Hypoglycemia and Hyperglycemia

Question 1

Glucose provides approximately what percentage of fetal energy needs

Answer 1

60% to 70%

Question 2

In the AAP report, the authors recommend measuring blood glucose levels and treatment for the following:…?

Answer 2

1. Symptomatic infants with blood glucose <40 mg/dL with intravenous (IV) glucose
2. Asymptomatic infants at risk for hypoglycemia defined as late preterm (34 to 36 6/7 weeks of gestation), term SGA, IDM, or LGA

Question 3

a. First 4 hours of life …

Answer 3

i. Initial screen <25 mg/dL (should be done within the first hours after birth), infants should be fed and rechecked, and if the next level, 1 hour later, is <25 mg/dL, treatment with IV glucose should be administered.

ii. If the second check is 25 to 40 mg/dL, feeding may be considered as an alternative to IV glucose.

Question 4

b. Four to 24 hours of life…?

Answer 4

i. Glucose <35 mg/dL, infants should be fed and glucose rechecked in 1 hour.

ii. If glucose continues to be <35 mg/dL, IV glucose should be administered.

iii. If recheck after initial feeding is 35 to 45 mg/dL, feeding may be attempted.

iv. Recommendation is to target glucose >45 mg/dL.

Question 5

Bedside reagent strips will be within——— mg/dL and less accurate in the hypoglycemic range.

Answer 5

±10 to 15

Question 6

Congenital hyperinsulinism ….?

Answer 6

Hyperinsulinism is seen in mutations of genes encoding the pancreatic beta-cell adenosine triphosphate (ATP)–sensitive potassium channel, such as ABCC8 and KCNJ11 which encode for SUR1 and Kir6.2. Elevated insulin levels are also associated with loss-of-function mutations in HNF4A gene. A

Question 7

hyperinsulinism Secondary to other conditions ..?

Answer 7

Syndromes such as Beckwith–Wiedemann syndrome (macrosomia, mild microcephaly, omphalocele, macroglossia, hypoglycemia, and visceromegaly)

Question 8

Maternal drug intake leading to hyperinsulinism in newborn …?

Answer 8

Maternal tocolytic therapy with beta-sympathomimetic agents (terbutaline)

Question 9

UAC and hypoglycaemia in newborn ..?

Answer 9

Malpositioned umbilical artery catheter used to infuse glucose in high concentration into the celiac and superior mesenteric arteries T11T12, stimulating insulin release from the pancreas

Question 10

Defects in carbohydrate metabolism leads to hypoglycaemia in newborn ..?

Answer 10

i. Glycogen storage disease

ii. Fructose intolerance

iii. Galactosemia

Question 11

Endocrine deficiency causing neonatal hypoglycaemia……?

Answer 11

i. Adrenal insufficiency
ii. Hypothalamic deficiency
iii. Congenital hypopituitarism
iv. Glucagon deficiency
v. Epinephrine deficiency

Question 12

Defects in amino acid metabolism causing hypoglycaemia …?

Answer 12

i. Maple syrup urine disease
ii. Propionic acidemia
iii. Methylmalonic acidemia
iv. Tyrosinemia
v. Glutaric acidemia type II
vi. Ethylmalonic-adipic aciduria

Question 13

Maternal or infant therapy with beta-blockers (e.g., labetalol or propranolol). Possible mechanisms include the following:…?

Answer 13

i. Prevention of sympathetic stimulation of glycogenolysis

ii. Prevention of recovery from insulin-induced decreases in free fatty acids and glycerol

iii. Inhibition of epinephrine-induced increases in free fatty acids and lactate after exercise

Question 14

The glucose level can fall up to—- mg/dL/hour in a blood sample that awaits analysis

Answer 14

6 mg/dL/hour

Question 15

If the insulin level is normal for the blood glucose level, when to consider additional testing to evaluate for other causes of persistent hypoglycemia…?

Answer 15

carbohydrate metabolism

endocrine deficiency and

defects in amino acid metabolism

Question 16

What is Mini bolus in IV glucose therapy ..?

Answer 16

The traditional 200 mg/kg dextrose “mini-bolus” given before instituting a continuous dextrose infusion for the treatment of neonatal hypoglycemia may not be necessary in asymptomatic hypoglycemic newborns

Question 17

Role of hydrocortisone in neonatal hypoglycaemia….?

Answer 17

hydrocortisone, 10 mg/kg/day intravenously in two to three divided doses

Hydrocortisone reduces peripheral glucose utilization, increases gluconeogenesis, and increases the effects of glucagon

Question 18

Diazoxide usage in neonatal hypoglycaemia…?

Answer 18

Diazoxide (8 to 15 mg/kg/day in divided doses every 8 to 12 hours) may be given orally to infants who are persistently hyperinsulinemic.

This drug inhibits insulin release by acting as a specific ATP-sensitive potassium channel agonist in normal pancreatic beta-cells and decreases insulin release.

It can take up to 5 days for a positive effect to be seen.

Question 19

Octreotide in neonatal hypoglycaemia…?

Answer 19

Octreotide (5 to 20 μg/kg/day subcutaneously or intravenously divided every 6 to 8 hours).

It is a long-acting somatostatin analog that inhibits insulin secretion.

It can be used when diazoxide does not successfully control the glucose level.

Tachyphylaxis can develop.

Question 20

18F-fluorol-DOPA positron emission tomography (PET) in neonatal hypoglycaemia..?

Answer 20

Identify focal lesions in the pancreas and consider surgical treatment by subtotal pancreatectomy.

Question 21

Long-term effects of neonatal hypoglycaemia …?

Answer 21

Infants and children had visuo-motor problems, poor executive function, low literacy, and numeracy.

Infants with hypoglycemia have been reported to exhibit a typical pattern of CNS injury particularly in the parieto-occipital cortex and subcortical white matter.

Question 22

Definition of HYPERGLYCEMIA in newborn ..?

Answer 22

It is usually defined as a whole blood glucose level higher than 125 mg/dL or

plasma glucose values higher than 145 mg/d

Question 23

Why hyperglycemia is bad in newborn ..?

Answer 23

major clinical problems associated with hyperglycemia are hyperosmolarity and osmotic diuresis.

Osmolarity of more than 300 mOsm/L usually leads to osmotic diuresis (each 18 mg/dL rise in blood glucose concentration increases serum osmolarity 1 mOsm/L)

Question 24

Drugs causing hyperglycaemia in newborn ?.?

Answer 24

The most common association is with glucocorticoids.

Other drugs associated with hyperglycemia are steroids, caffeine, theophylline, phenytoin, and diazoxide.

Question 25

Neonatal diabetes mellitus…..?

Answer 25

mutations involving regulation of the ATP-sensitive potassium channels of the pancreatic beta-cells. Activating mutations of either the KCNJ11 gene that encodes the Kir6.2 subunit or the ABCC8 gene that encodes the sulfonylurea receptor (SUR1) have been implicated in the cause of neonatal diabetes

Question 26

Which glucose transport proteins immaturity leads to hyperglycemia in newborn…?

Answer 26

GLUT-4

Question 27

When to use Exogenous insulin therapy in neonatal hyperglycemia…?

Answer 27

when glucose values exceed 250 mg/dL despite efforts to lower the amount of glucose delivered or when prolonged restriction of parenterally administered glucose would substantially decrease the required total caloric intake

Question 28

The insulin available in India is…?

Answer 28

40 U/mL

Dilution with 40 mL of dextrose (or normal saline) makes the preparation as 0.1 U/ mL

Question 29

usual starting dose of insulin is …?

Answer 29

Rate of infusion is 0.05 to 0.2 unit/kg/hour (usual starting dose is 0.05 unit/kg/hour)