Hypoglycemia

Question 1

What is hypoglycemia charcterized by?

Answer 1

BGL less than 55 or even 40 (2.2 mM)

Question 2

when do adrenergic symptoms usually occur?

Answer 2

when the blood glucose levels fall abruptly and epinephrine release is stimulated (regulated by hypothalamus)

-anxiety, palpitation, tremor, sweating

Question 3

when do neuroglycopenia symptoms usually occur?

Answer 3

from a gradual decline in blood glucose, often below 40 mg/dL. the slow decline deprives the brain of glucose, but fails to trigger the epinepherine response.

-headache, confusion, slirred speech, coma, death

Question 4

how can the symptoms of hypoglycemia be resolves?

Answer 4

administering glucose

Question 5

what can transcient hypoglycemia lead to?

Answer 5

cerebral dysfunction

Question 6

what can prolonged, severe hypoglycemia cause?

Answer 6

come and death

Question 7

what are injections with glucagon or epinephrine used for?

Answer 7

treatment in order to released glucose from the liver into the blood

Question 8

at low BGL, what systems are working to normalize the BGL?

Answer 8

• pituitary gland ACTH
• ANS
• directly, via the low serum BGL acting on the alpha cells of the pancreas

Question 9

what is released in response to low BGL?

Answer 9

catecholamines + cortisol

adrenergic and neuroglycopenia symptoms

Question 10

what are the 2 types of hypoglycemia related to blood insulin levels?

Answer 10

• postprandial hypoglycemia

- insulin-induced hypoglyemia

Question 11

what is postprandial hypoglycemia?

Answer 11

due to exaggerated insulin release in people

Question 12

what is insulin induced hypoglyemia ?

Answer 12

in patients treated with insulin or in patients with insulinoma

Question 13

what is the second most common hypoglycemia?

Answer 13

postprandial hypoglycemia

Question 14

in postprandial hypoglycemia, what type of hypoglycemia do you get with what type of symptoms?

Answer 14

transicent hypoglycemia

adrenergic symptoms (mild)

Question 15

with postprandial hypoglycemia, how do plasma glucose levels return to normal?

Answer 15

w/o eating

Question 16

how is postprandial hypoglycemia prevented?

Answer 16

frequent small meals

Question 17

how is mild hypoglycemia with insulin induced hypoglycemia treated?

Answer 17

with oral administration of carbs like OJ

Question 18

how is severe hypoglycemia with insulin induced hypoglycemia treated?

Answer 18

glucagon administration

Question 19

what is insulinoma?

Answer 19

tumor of pancreatic islet cells

Question 20

why is there severe hypoglycemia with insulinoma?

Answer 20

during fasting due to uptake of glucose into muscle and fat cells

Question 21

with an insulinoma, abnormally high levels of what do what?

Answer 21

insulin

block the action of the fasting state hormones

Question 22

what will a patient with insulinoma present with?

Answer 22

high insulin levels
C peptide and proinsulin in blood

*indicators of increased endogenous insulin production

Question 23

what can hypoglycemia often indicate?

Answer 23

serious medical problems - hereditary

alcohol intoxication

Question 24

what diseases is hypoglycemia found in?

Answer 24

glycogen storage diseases
abnormal fructose/galactose metabolism
abnormal metabolism of FA degradation
abnormal carnitine shuttle during fasting

Question 25

why is severe fasting hypoglycemia found in Von Gierke's disease?

Answer 25

glucose cannot be released into the blood by the liver, due to hereditary deficiency of G-6-Phosphatase

Question 26

what else do you find in patients with Von Gierke's disease?

Answer 26

extremely high levels of glycogen in liver and kidney lactic acidemia gout

Question 27

what diseases is milder hypoglycemia during fsating found?

Answer 27

Hers disease - deficiency of liver phosphorylase cori disease - deficiency of deb ranching enzyme - limit dextrinosis *both are GSD

Question 28

why is severe hypoglycemia found after ingestion of fructose in patients with hereditary fructose intolerance ?

Answer 28

due to deficiency of aldolase B fructose -1-P accumulates in the liver which leads to reduced cellular levels of inorganic phosphate. pi is needed as example for ATP synthase and glycogen phosphorylase

Question 29

what has to be removed from the diet in peolpe with HFI?

Answer 29

sucrose fructose sorbitol - is used in liver to form fructose catalyzed by sorbitol DH

Question 30

why is there severe hypoglycemia in patients after ingesting galatose with Classical galacotsemia?

Answer 30

hereditary deficiency of galatose 1-P uridyltransferase (GALT) leads to galatose-1-P and galactitol

Question 31

where does galatitol accumulate?

Answer 31

in the liver in the nerve lens kidney causes liver damage, severe mental retardation and cataracts

Question 32

what has to be removed from diet in people with CG?

Answer 32

lactose and galactose

Question 33

why is there severe hypoglyemia during fasting in hereditary defects in Beta oxidation?

Answer 33

Medium chain FA Co! DH are needed to provide energy for gluconeogenesis during fasting - deficiency can lead to death

Question 34

what does MCAD deficiency lead to (levels)?

Answer 34

high levels of medium chain FA carnitines | dicarboxylic acids in blood and urine

Question 35

why is there severe hypoglyemia during fasting with defects in carnitine shuttle?

Answer 35

- due to carnitine deficiency | - due to hereditary deficiency of CPT1 in liver

Question 36

why is there hypoglycemia with alcohol ingestion?

Answer 36

high ethanol in heptocytes = high NADH/NAD+ ratio in cytosol - gluconeogenesis doesn't work!

Question 37

what should you measure if factitious hypoglycemia is suspected?

Answer 37

insulin C-peptide proinsulin detection fo sulfonylurea in blood

Question 38

what is sulfonylurea used for?

Answer 38

treatment for DM type II acts by stimulating endogenous insulin secretion from pancreas

Question 39

what does endogenous insulin production leads to high levels of?

Answer 39

insulin C-peptide proinsulin

Question 40

what does exogenous administration of insulin show ?

Answer 40

high levels of insulin | low levels of C-peptide and low proinsulin

Question 41

what results are found in factitious hypoglycemia involving injecting insulin without having DM?

Answer 41

high insulin low C peptide low proinsulin sulfonylura is absent

Question 42

what results are found in factitious hypoglycemia involving sulfonylurea consumption in non DM?

Answer 42

high insulin high C peptide high proinsulin high sulfonylurea levels

Question 43

what types of disordered are factitious disorders?

Answer 43

mental/ personality

Question 44

what is the most severe form of factitious disorders?

Answer 44

Munchhausen syndrome stimulation of disease is central activity of these patients