Hypoglycemia Flashcards
blood glucose in hypoglycemia
less than 55 or even 40 mg/dL (2.2mM)
blood glucose fall abruptly and epinephrine stimulated
anxiety, palpitation, tremor, sweating
adrenergic symptoms
characteristics of neuroglycopenia symptoms
gradual decline in blood glucose but epinephrine response not triggered
(headache, confusion, slurred speech, coma)
type of hypoglycemia symptoms that can lead to death
neuroglycopenia symptoms
transient hypoglycemia can lead to ________ while prolonged hypoglycemia can lead to _________.
cerebral dysfunction; coma even death
patient is injected with _____ or _____ to activate liver’s release of glucose into blood
glucagon; epinepherine
Glucagon activates what processes?
glycogenolysis and gluconeogensis
cortisol activates ______ while epinephrine activates ____/
gluconeogenesis; glycogenolysis
systems activated to normalize blood glucose levels
pituitary gland and ACTH; autonomic nervous system; alpha cells of pancreas
what happens to type I diabetic patients that are injected with insulin
GLUT 4 activity picks up and muscle and adipose tissue take up glucose then eventually blood glucose level will drop
used to treat type I diabetic patients when their blood glucose levels drops and needs to be normalized
glucagon and saline
difference between treating type I diabetic patient with glucagon and saline
glucagon will increase blood glucose tremendously with glycogenolysis and gluconeogenesis before normalizing blood glucose while saline will gradually normalize blood glucose
common type of hypoglycemia with mild adrenergic symptoms
post prandial hypoglycemia
tumor of the pancreatic islet cells
insulinoma
difference between post prandial and insulin induced hypoglycemia
post prandial - exaggerated insulin release by body following meal
insulin-induced - injected insulin of diabetic patient or persons with insulinoma
how to prevent post prandial hypoglycemia
frequent small meals (though plasma glucose levels returns to normal without eating if otherwise)
treatment of insulin induced hypoglycemia
mild - carbs like OJ
severe - glucagon
how do you tell if increased insulin is due to endogenous insulin production
insulin made in body has C peptide and proinsulin so they will be increased with increased insulin
injected/ exogenous insulin will have low C peptide and proinsulin with increased insulin
most severe fasting hypoglycemia
Von Gierke - deficiency in glucose 6 phosphatase
characteristic of patients with Von Gierke
hypoglycemia, hepatomegaly, enlarged kidney, lactic acidosis, gout
deficiency in liver phosphorylase
Hers — hypoglycemia but mild
deficient in Cori disease AKA limit dextrinosis
debranching enzyme in both liver and muscle
what pathways do glucose 6 phosphatase work on
gluconeogenesis and glycogenolysis
deficient in hereditary fructose intolerance
aldolase B
what pathway needs aldolase B other than fructose metabolism
gluconeogenesis
treatment of hereditary fructose intolerance
sucrose, fructose, and sorbitol removed from diet
dietary sorbitol used in liver to form fructose from sorbitol DH
deficient in classical galactosemia
GALT - galactose 1-P uridyl transferase
galactitol can lead to –>
liver damage, cataracts, severe mental retardation
treatment of galactosemia
lactose and galactose removed from diet
what happens with fructose 1-P when it accumulates in liver
reduces amount of inorganic phosphate which is needed for ATP synthesis and glycogen phosphorylase
where does galactitol accumulate
liver, brain, nerve, lens, kidney
seen in blood and urine in MCAD deficiency
dicarboxylic acids and fatty acyl carnitines (medium ones to be specific)
damage in what organs can lead to carnitine deficiency
liver and kidney
CPT-I deficiency can manifest as
hypoglycemia, hypoketosis, and if severe –> death
characteristics of patients with high ethanol levels
high NADH/NAD+ levels, HYPOglycemia, HYPERketosis, lactic acidosis, ketoacidosis
factitious hypoglycemia can be seen in patients who…
inject insulin but are non-diabetic or ingest sulfonyurea but are non-diabetic
non-diabetic patients that inject insulin have high level of _____ but low levels of _______ and ______ with ______absent
insulin; C peptide; proinsulin; sulfonylurea
nondiabetic patients that ingest sulfonylurea have high level of ______, _______, ______ and ________
insulin; C peptide; proinsulin; sulfonylurea
sulfonylurea stimulates what from pancreas
endogenous insulin secretion
severe form of factitious disorder (mental/personality disorder)
Munchhausen syndrome
Patient with diabetes mellitus was on intensive therapy. He missed his treatment in the morning and took a double dose in the afternoon. He collapsed and was brought to the ER. His serum levels showed ______ insulin, _____ C peptide, _______ glucose
high insulin; low C peptide; low glucose
