Hypoglycemia, Autonomic Nervous System and Diabetes Mellitus: No Somogyi Effect

Presentation Description / Summary: Diabetes mellitus (DM) is a disease of insulin deficiency (relative or absolute) that typically results from beta cell loss or dysfunction. However, if DM was limited to a beta cell lesion, treatment with insulin therapy would be simple because numerous neural and endocrine mechanisms exist to combat insulin-induced hypoglycemia (IIH). Instead, hypoglycemia is the limiting factor that prevents the ability to achieve adequate glycemic control during insulin therapy for DM. This is because counterregulatory responses to IIH are often impaired in DM, resulting in great severity of, and delayed recovery from hypoglycemia. Both hyperglycemia and hypoglycemia, cause impairment in counterregulatory responses and increase the risk of future hypoglycemia. It is therefore recognized that beyond the immediate negative consequences of hyperglycemia and hypoglycemia, and beyond the well-known long-term negative consequences of hyperglycemia, both hyperglycemia and hypoglycemia should be avoided in order to prevent future hypoglycemic crises. We will discuss these counterregulatory responses and species differences in cats and dogs.

Learner Outcomes: 1. Describe the glucose counterregulatory response and the autonomic nervous system's role and how this becomes impaired in diabetes mellitus. 2. Recognize species differences in these responses and how that may impact clinical treatment of each species. 3. Understand how Insulin induced hypoglycemia is not benign and increases risk of future iatrogenic hypoglycemia.