Hypoglycemia Flashcards

1
Q

4 Defenses Against Hypoglycemia

A
  • 1- dec insulin secretion when low blood glucose (inc glycogenolysis, gluconeogenesis, lipolysis and eventually proteolysis - protein breakdown)
  • 2- glucagon secretion - main effect is inc hepatic glucose production
  • 3- epi inc (becomes critical when glucagon deficient - maybe pancreas removal or Type 1 DM); epi inc hepatic glucose production and dec glucose utilization in
    peripheral tissues
  • 4- GH and cortisol (delayed) - also inc hepatic glucose production and dec glucose utilization
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2
Q

Autonomic v. Neuroglycopenic Symptoms

A
  • Autonomic - anxiety, tremor, palpitations, pale, sweating, hunger, paresthesias
  • Neuroglycopenic - headaches, blurred vision, weakness, fatigue, slurred speech, behavior change, focal neuro deficit, sz, coma, LOC, confusion
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3
Q

Progression of Hypoglycemia by Serum Glucose

A

< 80 - Dec insulin

65-70 - Inc glucagon

65-70 sustained - Inc epi (critical) then later inc GH/cortisol (involved but not critical)

< 60 - Neurogenic, autonomic symptoms

< 50 - Neuroglycopenic

< 40 - Lethargy, combative

< 30 - Coma, sz, brain damage, death

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4
Q

5 Categories of Hypoglycemia

A
  • Severe - requires assistance
  • Symptomatic
  • Asymptomatic - glucose < 70 w/o symptoms
  • Probable symptomatic - symptoms w/o measurement
  • Pseudohypoglycemia - symptoms w/ glucose > 70
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5
Q

5 Causes of Hypoglycemia in Diabetics

A
  • Excessive insulin dose (use rapid instead of basal), wrong timing
  • Dec exogenous glucose (fasting, missing meal)
  • Inc insulin-indep glucose use (exercise)
  • Inc insulin sensitivity - inc w/ sleep, tight glycemic control, wt loss
  • Dec endogenous glucose production (alcohol ingestion - suggest eating w/ drinking)
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6
Q

Tx for Mild v Severe Hypoglycemia in Diabetics

A
  • Mild - RULE OF 15
  • 15 g fast acting carbs (OJ, table sugar, glucose tablets, lifesavers, honey, gels, non-diet soda)
  • If do NOT improve in 15 min … give another 15 g
  • Severe - cog impairment (swallowing may be impaired so no oral - aspiration risk); IV glucose or glucagon kit (IM or subQ injection)
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7
Q

Diagnosis of Hypoglycemia in Non-Diabetic

A
  • No set lower limit as in DM (variable)
  • Dx - Whipple’s Triad
    • 1- Signs/symptoms suggestive of
    • 2- Low plasma glucose corresponds to symptoms
    • 3- Resolution of symptoms when glucose corrected
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8
Q

Non-Diabetic Causes of Hypoglycemia

A
  • Meds - alcohol, insulin, pentamides, quinine, sulfonylureas, haloperidol
  • Insulinoma - 90% benign; 10% associated w/ MEN1; rare; autonomic insulin secretion
  • Factitious - inject self or child OR malicious (inject insulin w/ intention to harm)
  • Renal Failure
  • Severe Liver Disease
  • Counter-reg hormone def - adrenal deficiency OR hypopituitarism (dec GH, ACTH)
  • Malnutrition
  • Tumor-induced - secrete IGF-II or other insulin-like factors
    • GISTs, mesenchymal tumors, HCC, adrenocortical tumors, leukemias/lymphomas
  • Sepsis - bacteria may consume glucose
  • NIPHS
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9
Q

Insulinoma Dx and Tx

A
  • 72 hr supervised fast; at end meas glucose, insulin, C peptide (endogenous - insulinoma), pro-insulin and beta hydroxybutyrate (inc hydroxybutyrate if low insulin; opp)
  • Screen for oral agents (factitious)
  • Can give glucagon and look for response (means glycogen stores)
  • Surgery is curative if single/benign; octreotide, Ca channel blockers, etc
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10
Q

NIPHS

A

non-insulinoma pancreatogeous hypoglycemia syndrome

  • RARE islet cell hypertrophy or Langerhan’s neoformation
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11
Q

Post-Prandial / Reactive Hypoglycemia (dx, causes, tx)

A
  • Dx - mixed meal testing or oral glucose tolerance test
  • May see after gastric bypass (beta cell hyperplasia), pre-diabetes, congenital enzyme deficiencies, alimentary (late dumping syndrome - rapid motility/glucose absorption THEN inc insulin)
  • Many treated w/ diet modification
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