Disorders of the Endocrine Pancreas: Hypoglycemia

Question 1

identify the physiologic controls for high blood glucose

Answer 1

1. Insulin release increased in pancreatic beta cells that inhibits gluconeogenesis, glycogenolysis, and lipolysis
2. Glucagon release decreased in pancreatic alpha cells

Question 2

identify the physiologic controls for low blood glucose

Answer 2

1. insulin release decrease
2. glucagon release increased in pancreatic alpha cells stimulating gluconeogenesis and glycogenolysis
3. catecholamines are released by adrenal gland stimulating glycogenolysis

Question 3

what are the clinical signs of hypoglycemia in a patient

Answer 3

weakness, lethargy, dullness, dizziness, seizures, coma, death

Question 4

Whipple’s Triad

Answer 4

1. hypoglycemic symptoms
2. seizures glucose < 50mg/dl
3. glucose ingestion gives symptomatic relief

Question 5

Tx for hypoglycemia

Answer 5

treated with dextrose bolus IV or parenteral dextrose/sugar with exception of insulinomas where you should give slow low dextrose CRI

speed of replacement depends on clinical signs

support the endocrine system with glucagon

Question 6

Differentials for hypoglycemia

Answer 6

lack of substrate
toxin ingestion
hepatic failure
excessive insulin
hypoadrenocorticism
sepsis

Question 7

lack of substrate is common in __ that miss a meal or two

Answer 7

neonates

Question 8

how does addisons cause hypoglycemia?

Answer 8

addisons = no cortisol, cortisol is responsible for stimulating gluconeogenesis and glycogenolysis in response to stress

no cortisol-> no glucose -> mild hypoglycemia

don’t usually tx this

Question 9

how is an insulinoma diagnosed?

Answer 9

insulin to glucose ratio testing, with insulinomas, insulin levels in the blood will be normal in the face of hypoglycemia