EXAM #2: HYPOGLYCEMIA Flashcards
List the hormones that raise serum glucose.
1) Glucagon
2) Cortisol
3) GH
4) Adrenaline
5) NE
How can you tell the difference between too much endogenous vs. exogenous insulin?
Endogenous= insulin + c-peptide Exogenous= insulin only
What is the effect of insulin on K+ and phosphate?
Increased uptake of K+ and phosphate
How can kyperkalemia be treated?
Insulin + glucose
What are the symptoms of hypoglycemia?
STAB AT
- Sweating*
- Tremors
- Agitation/anxiety*
- Blurry vision
- AMS
- Tachycardia*
*These symptoms are related to the ANS; others are neurologic.
What is the most common cause of hypoglycemia in adults?
1) DM therapy, esp. insulin therapy in T1DM
What is the most common cause of hypoglycemia in non-diabetic patients?
1) Alcohol
2) Critical illness
3) Hormone deficiency
*Don’t forget inappropriate psych self med. with insulin
What is the effect of alcohol on blood sugar?
- Gluconeogenesis is inhibited
- Glycogenolysis is activated
What are the critical illnesses that can cause hypoglycemia?
1) Hepatic, renal, or cardiac failure
2) Sepsis
What is the most common cause of hypoglycemia caused by endogenous hyperinsulinemia?
Insulinoma
What causes post-pradial hypoglycemia?
1) S/p gastric resection
2) Islet cell tumor
3) Glycogen Storage Disease
4) Hereditary fructose intolerance
5) Galactosemia
What are the two major medications associated with hypoglycemia?
1) Gatifloxacin
2) Indomethacin
What is the Whipple Triad?
Triad of symptoms associated with an insulinoma:
1) Fasting glucose less than 40 mg/dL
2) Symptomatic
3) Immediate relief of symptoms after glucose infusion
What oral glucose medication can cause elevated levels of endogenous insulin and c-paptide?
Sulfonylurea
What are the expected lab findings in a patient with hypogylcemia due to exogenous insulin overdose?
1) insulin greater than 3
2) c-peptide less than 0.2
What are the expected lab findings in a patient with hypogylcemia due to insulinoma?
1) insulin greater than 3
2) c-peptide greater than 0.2
Why would you do a 72 hour fast?
Patient that has intermittent symptoms of hypoglycemia
*Normoglycemia patient will not have sx. during the fast; also, this is done in the hospital
How will a patient with an insulinoma respond to glucagon in a 72 hour fast?
- Rapid increase in blood sugar
- Followed by a drastic drop in blood sugar
*Normal patients will maintain elevated blood sugar levels for 3 hours post glucagon administration
What is the expected beta-hydroxybutarate response in a 72 hour fast if the patient has an insulinoma?
Low levels–insulin suppresses ketosis
What is Tolbutamide?
Drug that promotes production/ release of insulin
What test can be used to distinguish between a focal abnormality i.e. insulinoma or diffuse process?
Aterial Ca++ stimulation test
*This will stimulate an insulinoma to release insulin
