Hypoglycemia Flashcards
GLUT transporters on the brain
GLUT 1 and 3
GLut 1 is on endothelial cells and astrocytes, GLUT3 is on neurones

diagnosis of hypoglycemia– whipples triad
- symptoms of hypoglycemia
- low plasma glucose
- relied of symptoms with correction of hyppoglycemia
outline the counter regulatory response to hypoglycemia (4 steps)
- decrease in insulin is detected because of low sugar *happens around 4.4-4.7mmol glucose
- increase of glucagon (stimulates both glycogenolysis and gluconeogenesis)
- epinephrine (increases gluconeogenesis)
- GH and cortisol: limits glucose utilization (saves it for the brain), enhances glucose production

epinephrine and glucagon ___ glucose levels
increase glucose levels

Neurogenic
– Due to____
– In normal subjects below 3.1 mmol/L
• Neuroglycopenic
– Due to ____
– In normal subjects below 2.8 mmol/L
Neurogenic
– Due to counter regulatory hormones
– In normal subjects below 3.1 mmol/L
• Neuroglycopenic
– Due to brain glucose deficiency
– In normal subjects below 2.8 mmol/L

symptoms and signs of neurogenic hypoglycemia

signs and symptoms of neuroglycopenic hypoglycemia

what is hypoglycemia unawareness
in this condition, you skip the autonomic/neurogenic symptoms (due to increase epinephrine, cortisol, glucagon) that usually act as warning sings, and you go straight to life threatninig neuroglycopenic signs.
- it often happens in people with frequent hypoglycemic episodes, with diabetic autonomic neuropathy, and older patients


hypoglycemia classification
usually fasting vs post prandial

hypoglycemia mechanisms/causes
- excessive insulin
- defective glucose production– impaired gluconeogenesis or glycogenolysis
- reduced availability of alternate fuels
- defective counter-regulatory hormone
causes of excess insulin (mechanism of hypoglycemia)

causes of defective glucose production

Causes of decreased alternative fuel sources (cause of hypoglycemia)

causes of decreased counter-regulatory hormones (cause of hypoglycemia)


Hypoglycemia Investigation
- 72 hour fast– if someone had proper stores, they would not yet be in ketosis after 72 hours.

outline the process of a 72 hour fast
No caloric intake; closely supervised
• Measure glucose at intervals and decrease the
interval as the glucose values drop below 4 mmol/l
• End fast when patient has symptoms and a glucose
- *value that is < 2.5 mmol/l** measuring
- *– Insulin – Pro insulin – C-peptide – beta-hydroxybutyrate - Sulfonylurea**
- when a deficiency is suspected, measure the plasma cortisol, GH, or glucagon at the beginning and end of the fast
