Glucose Management Flashcards
What is hyperinsulinism?
A condition characterized by excessive insulin production, often leading to hypoglycemia
What is the primary cause of persistent neonatal hyperinsulinism?
Autosomal recessive disorder caused by regulatory defects in pancreatic B cell function
What syndrome is associated with pancreatic islet cell hyperplasia?
Beckwith-Wiedemann syndrome
What metabolic process occurs under anaerobic conditions?
One molecule of glucose produces 2 molecules of ATP and lactic acid
What is a significant outcome of maternal diabetes during pregnancy?
Increased perinatal mortality rates
What are some morbidities associated with infants of diabetic mothers (IDM)?
- Neurologic sequelae
- Developmental delay
- Behavioral differences
- Obesity
- Diabetes
What complications can arise from being an infant of a diabetic mother?
- Shoulder dystocia
- Renal vein thrombosis
- Birth asphyxia
- Development of juvenile insulin-dependent diabetes
What is the main goal in managing infants of diabetic mothers?
To achieve and maintain euglycemia
What should be done if an infant is unable to tolerate enteral feedings?
IV administration of glucose
What are inborn errors of metabolism related to inadequate glucose production?
- Defective gluconeogenesis
- Glycogenolysis
- Galactosemia
- Amino acid disorders
- Organic acid deficiencies
What is glycogen storage disease?
Autosomal recessive defects causing a deficiency in the formation or degradation of glycogen in the liver
What physiological response occurs during hypoglycemia?
The brain increases blood flow to improve glucose delivery
What fuels can the brain use when glucose consumption exceeds supply?
- Ketone bodies
- Lactic acid
- Free fatty acids
- Glycerol
What is a significant risk for preterm or SGA infants concerning glucose supply?
Severely limited ability to mount a ketogenic response
What are the clinical signs of hypoglycemia in neonates?
- Tremors
- Jitteriness
- Irritability
- Abnormal cry
- Respiratory distress
- Stupor
- Hypotonia
- Lethargy
- Hypothermia
- Seizures
What is the AAP definition of hypoglycemia in infants?
Blood glucose < 40 mg/dl
What is the incidence of hypoglycemia in at-risk infants?
May be as high as 30%
What is the typical blood glucose level for a neonate after birth?
Falls after birth, lowest level 1-2 hours after delivery
What are the mechanisms of glucose homeostasis in the neonate?
- Secreting glucagon
- Catecholamines
- Suppressing insulin release
What is the role of insulin in glucose metabolism?
Decreases blood glucose level by promoting glycogen formation
What is glucagon’s role in glucose metabolism?
Increases blood glucose level by promoting glycogenolysis and gluconeogenesis
What is the significance of fetal insulin during pregnancy?
Plays an important role in fetal growth
What is the effect of maternal hyperglycemia on the fetus?
Glucose crosses the placenta while insulin does not
What should be done if an infant’s glucose level is 25-40 mg/dl and asymptomatic?
Feed infant breast milk or formula
What is the recommended management for persistent hypoglycemia in infants?
IV glucose infusion is indicated
What is the incidence of congenital anomalies in infants of diabetic mothers?
Higher incidence throughout pregnancy
What is reactive hypoglycemia?
Return of symptoms if IV glucose infiltrates or is stopped abruptly
What is the role of diazoxide in managing hyperinsulinism?
Decreases insulin secretion
