Hypoglycemia and the somogyi phenomenon

摘要

Hypoglycemia is defined as a blood glucose concentration less than 60 mg/dl. Hypoglycemia is arguably the most common complication of insulin therapy in diabetic dogs and cats. Hypoglycemia induced by insulin therapy is classified as symptomatic andasymptomatic. Symptomatic hypoglycemia is easily diagnosed, in part, because clinical signs of hypoglycemia (i.e., lethargy, weakness, ataxia, seizures) are observed by the owner. Symptomatic hypoglycemia is most apt to occur following sudden large increases in the insulin dose, with excessive overlap of insulin action in dogs and cats receiving insulin twice a day, following prolonged inappetence, and in insulin-treated dogs and especially cats that have reverted to a non-insulin-dependent diabetic state. In these situations, severe hypoglycemia may occur before glucose counterregulation (see below) is able to compensate for and reverse the hypoglycemia. The occurrence and severity of clinical signs is dependent on the rate of blood glucose decline and the severity of hypoglycemia. Symptomatic hypoglycemia is treated with glucose administered as food, sugar water, or dextrose IV. Whenever signs of hypoglycemia occur, the owner should be instructed to stop insulin therapy until hyperglycemia and glycosuria recur. Urine glucose testing by the owner with the dog or cat in its home environment is useful for identifying when hyperglycemia and glycosuria recur. Adjustments in the insulin treatment regimen are indicated when the administration of insulinis initiated again. Failure of glycosuria to recur suggests reversion to a non-insulin-dependent diabetic state.