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Path - Chempath > Hypoglycaemia > Flashcards

Hypoglycaemia Flashcards

1
Q

What does management of hypoglycaemia depend on?

A

On the patient’s level of alertness

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2
Q

How do you treat hypoglycaemia if patient is alert and orientated?

A

Oral carbohydrates

  • rapid acting: juice/sweets
  • longer acting: sandwich
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3
Q

How do you treat hypoglycaemia if patient is drowsy but swallowing intact?

A 
Buccal glucose (sublingual
- hypostop/glucogel

AND start thinking about IV access

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4
Q

How do you treat hypoglycaemia if unconscious or concerned about swallowing?

A

IV access

20% glucose IV

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5
Q

What should you consider if patient is deteriorating / refractory hypoglycaemic /difficult IV access?

A

IM/SC 1mg glucagon

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6
Q

What must you consider when administering glucagon?

A

If the patient has sufficient hepatic glycogen stores

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7
Q

What is generally low glucose on a ward?

A

<4mmol/L

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8
Q

What is generally low glucose in ITU/neonates?

A

<2.5mmol/L

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9
Q

What are symptoms of hypoglycaemia

A

Adrenergic:

  • tremor
  • palpitations
  • sweating
  • hunger

Neuroglycopoenic

  • somnolence
  • confusion
  • incoordination
  • seizures
  • coma
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10
Q

What occurs to symptoms if a patient has recurrent hypoglycaemic episodes?

A

HYPOGLYCAEMIA UNAWARENESS

so the lack of adrenergic symptoms due to hypoglycaemia

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11
Q

What is the triad for diagnosis of hypoglycaemia?

A

Low glucose
Symptoms
Relief of symptoms with glucose administration

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12
Q

What is the order of hormone changes following hypoglycaemia?

A
  1. Suppression of insulin
  2. Release of glucagon
  3. Release of adrenaline
  4. Release of cortisol
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13
Q

Explain counter regulation of hypoglycaemia

A
  1. Low glucose means insulin suppression
  2. Immediately after low glucose means increased glucagon
  3. Low insulin and high glucagon mean:
    • reduce peripheral uptake of glucose
    • increase glycogenolysis
    • increase gluconeogenesis
    • increase lipolysis
  4. This means increased glucose, increased FFA
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14
Q

What do FFAs do once produced by lipolysis?

A

The enter the beta oxidation cycle to generate ATP

Others will form ketone bodies

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15
Q

What are the two key ways of measuring glucose?

A
  1. VENOUS GLUCOSE

2. CAPILLARUY GLUCOSE

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16
Q

What is negative about measuring blood glucose via capillary?

A

POOR PRECISION at low glucose levels

17
Q

What are common causes of hypoglycaemia in people without diabetes?

A 
Critically unwell 
Organ failure 
Hyperinsulinism 
Post-gastric bypass, extreme weight loss
Drugs
18
Q

What are causes of hypoglycaemia in diabetics?

A 
Medications 
Inadequate carbohydrate intake / missed meals 
Excessive alcohol 
Strenuous exercise
Co-existing AI conditions
19
Q

What are DIABETES medications that can cause hypoglycaemia

A

Sulphonylureas
GLP1 agents
Insulin (both short and long acting)

20
Q

Which OTHER medications can cause hypoglycaemia?

A

Beta blockers
Saliclylate
Alcohol

21
Q

What must you do to drug doses for diabetes in someone who also has liver /renal failure?

A

REDUCE THE DOSE

As they have impaired drug clearancer

22
Q

What comorobidities are dangerous if someone is on drugs for diabetes=?

A

liver / renal failure

Addisons

autonomic neuropathy

23
Q

What is C peptide a product of?

A

A product of PRO-insulin

24
Q

What is the ratio between C peptide and insulin?

A

1:1 EQUIMOLAR

25
Q

What are important biochemical tests to find the cause of hypoglycaemia?

A
  • Insulin levels
  • C peptide
  • Drug screen
  • Auto antibodies
  • Cortisol, GH
  • FFA
  • Lactate
26
Q

Explain the process behind normal insulin secretion

A

Glucose crosses the membrane and enters glycolysis via glucokinase
Glycolysis produces ATP
The rise in ATP leads to closure of the ATP sensitive K+ channel
K+ can no longer leave the cell
This leads to membrane depolarisation and calcium influx
This leads to insulin release from the cell

27
Q

What is the MOA of sulpholynusrea?

A

They block the ATP sensitive K+ channel

So the rest of the pathway is always activated and insulin is always secreted

28
Q

Which congenital disease are insolinoma associated with?

A

MEN1

29
Q

Explain how paraneoplastic syndrome can cause hypoglycaemia

A

Mesenchymal tumours / epithelial tumours secrete “big IGF2”
Big IGF2 binds to IGF1 and insulin receptors
They behave like insulin, so endogenous insulin production is wswitched off and FFA production is suppressed

30
Q

what is a specific pathogenic cause of low insulin, low glucose, low FFA

A

NON ISLET CELL TUMOUR HYPOGLYCAEMIA

31
Q

what is a NON ISLET CELL TUMOUR HYPOGLYCAEMIA

A

tumour causing paraneoplastic syndrome
secretion of big IGF-2
IGF-2 binds to IGF1 receptors and insulin receptors
Behaves like insulin > switches off insulin production and FFA production

32
Q

What are causes of NON ISLET CELL TUMOUR HYPOGLYCAEMIA

A 
Mesenchymal tumour (mesothelioma,. fibroblastoma) 
Epithelial tumours (carcinoma)

Path - Chempath (23 decks)

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