HYPOGLYCEMIA Flashcards
what is hypoglycemia?
a medical emergency in which blood glucose levels are lower than normal (<70)
what patients usually experience hypoglycemia?
diabetics (T1>T2)
>d/t inadequate oral intake w/ insulin administration
what occurs in patients w/ diabetes after 5 years?
they lose their glucagon response
what does glucagon do?
increases glucose in the blood
can hypoglycemia occur in patients w/o diabetes?
yes!
is hypoglycemia defined as a limit for the glucose level?
no. by clinical features
how does hypoglycemia occur?
five bullet points
- eating less and exercising more
- alcohol consumption
- meds
- hyper-metabolic states like sepsis and burns
- tumors (insulinomas)
whats the normal serum glucose levels?
71-99 mg/dL
how is glucose maintained?
by coordinated balance between insulin, glucagon, and sympathetic nervous system
with decreased glucose levels, what happens at around 80 mg/dL?
insulin secretion decreases
with decreased glucose levels, what happens at around 68 mg/dL?
glucagon, norepinephrine, and epinephrine are secreted
what does glucagon mobilize during decreased glucose levels?
glycogen from the liver raising blood glucose by about 36 mg/dL in 15 min
what does norepinephrine do during decreased glucose levels?
norepinephrine acts systematically to cause adrenergic symptoms of hypoglycemia, including tachycardia and diaphoresis
what does epinephrine do during decreased glucose levels?
four things
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
with decreased glucose levels, what happens at around 58-66 mg/dL?
- growth hormone and cortisol are secreted
- increased lipolysis in adipose tissues
- increases ketogenesis and gluconeogenesis in the liver
what meds cause hypoglycemia?
- INSULIN
- meglitinides (repaglinide)
- sulfonylurea (glipizide)
- beta blockers
- ethanol
- quinolones
- salicylates
- MAO inhibitors
what glucose number are signs and symptoms seen in?
<55 mg/dL in most
(<70 mg/dL in some)
what is the clinical presentation for a patient with a glucose of roughly 60?
this value is just when initial symptoms begin
what is the clinical presentation for a patient with a glucose of roughly 50?
cognitive/behavioral impairment
what does low blood glucose trigger the release of?
epinephrine (Adrenaline) aka fight or flight symptoms
what happens if blood glucose levels continue to fall and the brain goes without glucose?
neuroglycopenic symptoms
what are hypoglycemic clinical presentations going from mild to severe?
feeling shaky/anxious
sweaty and pale
tachycardic
light-headed
impaired vision
numbness/tingling in lips tongue or cheeks
confused
clumsy
seizures
coma
death
what is the whipple triad for?
it is a triad associated with hypoglycemia in non-diabetic patients
what are the 3 components of whipples triad?
- confirmed glucose < or equal to 70
- signs and sx associated with hypoglycemia
- resolution of sx after the management of hypoglycemia
do non diabetic patients presenting with whipples triad require further work up? why?
ofcourse they do. this is so that you can find out the etiology of a possible hypoglycemic disorder
what are 2 reliable dx modalities required for measuring glucose?
- hospital point-of care testing
- laboratory measurement
what is level 1 hypoglycemia?
54-70 mg/dL
what is level 2 hypoglycemia?
<54 mg/dL
what is level 3 hypoglycemia?
severe event characterized by altered mental status and/or physical status
what is the management for mild-moderate hypoglycemia?
15-15 rule
what is the 15-15 rule?
- check blood glucose
- eat 15 g of simple carbohydrate
- simple carbohydrates
>glucose tablets
>4 oz juice or regular soda
>1 tb of sugar or honey
>hard candies
- simple carbohydrates
- recheck blood glucose in 15 min
repeat until blood sugar levels are > or equal to 70
identify underlying cause and make corrections as needed
what is the management for severe hypoglycemia?
- amp of D50 IV (35 g dextrose monohydrate in 50 mL of water)
- 1 mg of glucagon IM
- 3 mg of glucagon intranasally
- repeat point-of-care blood glucose measurement in 15 min
- dose may be repeated if glucose level still low
what should a patient do post- severe hypoglycemia that treatment once glucose is corrected and mental status is regained?
normal oral intake should be restarted
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?
add dextrose to maintenance fluid
