed persistent hypoglycemia. The animal was euthanized and a necropsy performed. Discrete pancreatic nodules were discovered and submitted for histopathologic analysis. One of the nodules was found to contain pancreatic islet cell tumors; other areas contained foci of islet cell and acinar hyperplasia. Pancreatic islet cell tumors, commonly referred to as insulinomas, are common tumors in ferrets and typically occur in middle-aged and older animals. These animals, when properly diagnosed, can be managed either medically or surgically or, often, by a combination of medical and surgical treatments, and their lives greatly extended.