Hypoglycamia

Question 1

acute management of hypoglycaemia in alert

Answer 1

oral carbs, rapid acting - juice, longer acting - sandwich

Question 2

acute management of hypoglycaemia if drawsy

Answer 2

buccal glucose, glucogel, IV access

Question 3

Acte management of hypo in unconcious

Answer 3

IV access, 20% glucose IV,

Question 4

when would you consider 1mg glucagon

Answer 4

deteriorating, refractory, insulin induced, difficult IV access

Question 5

how does gthe body naturally counter regulate low glucose

Answer 5

decreases insulin, increases glucagon (reduce peripheral uptake of glucose, increased glycongenolysis, increase gluconeogenesis, increased lipolysis) increases flucose ND FFA which re oxidised into ketones, low neuronal glucose sensed in hypothalamus and catecholamines, ACTH cortisol and GH are produced

Question 6

how is glucose measured

Answer 6

venous glucose is gold standard, capillary blood glucose is point of case but poor precision

Question 7

causes of hypos

Answer 7

diabetes, paeds, critically unwell, organ failure, hyperinsulinism, insuulinoma, gastric bypass, drugs, extremem weight loss, facticious

Question 8

which diabetic meds lower glucose

Answer 8

sulphonylureas, GLP1, meglitinides, insulin, b blockers, salicyltes , alcohol

Question 9

what is c peptide

Answer 9

cleavage product of insulin, secreted in equimolar amounts to insulin, half life 2 hours, interferes with insulin measurement,s inddicates how much insulin body is making

Question 10

low insulin low c peptide

Answer 10

hypoinsulinaemic hypoglycaemia - due to fasting, starving, strenous exercise, critical illness, endocrine deficiencies, liver failrue

Question 11

high insulin high c peptide

Answer 11

hyperinsulinaemic hypoglycaemia - insulinoma, sulphonylurea excess

Question 12

high insulin low c peptide

Answer 12

exogenous insulin

Question 13

what does absence of ketones signify in low glucose

Answer 13

insulin deficiency, fatty acid oxidation defect, starvation

Question 14

causes of neonatla hypoglycaemia

Answer 14

premature, iugr, indadequate glycogen and fat sttores - should improve with feeding
pathological - inborn metabolic defecgt

Question 15

inherited metabolic disorders

Answer 15

fatty acid oxidation defect, gluconeogentic disorder type 1, medium chain acyl coa dehydrogenase defect, carnitine disorders

Question 16

what is 3 hydroxybutyrate

Answer 16

product of FFA

Question 17

ffa raised 3 hydroxybutyrate raised and no hepatomegaly

Answer 17

maple syrup urine, growth hormone deficiency, tyrosinaemia, drug toxicity, sepsis

Question 18

innapropriately raiased insulin causes

Answer 18

insulinoma, sulphonylurea, islet cell hyperplasia, beckwith weidmann syndrome, infant of diabetic mum, hyperinsulinism, rare autoimmune

Question 19

how do sulphonylureas work

Answer 19

binds to k+ atp channel independently of glucose causng membrane dedpoloratisation and insulin release

Question 20

low glucose low insulin low c peptide low ffa low ketones

Answer 20

non islet cell tumour hypoglycaemia - paraneoplastic syndrome secreting big igf2 which acts like insulin