Clinical Decision‐Making in Endocrine Physiology: Induced Hypoglycemia in Dogs

Abstract

Clinical endocrinology cases present unique challenges to veterinary students, as assessment and management encompasses various shades of grey. In order to process nuances and make clinical decisions, students must have a firm grasp of the basic tenets of endocrine physiology, such as the relationship between various hormones and negative feedback loops. We hypothesized that incorporating current diabetes monitoring technology into a hands‐on first‐year veterinary physiology laboratory would improve their understanding of glucose homeostasis. Students receive didactic instruction in foundational endocrine physiology concepts during their physiology lecture class. The laboratory applies the concept of glucose homeostasis and the role of insulin and counterregulatory hormones, as well as the impetus for clinical decision‐making in hypoglycemic patients. Before entering the laboratory, students complete a pre‐laboratory questionnaire assessing medical math, glucose homeostasis concepts, and overall predictions for decision‐making as a team (approximately six students per laboratory group). Each group is assigned a dog from the Veterinary Physiology and Pharmacology (VTPP) teaching colony. The dogs are non‐diabetic and fasted the night before the laboratory takes place. A flash glucose monitoring system (FGMS), which measures interstitial glucose concentration, is applied to each dog before the start of that day’s laboratory. The students must weigh their dog and calculate a dose of regular insulin at 0.3 U/kg; one of the abstract’s authors double checks each dose for accuracy. Students administer regular insulin intravenously and use various methods to check the blood glucose with a portable blood glucose meter (PBGM) and the interstitial glucose concentration with the FGMS every 10 minutes. Based on the glucose concentration and the dog’s clinical signs, students are empowered to make corrections using a single dose of dexamethasone, intravenous dextrose, and/or food. Once the dog is normoglycemic and they have completed at least 90 minutes’ worth of readings, the exercise is complete. Students complete a post‐laboratory survey assessing the same concepts as the pre‐laboratory survey. In the pre‐laboratory survey, students frequently commented that they expected to gain a better understanding of glucose homeostasis and the effects of insulin on dogs. They discussed delegating work and the impact of various communication styles on the overall flow of the laboratory session. In the post‐laboratory survey, students frequently commented on their newfound respect for how rapidly insulin acts within the body, as well as treating the clinical signs of hypoglycemia quickly. The students identified communication obstacles and various techniques and solutions developed in a short time period. Our endocrine physiology laboratory cements key concepts introduced in lecture, as 94% (164/174) of students reported that the laboratory improved their understanding of glucose homeostasis. When asked if their group communicated well, 97% (168/174) of students agreed. The laboratory is uniquely situated to blend conceptual physiology knowledge with critical thinking and clinical decision‐making skills.