Diabetes Mellitus Flashcards

Question

Causes of Hypoglycemia in diabetics

Answer 1

Drugs (most common) A - In Diabetics - Exogenous insulin and insulin secretagogue - (giblencamide - 2nd gen long acting secretagogue, stimulate pancreas and prod excess insulin) (sulfonylureas) - Less common causes - insulin sensitizers (metformin taken with sulfonylureas , thiazolidinediones), gluconidase inhibitors, glucagon like peptide 1 (GLP-1) receptor agonists, and dipeptidyl peptidase IV inhibitors

Answer 2

Drugs Insulin Sulfonylureas Quinolones Pentamidine Quinine Angiotensin converting enzyme inhibitors - increase insulin sensitivity IGF - 1 (Insulin Like Growth Factor 1) Alcohol Salicylates

Answer 3

Endocrine causes - Hypopituitarism, ACTH deficiency, and Addison’s disease Endogenous hyperinsulinism - Beta cell secretagogue- such as sulfonylurea (gibenclamide) - Insulinoma - can be in pancreas - Insulin autoimmune hypoglycemia

Answer 4

-Pancreatic islet cell tumour that secrete insulin - Diagnosed by Whipple’s triad, plus measurement of overnight fasting (16 hours) glucose and insulin levels, C-peptide or pro insulin during a spontaneous episode of hypoglycemia.

Answer 5

Mesenchymal tumors, fibromas, carcinoid, myelomas, lymphomas, hepatocellular and colorectal carcinomas. They lower glucose by: *Secretion of insulin-like growth factor-2 *Excessive consumption of glucose by the tumour *True ectopic insulin secretion is extremely rare.

Answer 6

*Sepsis - Because of cytokine induced inhibition of gluconeogenesis in the setting of glycogen depletion . *CKD - Impaired gluconeogenesis, reduced renal clearance of insulin, reduced renal glucose production. *In fulminant liver failure, Gluconeogenesis is also impaired.

Answer 7

*Sepsis - Because of cytokine induced inhibition of gluconeogenesis in the setting of glycogen depletion . *CKD - Impaired gluconeogenesis, reduced renal clearance of insulin, reduced renal glucose production. *In fulminant liver failure, Gluconeogenesis is also impaired. Malnourishment - as a result of substrate limitation of gluconeogenesis and glycogenolysis in the setting of glycogen depletion.

Answer 8

Occurs within four hours after meals after gastric surgery

Answer 9

Take insulin injections or anti-psychotics. *Measurement of C-peptide levels during hypoglycaemia should identify patients who are injecting insulin; *Sulphonylurea abuse can be detected by chromatography of plasma or urine.

Answer 10

Nocturnal hypoglycemia Can lead to disruption of sleep and delays in correction of the hypoglycemia. If high morning sugars preceded by an episode of Nocturnal hypoglycemia (Somogyi effect).

Answer 11

occurs in longstanding diabetes, especially type 1. It is an impairment of counter regulatory response to hypoglycemia (epinephrine and glucagon), so many patients will develop neuroglycopenic symptoms, without warnings symptoms of hypoglycemia which is dangerous .

Answer 12

- Postprandial syndrome - Cardiac disease (Arrhythmia, Valvular heart ) - Medications - Psychiatric disease, - Hyperthyroidism - Pheochromocytoma

Answer 13

Clinical evaluation and history including : Timing of symptoms (particularly in relationship to meals), Underlying illnesses or conditions Medications taken by the individual by family members, and Social history. Clinical examination to explore the cause

Answer 14

Fasting or Postprandial evaluation for : 2. Glucose 3. Insulin 4. C-peptide 5. Beta-hydroxybutyrate6. Proinsulin 7. Sulfonylurea and meglitinide screen

Answer 15

If plasma insulin, C-peptide, and proinsulin values are elevated - could be an insulinoma or endogenous hyperinsulinism Plasma insulin values are high, but plasma C-peptide and proinsulin values are low - then caused by Exogenous insulin

Answer 16

Plasma insulin, C-peptide, and proinsulin concentrations are not elevated.

Answer 17

Radiologic studies: Computed tomography, MRI, and ultrasonography can detect most insulinomas.

Answer 18

1-Patient education *Keeping a diary of low blood sugar symptoms *Regular check of blood sugar 2--Modifying *Diet (what, when, and how much you eat). *The dosage or types of medicines. *The timing and level of physical activity *Glycemic targets for individual patients - depends on age.

Answer 19

3-Hypoglycemia awareness : Avoidance of hypoglycemia for several weeks may help to improve it. 4-Nocturnal hypoglycemia Bedtime snacks Take the intermediate insulin at bedtime rather than before supper Reducing the dose of soluble insulin before supper, changing to a rapid-acting insulin analogue

Answer 20

Symptomatic diabetic with a low glucose value, <3.5 mmol/l. Non diabetic with low glucose (3.0mmol/lL) . Symptomatic hypoglycemia but rapid blood glucose measurement is not available.

Answer 21

3 teaspoons of sugar (dissolved in water) 1-2 tablespoons of honey 3 or 4 glucose tablets 4-6 small hard candies 200 g regular (not diet) soda (about half a can) 120 g fruit juice

Answer 22

*Fast acting carbohydrates (15g). *Check blood glucose 10-15 minutes after treatment *Repeat treatment of 15 grams if blood glucose level remains low and recheck at another 15 minutes

Answer 23

*give an IV bolus of 12.5 to 25 gm of glucose (25 percent dextrose - 100 mls) (50 ml of 50% - thrombophlebitis, otherwise give saline). *Measure a blood glucose 10 to 15 minutes after the IV bolus. *Re-administer 12.5 to 25 grams of glucose as needed to maintain the blood glucose above 5 mmol/l. *If glucose cannot be given by parenteral or oral routes, give glucagon 1 mg IM or SQ. followed by careful glucose monitoring and oral or intravenous glucose administration - you may repeat after 30 mins. *Once the patient is able to ingest carbohydrate safely, providing a mixed meal . Admit patients with ingestion of a long-acting hypoglycemic agent.

Answer 24

*Adjust dose of antidiabetics *Surgical removal of the insulinoma of the Non islet tumours *oral glucocorticoids, diazoxide and octreotide, glucagon. *Replacement therapy for Addison disease - corticosteroids.