April 12, 2016 - Hypoglycemia

Question 1

Range for Blood Glucose

Answer 1

Narrow range of 3-8

Balance of insulin vs. counter regulatory hormones

Question 2

Whipple’s Triad

Answer 2

Symptoms of hypoglycemia

Low plasma glucose

Relief of symptoms with correction of hypoglycemia

Characteristic of hypoglycemia. On a note, hypoglycemia without the presence of diabetes is very rare.

Question 3

Counter-Regulatory Response to Hypoglycemia

Answer 3

1. Decreased insulin (4.4-4.7)
2. Increased glucagon (3.6-3.9)
3. Epinephrine (3.6-3.9)
4. GH and Cortisol

Question 4

Neurogenic vs. Neuroglycopenic

Answer 4

Neurogenic is due to counter regulatory hormones like epinephrine which usually begin to be secreted below 3.1

Neuroglycopenic are due to brain glucose deficiency which occurs in normal subjects below a 2.8

Question 5

Symptoms of Neurogenic

Answer 5

Shakiness, tremulousness, palpitations, nervousness/anxiety, sweating, hunter, tingling, nausea

Question 6

Symptoms of Neuroglycopenic

Answer 6

Warmth, weakness, difficulty thinking, difficulty speaking, confusion, tiredness, drowsiness, stupor, seizure, coma, death.

Question 7

Counter Regulatory Response to Hypoglycemia

Answer 7

Decrease insulin (4.4 - 4.7)

Increase glucagon (3.6 - 3.9)

Epinephrine (3.6 - 3.9)

GH and Cortisol (3.6 - 3.9)

Question 8

Mechanisms for Hypoglycemia

Answer 8

1. Excessive insulin
2. Defective glucose production
3. Reduced availability of alternate fuel
4. Defective counter-regulatory hormone

Question 9

Excess Insulin

Answer 9

Can be caused by…

Insulinoma

Nesidioblastosis/NIPHS (pancreas hypertrophy)

Infants of poorly controlled diabetic mothers

Factitious

SUR1 gene mutation

Question 10

Defective Glucose Production

Answer 10

Can be by hepatic or renal failure

Glycogen storage disease (G6P deficiency)

Amino acid metabolism

Question 11

Decreased Alternate Fuels

Answer 11

Galactosemia

Disorders of fatty acid oxidation

Question 12

Decreased Counter Regulatory

Answer 12

Severe liver disease

Adrenal deficiency

Pituitary problem (ACTH or GH deficiency)

Question 13

72-Hour Fast

Answer 13

Can be useful in distinguishing the cause of hypoglycemia

Question 14

Values for Insulinoma

Answer 14

Symptoms - yes

Glucose - low

Insulin - high

C-peptides - high

Proinsulin - high

Question 15

Values for Sulfonylurea-Induced Hypoglycemia

Answer 15

Symptoms - yes

Glucose - low

Insulin - high

C-peptides - high

Proinsulin - high

Sulfonylurea in plasma - YES

Looks very similar to insulinoma