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Year 5 path SW > Chempath 17: Hypoglycaemia > Flashcards

Chempath 17: Hypoglycaemia Flashcards

1
Q

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

A

Buccal glucose

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2
Q

Which one of these is an Adrenergic sign of hypoglycaemia ?

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

D) Tremor

All the other options are neuroglycopaenic signs/symptoms

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3
Q

Which 3 hormones are released as a result of Hypoglycaemia ?

A

Glucagon
Adrenaline
Cortisol

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4
Q

Which of these diabetic drugs does not induce Hypos ?

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

A

D) Metformin

All the others induce Hypos

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5
Q

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

A

C-peptide

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6
Q

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

A

Beta
Beta
Ketones

FFA- free fatty acids

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7
Q

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

Insulin: low
C-peptide: low

A

Appropriate response to hypoglycaemia

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

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8
Q

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

Insulin: High
C-peptide: High

A

Excess endogenous Insulin

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9
Q

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

Insulin: High
C-peptide: low

A

Excess exogenous Insulin (injecting too much insulin)

C peptide does not increase with unless endogenous insulin release

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10
Q

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

A

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

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11
Q

List 4 causes of High insulin levels ?

A

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

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12
Q

Which syndrome features insulinomas ?

A

MEN1

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13
Q

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

A
  • Insulinoma
  • islet cell hyperplasia
  • Hyperinsulinaemic hypoglycaemia of infancy (When mother has gestational diabetes)
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14
Q

How should you treat someone who is hypoglycaemic but alert

A

oral carbs
rapid acting - juice/sweets
longer acting - sandwich

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15
Q

How should you treat someone who is hypoglycaemia and drowsy but with swallow intact

A

buccal glucose
eg hypostop/glucogel
start thinking about IV access

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16
Q

How should you treat someone who is hypoglycaemic and unconscious/ can’t swallow

A

IV access
50ml 50% glucose min-jet
or 100ml 20% glucose

17
Q

How should you treat someone who is hypoglycaemic and deteriorating/ refractory/ insulin induced/ difficult IV access

A

IM/SC 1mg glucagon

18
Q

how long does glucagon take to work

A

15-20 mins
mobilises glycogen stores
(consider whether they have adequate glycogen stores)

19
Q

what level of blood glucose is considered hypoglycaemic

A

< 4 mmol/L in adults

<2.5 mmol/L in neonates

20
Q

what are the two types of hypoglycaemia symptoms

A

ADRENERGIC - tremors, palpitations, sweating, hunger

NEUROGLYCOPAENIC - confusion, incoordination, seizures, coma

21
Q

describe what happens normally when low blood glucose is detected

A 
insulin secretion reduced
increase in glucagon 
- reduce peripheral uptake of glucose
- increase gluconeogenesis
- increase glycogenolysis
- increase lipolysis

Increases glucose levels and FFA levels
FFAs enter beta oxidation - ATP
If lots of FFA - ketone bodies

Also release of ATCH, cortisol, GH

22
Q

how can we confirm hypoglycaemia

A

lab glucose - gold standard
- grey top (flouride oxalate)

blood glucose meter - less precise at low glucose levels

23
Q

list causes of hypoglycaemia without diabetes

A 
fasting 
critically unwell 
organ failure
hyperinsulinism 
post gastric bypass
drugs 
extreme weight loss 
facticious
24
Q

list causes of hypoglycaemia in diabetics

A 
medications 
inadequate carb intake
impaired awareness
excessive alcohol
strenuous exercise
co-existing AI conditions
25
Q

list medications than can cause hypoglycaemia

A 
sulphonylureas
meglitinides
GLP-1 agents 
insulin
beta-blockers
salicylates
alcohol (inhibits lipolysis)
26
Q

what co-morbidities may result in hypoglycaemia in someone with diabetes

A

renal/liver failure
Addisons
poor awareness in autonomic neuropathy

27
Q

why is c peptide measured

A

marker of b cell function

30 min half life

28
Q

what causes hypoinsulinaemic hypoglycaemia

A

something other than insulin

fatsing/starvation 
strenuous exercise 
illness 
endocrine - hypopituitarism/adrenal failure
liver failure
anorexia nervosa
29
Q

what causes hyperinsulinaemic hypoglycaemia

A

excess endogenous insulin

high insulin + low c peptide - exogenous insulin

30
Q

name 3 ketone bodies

A

3-hydroxybutarate
acetone
acetoacetate

31
Q

what causes neonatal hypoglycaemia

A

explainable:
- premature, co-morbidities, IUGR, SGA, inadequate fat stores, should improve with feeding

pathological:
- inborn errors of metabolism

32
Q

causes of neonatal hypoglycaemia with suppressed insulin and c peptide

A

fatty acid oxidation disorder - no ketones made
glycogen storage disease
MCAD deficiency
carnitide disorders

33
Q

what would you expect to see in neonatal hypoglycaemia with low insulin and c peptide

A

high FFA

detectable ketone bodies

34
Q

list causes of inappropriately high insulin

A

Islet cell tumours eg insulinoma
Drugs eg insulin, sulphonylureas
Islet cell hyperplasia eg infant of diabetic mother, Beckwidth-Wiedemann syndrome, Nesidioblastosis

35
Q

how do sulphonylurease cause raised insulin

A

bind ATP sensitive K+ channels without ATP - makes them close - insulin released

36
Q

what causes non-islet cell tumour hypoglycaemia

A

mesenchymal tumours or epithelial tumours secreting big IGF-2
binds IGF1 receptors and insulin receptors
endogenous insulin production stopped and FFA production suppressed

37
Q

list genetic causes of hypoglycaemia

A 
glucokinase activating mutations 
congenital hyperinsulinism:
- KCNJ11/ABCC8
- GLUD-1
- HNF4A
- HADH
38
Q

what causes reactive/post-prandial hypoglycaemia

A

gastric bypass
hereditary fructose intolerance
early diabetes
insulin-sensitive individuals post large meals/ exercise

Year 5 path SW (106 decks)

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