Hypoglycemia

Question 1

GLUT transporters on the brain

Answer 1

GLUT 1 and 3

GLut 1 is on endothelial cells and astrocytes, GLUT3 is on neurones

Question 3

diagnosis of hypoglycemia– whipples triad

Answer 3

1. symptoms of hypoglycemia
2. low plasma glucose
3. relied of symptoms with correction of hyppoglycemia

Question 4

outline the counter regulatory response to hypoglycemia (4 steps)

Answer 4

1. decrease in insulin is detected because of low sugar *happens around 4.4-4.7mmol glucose
2. increase of glucagon (stimulates both glycogenolysis and gluconeogenesis)
3. epinephrine (increases gluconeogenesis)
4. GH and cortisol: limits glucose utilization (saves it for the brain), enhances glucose production

Question 5

epinephrine and glucagon ___ glucose levels

Answer 5

increase glucose levels

Question 6

Neurogenic
– Due to____
– In normal subjects below 3.1 mmol/L

• Neuroglycopenic
– Due to ____
– In normal subjects below 2.8 mmol/L

Answer 6

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

Question 7

symptoms and signs of neurogenic hypoglycemia

Answer 7

Question 8

signs and symptoms of neuroglycopenic hypoglycemia

Answer 8

Question 9

what is hypoglycemia unawareness

Answer 9

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

Question 10

Question 11

hypoglycemia classification

Answer 11

usually fasting vs post prandial

Question 12

hypoglycemia mechanisms/causes

Answer 12

1. excessive insulin
2. defective glucose production– impaired gluconeogenesis or glycogenolysis
3. reduced availability of alternate fuels
4. defective counter-regulatory hormone

Question 13

causes of excess insulin (mechanism of hypoglycemia)

Answer 13

Question 14

causes of defective glucose production

Answer 14

Question 15

Causes of decreased alternative fuel sources (cause of hypoglycemia)

Answer 15

Question 16

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

Answer 16

Question 17

Question 18

Hypoglycemia Investigation

Answer 18

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

Question 19

outline the process of a 72 hour fast

Answer 19

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