Glucose Management Flashcards

1
Q

What is glucose vital for?

A

Cellular metabolism

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2
Q

What determines blood glucose concentration?

A

Balance between intake/production of glucose and glucose use by the body

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3
Q

What happens to excess glucose intake in the body?

A

Converted to glycogen and stored in liver, heart, and skeletal muscle

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4
Q

What is glycogenolysis?

A

The process of breaking down glycogen to re-form glucose

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5
Q

Define gluconeogenesis.

A

Production of glucose and glycogen in the liver using non-glucose precursors

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6
Q

What are the end products of glucose metabolism through glycolysis?

A

Carbon dioxide, water, and energy in the form of ATP

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7
Q

What percentage of cerebral energy production does glucose provide?

A

99%

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8
Q

During hypoglycemia, what substrates can the brain use for energy?

A
  • Ketone bodies
  • Lactate
  • Glycerol
  • Amino acids
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9
Q

What is the role of insulin in glucose regulation?

A

Decreases blood glucose level by promoting glycogen formation

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10
Q

What is the function of glucagon?

A

Increases blood glucose level by promoting glycogenolysis and gluconeogenesis

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11
Q

How does glucose reach the fetus?

A

By facilitated diffusion across the placenta at 60% - 80% of mother’s glucose level

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12
Q

When does a neonate’s blood glucose typically fall after birth?

A

Lowest level 1 – 2 hours after delivery

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13
Q

What mechanism helps the neonatal brain protect itself from hypoglycemia?

A

Metabolizes lactate, which is abundant

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14
Q

What is the typical glucose production rate in a neonate?

A

4-6 mg/kg/minute

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15
Q

What is the definition of hypoglycemia in infants according to AAP?

A

Blood glucose < 40 mg/dl in any infant, regardless of gestational age or presence of symptoms

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16
Q

What are some risk factors for neonatal hypoglycemia?

A
  • Large for gestational age
  • Small for gestational age
  • Infant of diabetic mother
  • Premature and sick or stressed infants
17
Q

What happens to blood flow in the brain during hypoglycemia?

A

Increases to improve glucose delivery

18
Q

What biochemical changes can prolonged hypoglycemia induce?

A

Damage to neuronal and glial cells of the brain, impairing growth and causing cell death

19
Q

What are the two main groups of causes for inadequate glucose supply or production?

A
  • Decreased substrate
  • Immature or altered enzyme pathways
20
Q

What is a common complication of hyperinsulinism in neonates?

A

Persistent neonatal hyperinsulinism

21
Q

What are some clinical signs of hypoglycemia in neonates?

A
  • Tremors
  • Jitteriness
  • Irritability
  • High-pitched cry
  • Hypothermia
22
Q

What is the main goal in the management of hypoglycemia in neonates?

A

Achieve and maintain euglycemia

23
Q

What should be done if a neonate’s glucose level is between 25-40 mg/dl and they are asymptomatic?

A

Feed infant breast milk or formula and recheck glucose after 30 minutes

24
Q

What management is indicated if glucose levels remain < 25 mg/dl after feeding?

A

IV glucose bolus D10W 2mL/kg

25
What is a potential long-term outcome of persistent neonatal hyperinsulinism?
Subsequent mental retardation
26
What complications can arise from hypoglycemia management?
* Recurrence of hypoglycemia * Necrosis from extravasation * Reactive hypoglycemia
27
What is the risk of perinatal mortality associated with infants of diabetic mothers?
Increased due to high rates of congenital malformations and stillbirths
28
What is the incidence of hypoglycemia in infants of diabetic mothers?
~20% in those with gestational diabetes, 35% with other forms of diabetes
29
What is the expected clinical outcome for SGA infants of mothers with gestational diabetes?
Worse than AGA or LGA infants