HYPOGLYCEMIA

Question 1

what is hypoglycemia?

Answer 1

a medical emergency in which blood glucose levels are lower than normal (<70)

Question 2

what patients usually experience hypoglycemia?

Answer 2

diabetics (T1>T2)
>d/t inadequate oral intake w/ insulin administration

Question 3

what occurs in patients w/ diabetes after 5 years?

Answer 3

they lose their glucagon response

Question 4

what does glucagon do?

Answer 4

increases glucose in the blood

Question 5

can hypoglycemia occur in patients w/o diabetes?

Answer 5

yes!

Question 6

is hypoglycemia defined as a limit for the glucose level?

Answer 6

no. by clinical features

Question 7

how does hypoglycemia occur?

five bullet points

Answer 7

• eating less and exercising more
• alcohol consumption
• meds
• hyper-metabolic states like sepsis and burns
• tumors (insulinomas)

Question 8

whats the normal serum glucose levels?

Answer 8

71-99 mg/dL

Question 9

how is glucose maintained?

Answer 9

by coordinated balance between insulin, glucagon, and sympathetic nervous system

Question 10

with decreased glucose levels, what happens at around 80 mg/dL?

Answer 10

insulin secretion decreases

Question 11

with decreased glucose levels, what happens at around 68 mg/dL?

Answer 11

glucagon, norepinephrine, and epinephrine are secreted

Question 12

what does glucagon mobilize during decreased glucose levels?

Answer 12

glycogen from the liver raising blood glucose by about 36 mg/dL in 15 min

Question 13

what does norepinephrine do during decreased glucose levels?

Answer 13

norepinephrine acts systematically to cause adrenergic symptoms of hypoglycemia, including tachycardia and diaphoresis

Question 14

what does epinephrine do during decreased glucose levels?

four things

Answer 14

it acts on multiple organs
1. stimulates glycogenolysis and gluconeogenesis in the liver
2. decreases insulin secretion and increases glucagon secretin in pancreatic islet cells
3. increases lipolysis in adipose tissue, which provides glycerol for gluconeogenesis
4. decreases glucose uptake by muscle cells

Question 15

with decreased glucose levels, what happens at around 58-66 mg/dL?

Answer 15

1. growth hormone and cortisol are secreted
2. increased lipolysis in adipose tissues
3. increases ketogenesis and gluconeogenesis in the liver

Question 16

what meds cause hypoglycemia?

Answer 16

1. INSULIN
2. meglitinides (repaglinide)
3. sulfonylurea (glipizide)
4. beta blockers
5. ethanol
6. quinolones
7. salicylates
8. MAO inhibitors

Question 17

what glucose number are signs and symptoms seen in?

Answer 17

<55 mg/dL in most

(<70 mg/dL in some)

Question 18

what is the clinical presentation for a patient with a glucose of roughly 60?

Answer 18

this value is just when initial symptoms begin

Question 19

what is the clinical presentation for a patient with a glucose of roughly 50?

Answer 19

cognitive/behavioral impairment

Question 20

what does low blood glucose trigger the release of?

Answer 20

epinephrine (Adrenaline) aka fight or flight symptoms

Question 21

what happens if blood glucose levels continue to fall and the brain goes without glucose?

Answer 21

neuroglycopenic symptoms

Question 22

what are hypoglycemic clinical presentations going from mild to severe?

Answer 22

feeling shaky/anxious
sweaty and pale
tachycardic
light-headed
impaired vision
numbness/tingling in lips tongue or cheeks
confused
clumsy
seizures
coma
death

Question 23

what is the whipple triad for?

Answer 23

it is a triad associated with hypoglycemia in non-diabetic patients

Question 24

what are the 3 components of whipples triad?

Answer 24

1. confirmed glucose < or equal to 70
2. signs and sx associated with hypoglycemia
3. resolution of sx after the management of hypoglycemia

Question 25

do non diabetic patients presenting with whipples triad require further work up? why?

Answer 25

ofcourse they do. this is so that you can find out the etiology of a possible hypoglycemic disorder

Question 26

what are 2 reliable dx modalities required for measuring glucose?

Answer 26

1. hospital point-of care testing
2. laboratory measurement

Question 27

what is level 1 hypoglycemia?

Answer 27

54-70 mg/dL

Question 28

what is level 2 hypoglycemia?

Answer 28

<54 mg/dL

Question 29

what is level 3 hypoglycemia?

Answer 29

severe event characterized by altered mental status and/or physical status

Question 30

what is the management for mild-moderate hypoglycemia?

Answer 30

15-15 rule

Question 31

what is the 15-15 rule?

Answer 31

1. check blood glucose
2. eat 15 g of simple carbohydrate
   
   • simple carbohydrates
     >glucose tablets
     >4 oz juice or regular soda
     >1 tb of sugar or honey
     >hard candies
3. recheck blood glucose in 15 min

repeat until blood sugar levels are > or equal to 70

identify underlying cause and make corrections as needed

Question 32

what is the management for severe hypoglycemia?

Answer 32

1. amp of D50 IV (35 g dextrose monohydrate in 50 mL of water)
2. 1 mg of glucagon IM
3. 3 mg of glucagon intranasally

• repeat point-of-care blood glucose measurement in 15 min
• dose may be repeated if glucose level still low

Question 33

what should a patient do post- severe hypoglycemia that treatment once glucose is corrected and mental status is regained?

Answer 33

normal oral intake should be restarted

Question 34

what should a patient do post- severe hypoglycemia that treatment once glucose is corrected and mental status is regained but patient can not tolerate oral intake?

Answer 34

add dextrose to maintenance fluid