Chapter 70 (CECIL) HYPOGLYCEMIA Flashcards
What is hypoglycemia?
Book defines it simply as:
A recorded blood glucose concentration lower than normal (72-144). This range is fasting and non fasting.
What is Wipple’s Triad
Clinically significant hypoglycemia is based on demonstration of Whipple’s triad is a collection of 3 criteria that suggest a patient’s symptoms result from hypoglycemia which may indicate insulinoma.
- Signs and Symptoms known or likely to be caused by hypoglycemia
- A low plasma glucose measured at the time of the symptoms
- Relief of symptoms when the glucose is raised to normal
This is CLINICAL hypoglycemia
What would NOT constitute clinical hypoglycemia based on Whipple’s Triad?
Low plasma glucose levels without signs and symptoms or vice versa.
What is the postprandial state?
The postprandial state comprises the first 4-5 hours after a meal. Glucose levels should return to normal within the 3-4 hour mark.
Does insulin secretion decline when plasma glucose declines?
Yes.
What is the bodies response to low plasma glucose levels?
Glucose counter-regulation.
What is glucose counter-regulartion?
In healthy people, counterregulatory hormones constitute a principal defense against hypoglycemia, and levels are expected to rise as the glucose falls.
How does glucose counter-regulation occur in the CNS?
Detection of low glucose levels stimulate the hypothalamus and pituitary to release GH and Adrenocorticotropin.
Catecholamines (EPI) are released from the adrenal medulla and cortisol is released from the adrenal cortex.
Insulin secretion is reduced and glucagon secretion is augmented as a DIRECT EFFECT of low glucose in response to central nervous stimulation.
By doing all of this, the body has returned to normoglycemia.
What are the four counter-regularory hormones?
Glucagon, EPI, GH, cortisol.
Glucagon is the most important in the acute response to hypoglyemia.
How does Glucagon help with hypoglycemia?
It acts rapidly to increase hepatic glucose production through glycogenesis (major source of fasting glucose) and gluconeogenesis, which becomes increasingly important as glycogen stores are depleted.
In patients with type I diabetes mellitus, in counter-regulation, which main hormone response is lost?
Glucagon response
In type I diabetes patients suffering from hypoglycemia, which hormone replaces Glucagon response?
Epinephrine. However, this response is lost about 10-15 years post diagnosis with DM type I.
Signs and symptoms of hypoglycemia are divided into two categories, what are they?
- Neuroglycopenic (Warmth, weakness, headache, fainting, dizziness, seizures) and 2. Neurogenic (sweating, pallor, hunger, tachycardia, hypertension, tremor)
What is hypoglycemic unawareness?
This is what 25% of type I DM patients suffer from. It is the loss of warning signs and symptoms resulting from a progress
