Chempath 17: Hypoglycaemia

Question 1

How should you give glucose to a diabetic who is drowsy and confused but able to swallow ?

Answer 1

Buccal glucose

Question 2

Which one of these is an Adrenergic sign of hypoglycaemia ?

A)Confusion
B)Solomolence
C)Seizures
D)Tremor
E) loss of coordination

Answer 2

D) Tremor

All the other options are neuroglycopaenic signs/symptoms

Question 3

Which 3 hormones are released as a result of Hypoglycaemia ?

Answer 3

Glucagon
Adrenaline
Cortisol

Question 4

Which of these diabetic drugs does not induce Hypos ?

A) Sulphonylureas
B) GLP-1 agents
C) Metformin
D) Insulin

Answer 4

D) Metformin

All the others induce Hypos

Question 5

Name a molecule that is a good marker of Beta cell function ?

Answer 5

C-peptide

Question 6

During hypoglycaemia levels of FFA increases. FFAs enter the …… oxidation cycle to produce ATP. Some FFAs do not undergo …….. oxidation and form ………. instead.

Answer 6

Beta
Beta
Ketones

FFA- free fatty acids

Question 7

A patient has a hypo. What cause is suggested by these test results:

Insulin: low
C-peptide: low

Answer 7

Appropriate response to hypoglycaemia

Fasting (no glycogen stores)
Adrenal failure (No cortisol)
Anorexia (no glycogen stores)

Question 8

A patient has a hypo. What cause is suggested by these test results:

Insulin: High
C-peptide: High

Answer 8

Excess endogenous Insulin

Question 9

A patient has a hypo. What cause is suggested by these test results:

Insulin: High
C-peptide: low

Answer 9

Excess exogenous Insulin (injecting too much insulin)

C peptide does not increase with unless endogenous insulin release

Question 10

List 4 Inborn errors of metabolism that can cause a neonatal hypoglycaemia with low Insulin and low C-peptide ?

Answer 10

FAOD- fatty acid oxidation disorders (no ketones are made)
GSD- Glycogen storage disease type 1
MCAD deficiency
Carnitine disorders

Question 11

List 4 causes of High insulin levels ?

Answer 11

Insulinoma (islet cell tumour)
Drugs: Insulin, Sulphonylurea
Islet cell hyperplasia: Beckwith-wiedemann syndrome, mother is diabetic, Nesidioblastosis

Question 12

Which syndrome features insulinomas ?

Answer 12

MEN1

Question 13

List 3 causes of hypoglycaemia with high insulin and high C-peptide ?

Answer 13

• Insulinoma
• islet cell hyperplasia
• Hyperinsulinaemic hypoglycaemia of infancy (When mother has gestational diabetes)