HYPOGLYCEMIA

Question 1

The following together are known as what?

1. Blood glucose <70mg/dl
2. signs and symptoms of hypoglycemia
   a. confusion
   b. irritability
   c. fatigue
   d. anxiety
   e. sweating
   f. irregular heart rhythm
   g. perioral paresthesia
3. signs and symptoms resolves with glucose elevation

Answer 1

Whipple’s Triad

Question 2

Symptoms of hypoglycemia begin at plasma glucose levels in the range of ___ and impairment of brain function at approximately ___

Answer 2

1. 60mg/dL

2. 50mg/dL

Question 3

What are the two principal types of spontaneous hypoglycemia in adults?

Answer 3

1. fasting

2. postprandial

Question 4

What type of hypoglycemia is often subacute or chronic and usually presents with neuroglycopenia as its principal manifestations?

Answer 4

Fasting Hypoglycemia

Question 5

What type of hypoglycemia is relatively acute and is often heralded by symptoms of neurogenic autonomic discharge (sweating, palpitations, anxiety, and tremulousness)? (may been seen in patients after GI surgery)

Answer 5

Postprandial Hypoglycemia

Question 6

The clinical manifestations of hypoglycemia are are divided into what two broad categories?

Answer 6

1. neuroglycopenic

2. sympathomimetic

Question 7

Neuroglycopenic

As glucose is the main energy source for CNS function, most episodes of symptomatic hypoglycemia include what?

Answer 7

Neurologic dysfunction

Question 8

Neuroglycopenic

With a decline in serum sugar, the brain quickly exhausts its reserve supply of ____, resulting in CNS dysfunction

Answer 8

carbohydrate fuel

Question 9

The neuroglycopenic category of hypoglycemia most commonly manifests in what?

Answer 9

1. alterations in consciousness
2. lethargy
3. confusion
4. combativeness
5. agitation
6. unresponsiveness
   other manifestations include seizures and focal neuro deficits

Question 10

A rapid fall in blood glucose levels or the hypothalamic sensing of neuroglycopenia causes the release of the counter-regulatory hormones, primarily the catecholamines epinephrine and norepinephrine is what category of hypoglycemia?

Answer 10

Sympathomimetic

Question 11

What are the typical symptoms of sympathomimetic hypoglycemia?

Answer 11

1. anxiety
2. nervousness
3. irritability
4. nausea
5. vomiting
6. palpitations
7. tremors

Question 12

Symptoms for hypoglycemia starts at what finger stick blood glucose level?

Answer 12

60mg/dL

Question 13

Impairment of the brain function starts at what finger stick blood glucose level?

Answer 13

50mg/dL

Question 14

If considering an auto-immune cause of hypoglycemia what labs should you run?

Answer 14

Serum antibody testing such as:

1. GAD-65
2. Anti-islet cell
3. Anti-insulin antibodies

Question 15

If considering a surreptitious cause for hypoglycemia what labs should you run?

Answer 15

1. C-peptide
2. Serial glucose/insulin levels in supervised setting
3. Serum sulfonylurea levels

Question 16

What is caused by a pancreatic B-cell tumor and accidental or surreptitious insulin or sulfonylurea administration?

Answer 16

Hyperinsulinism

Question 17

True or False
Hypoglycemia
Do not attempt PO interventions on a patient with altered mental status

Answer 17

True

patients are at a high aspiration risk

Question 18

In patients with hypoglycemia who are unable to eat or drink can be given what?

Answer 18

1. Glucagon 0.5 or 1mg SC/IM

2. 50% dextrose 50-100mL IV bolus with or without continuous infusion of 5-10% dextrose solution

Question 19

Hypoglycemia
Either continued or recurrent mental status alteration, recurrent hypoglycemia, or a downward trend in serial glucose values during observation despite adequate replacement therapy demands what disposition for the patient?

Answer 19

admission to the hospital MEDEVAC

Question 20

True or False
It is strongly advised to involve the medical officer early in the treatment when the cause for hypoglycemia is not clearly evident

Answer 20

True

Question 21

What are some complications of hypoglycemia?

Answer 21

1. coma
2. brain damage
3. traumatic injuries (MVA, falls, etc.)
4. Death