Chem Path: Hypoglycaemia Flashcards
What is the advantage of buccal glucose administration?
Fast absorption as it bypasses hepatic first pass
What would you need to consider regarding IM glucagon
Patient needs to have adequate glucose stores and it will take 15-20 mins for glucose levels to be up
What triad to we think of hypoglycaemia
Whipple’s
What are the 3 components of the triad
Low glucose, adrenergic and neurogylcopaenic symptoms and relief of symptoms with glucose administration
What are adrenerigc and neurogylcopaenic symptoms
Tremors, palpitations, sweating and hunger
Drowsy, confusion, incordinance, seizure and coma
Explain what happens when there is hypoglycaemia
Insulin is switched off, and glucagon production increases and lipolysis increases
What happens in lipolysis
Lipids are broken down, thereby increase FFAs
What happens to FFAs
Beta oxidation, thereby producing ketones
What happens when there is sympathetic activation due to hypoglycaemia
Increased catecholamines (adrenaline) production along with ACTH, cortisol and GH
What is the gold standard of measuring glucose
Venous glucose
What drugs can cause hypoglycaemia
Insulin
Sulphonylurea
Salicylates
Beta blockers
Why might you not get hypoglycaemic symptoms with beta blockers
They block adrenergic symptoms
What is polyglandular autoimmune syndrome?
Addison’s that can result in hypoglycaemia
What is C peptide and how is it released
It is a cleavage product of pro insulin and it is released in equimolar amounts of insulin
Hypogylcaemia due to excess injected insulin would result in low or high c peptide?
Low c peptide
What is lanugo hair?
baby hair that grows during severe anorexia
How would insulin and c peptide levels be in severely malnourished people?
Low levels of both as she will have no glycogen stores and that usually turns off insulin production
What are the 3 ketones we produce?
Acetone
Acetoacetate
3 hyroxybutyrate
Explain how ketones are produced in hypoglycaemia
When glucose levels are low, insulin levels also fall. This leads to increased lipolysis, which produces a lot of FFA. FFA go through beta oxidation, which thereby produces ketones
What is the cause of a premature neonate jittery baby which is not feeding and has low glucose a few after feeding?
Fatty acid oxidation defect
What are 4 of the inherited metabolic disorders
Fatty acid oxidation disorders
Glycogen storage disease type 1
MCADD - problem breaking down fat for energy
Carnitine disorders - nutrients cannot get into cells so you will have muscle wasting and may have cardiac and hepatic problems
What are some causes of high insulin levels?
Insulinoma Druga - Inssulin and sulphonylurea Infant of diabetic mother Beckwith Weidemann syndrome Nesidioblastosis - Overexcitable beta cells
How does sulphonylurea cause a raise in isulin AND c peptide
It binds to K+ATP channels independently and closes these channels. This drives insulin production from beta cells
How do insulinomas usually present?
Fasting hypoglycaemia
What is non islet cell tumour hypoglycaemia and how does it present?
Tumours producing IGF 2 that act as insulin. You will have low glucose, low insulin, low c peptide, no FFA and no ketones
