Chemical Pathology 16 - Hypoglycaemia Flashcards

1
Q

How should hypoglycaemia be managed if the patient is alert and oriented?

A

Juice and a sandwich

Continuous monitoring and treat cause

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2
Q

How should hypoglycaemia be managed if the patient is drowsy, but not unconscious?

A
Bucchal glucose (this bypasses 1st pass metabolism) 
Continuous monitoring and treat cause
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3
Q

How should hypoglycaemia be managed if the patient is unconscious or has a reduced swallow reflex?

A

IV glucose 20%

Continuous monitoring and treat cause

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4
Q

What are the possible symptoms of hypoglycaemia?

A

Adrenergic symptoms - tremors and sweating
Neuroglycopaenic symptoms - somnolence and confusion
None - in some type 1 diabetic

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5
Q

What is the body’s physiological response to hypoglycaemia, and which of these responses if the first?

A

1st - reduced insulin

Then catecholamine release (ACTH, cortisol and GH increase, causes adrenergic symptoms) and increased glucagon

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6
Q

Recall the effects of glucagon

A
Directly: 
1. Decreases peripheral glucose uptake
2. Increases glycogenolysis
3. Increases gluconeogenesis in the liver and kidneys 
4. Increases lipolysis 
This then leads to: 
1. Increased glucose 
2. Inceased free fatty acids 
Fatty acids undergo beta oxidation --> ketones
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7
Q

What is the best measure of glucose?

A

Venous glucose (way better than capillary)

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8
Q

Recall 6 differentials for the cause of hypoglycaemia in a NON-diabetic patient

A
  1. Critically unwell pt
  2. Organ failure
  3. Hyperinsulinism
  4. Drugs
  5. Extreme weight loss
  6. Factitious
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9
Q

Recall 5 differentials for the cause of hypoglycaemia in diabetic patients

A
  1. Medications - these iatrogenically reduce glucose
  2. Inadequate CHO intake (T1D especially)
  3. Impaired awareness (eg EtOH)
  4. Exercise
  5. In presence of autoimune conditions eg Addissons
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10
Q

What class of drug is gliclazide?

A

Sulphonylurea

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11
Q

Which 2 classes of oral diabetic drug are most likely to cause a hypo?

A

Sulphonylureas (eg gliclazide)

GLP-1 agents

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12
Q

Recall 3 non-diabetes drugs that can cause a hypo

A

Beta blockers (impair adrenergic response so have impaired awareness of symptoms)
Salicylates - impair regulation of glucose
Alcohol

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13
Q

In a neonate with hypoglycaemia but no ketones, what is the likely diagnosis?

A

Inborn error of fatty acid metabolism

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14
Q

Recall 3 possible causes of hyperinsulinaemic hypoglycaemia

A
  1. Insulinoma (islet cel tumour)
  2. Drugs (eg insulin/ sulphonylurea)
  3. Islet cell hyperplasia
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15
Q

Recall 3 causes of islet cell hyperplasia in the neonate

A
  1. Infant of a diabetic mother
  2. Beckworth Wiedmann syndrome
  3. Nesidioblastosis
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16
Q

How can non-islet cell tumours cause hypoglycaemia?

A

This is a RARE case - most likely to occur in mesothelioma/ carcinoma of the lung
These tumours secrete ‘big IGF-2’ (paraneoplastic syndrome) which binds to both IGF-1 and insulin receptors
In this case, insulin and C peptide will both be low

17
Q

What are the 4 first basic biochemical tests that should be done in hypoglycaemia investigation?

A
  1. Glucose
  2. Insulin
  3. C peptide
  4. Drug screen
18
Q

Recall 5 advanced biochemical tests that can be used in investigating a hypoglycaemia

A
Ketones and FFAs
IGF studies
Ammonia
Lactate
Inborn error of metabolism screen