Chem Path: Hypoglycaemia

Question 1

What is the advantage of buccal glucose administration?

Answer 1

Fast absorption as it bypasses hepatic first pass

Question 2

What would you need to consider regarding IM glucagon

Answer 2

Patient needs to have adequate glucose stores and it will take 15-20 mins for glucose levels to be up

Question 3

What triad to we think of hypoglycaemia

Answer 3

Whipple’s

Question 4

What are the 3 components of the triad

Answer 4

Low glucose, adrenergic and neurogylcopaenic symptoms and relief of symptoms with glucose administration

Question 5

What are adrenerigc and neurogylcopaenic symptoms

Answer 5

Tremors, palpitations, sweating and hunger

Drowsy, confusion, incordinance, seizure and coma

Question 6

Explain what happens when there is hypoglycaemia

Answer 6

Insulin is switched off, and glucagon production increases and lipolysis increases

Question 7

What happens in lipolysis

Answer 7

Lipids are broken down, thereby increase FFAs

Question 8

What happens to FFAs

Answer 8

Beta oxidation, thereby producing ketones

Question 9

What happens when there is sympathetic activation due to hypoglycaemia

Answer 9

Increased catecholamines (adrenaline) production along with ACTH, cortisol and GH

Question 10

What is the gold standard of measuring glucose

Answer 10

Venous glucose

Question 11

What drugs can cause hypoglycaemia

Answer 11

Insulin
Sulphonylurea
Salicylates
Beta blockers

Question 12

Why might you not get hypoglycaemic symptoms with beta blockers

Answer 12

They block adrenergic symptoms

Question 13

What is polyglandular autoimmune syndrome?

Answer 13

Addison’s that can result in hypoglycaemia

Question 14

What is C peptide and how is it released

Answer 14

It is a cleavage product of pro insulin and it is released in equimolar amounts of insulin

Question 15

Hypogylcaemia due to excess injected insulin would result in low or high c peptide?

Answer 15

Low c peptide

Question 16

What is lanugo hair?

Answer 16

baby hair that grows during severe anorexia

Question 17

How would insulin and c peptide levels be in severely malnourished people?

Answer 17

Low levels of both as she will have no glycogen stores and that usually turns off insulin production

Question 18

What are the 3 ketones we produce?

Answer 18

Acetone
Acetoacetate
3 hyroxybutyrate

Question 19

Explain how ketones are produced in hypoglycaemia

Answer 19

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

Question 20

What is the cause of a premature neonate jittery baby which is not feeding and has low glucose a few after feeding?

Answer 20

Fatty acid oxidation defect

Question 21

What are 4 of the inherited metabolic disorders

Answer 21

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

Question 22

What are some causes of high insulin levels?

Answer 22

Insulinoma 
Druga - Inssulin and sulphonylurea 
Infant of diabetic mother 
Beckwith Weidemann syndrome 
Nesidioblastosis - Overexcitable beta cells

Question 23

How does sulphonylurea cause a raise in isulin AND c peptide

Answer 23

It binds to K+ATP channels independently and closes these channels. This drives insulin production from beta cells

Question 24

How do insulinomas usually present?

Answer 24

Fasting hypoglycaemia

Question 25

What is non islet cell tumour hypoglycaemia and how does it present?

Answer 25

Tumours producing IGF 2 that act as insulin. You will have low glucose, low insulin, low c peptide, no FFA and no ketones