Hypoglycemia (DJ)

Question 1

What are the 2 types of spontaneous hypoglycemia?

Answer 1

fasting

postprandial

Question 2

What are risk factors for iatrogenic hypoglycemia?

Answer 2

1. skipped or insufficient meals
2. unaccustomed physical exertion
3. misguided therapy
4. alcohol
5. drug overdose

Question 3

Why do recurrent episodes of hypoglycemia increase the risk for severe hypoglycemia?

Answer 3

they impair recognition of the symptoms of hypoglycemia

Question 4

What are autonomic symptoms of hypoglycemia?

Answer 4

tremulousness, sweating, palpitations, hunger

Question 5

What causes the symptoms of autonomic hypoglycemia?

Answer 5

Increased secretion of counterregulatory hormones (e.g., epinephrine)

Question 6

What are the symptoms of neuroglycopenia?

Answer 6

impaired concentration, irritability, blurred vision, lethargy and development of seizure or coma

Question 7

What are the warning symptoms for neuroglycopenia?

Answer 7

autonomic symptoms of hypoglycemia

Question 8

What is hypoglycemia unawareness?

Answer 8

defective glucose counterregulation, which results in a blunting of autonomic symptoms and counterregulatory hormone secretion during hypoglycemia

Question 9

What is a serious consequence of hypoglycemia unawareness?

Answer 9

seizures or coma without the usual warning symptoms of hypoglycemia

Question 10

What type of patient is at risk for hypoglycemia unawareness?

Answer 10

patients undergoing intensive diabetes therapy

Question 11

_________ should be obtained, whenever feasible, to confirm hypoglycemia.

Answer 11

Plasma or capillary blood glucose

Question 12

Severe hypoglycemia is an indication for:

Answer 12

supervised treatment

which should be guided by patient’s mental status

Question 13

What are 3 ways to treat/manage iatrogenic hypoglycemia?

Answer 13

1. Readily absorbable carbohydrates
2. Intravenous dextrose
3. Glucagon

Question 14

Hypoglycemia associated with acarbose or miglitol therapy should preferentially be treated with:

Answer 14

glucose

alpha-glucosidase inhibitors block digestion of disaccharides and complex carbs

Question 15

What is IV dextrose indicated for?

Answer 15

1. severe hypoglycemia
2. patients with altered consciousness
3. during restriction of oral intake

Question 16

Aggressive and prolonged IV dextrose infusion, together with close clinical observation, is warranted in:

Answer 16

1. sulfonylurea overdose
2. elderly
3. patients with defective counterregulation

Question 17

What is glucagon indicated for?

Answer 17

initial therapy for severe hypoglycemia in patients who:

1. can’t maintain oral intake
2. you can’t get immediate IV access

Question 18

What is a frequent side effect of glucagon?

Answer 18

vomiting

Question 19

Can patients with hypoglycemia unawareness regain the warning symptoms?

Answer 19

yes, with slight relaxation in glycemic control and scrupulous avoidance of hypoglycemia
(whatever that means; they sound contradictory to me)

Question 20

What CV drugs are contraindicated in patients with hypoglycemia unawareness?

Answer 20

beta-adrenergic blockers (affect perception of hypoglycemia symptoms)

Question 21

Fasting hypoglycemia can be caused by:

Answer 21

1. inappropriate insulin secretion
2. toxic effects of alcohol
3. severe hepatic or renal insufficiency
4. hypopituitarism
5. glucocorticoid deficiency
6. ingestion of sulfonylurea

Question 22

Postprandial hypoglycemia often is suspected, but seldom proven, in patients with:

Answer 22

vague symptoms occurring one or more hours after meals.

Question 23

Alimentary hypoglycemia tends to occur in what patients?

Answer 23

history of partial gastrectomy or intestinal resection

Question 24

When do the symptoms of alimentary hypoglycemia develop?

Answer 24

1-2 hours after eating

Question 25

What is one possible cause of alimentary hypoglycemia (particularly in gastric bypass patients)?

Answer 25

proliferation of insulin-secreting islet beta-cells (nesidioblastosis)
**Possibly related to excessive secretion of incretins (GLP-1 and GIP)

Question 26

By what mechanism does alimentary hypoglycemia occur?

Answer 26

too rapid glucose absorption resulting in a robust insulin response

Question 27

What may help reduce symptoms of alimentary hypoglycemia?

Answer 27

1. frequent, small meals with reduced carbohydrate content

2. alpha-glucosidase inhibitors

Question 28

What is functional hypoglycemia?

Answer 28

presence of symptoms possibly suggestive of hypoglycemia, which may or may not be confirmed by plasma glucose measurement

Question 29

When do the symptoms of functional hypoglycemia develop?

Answer 29

3-5 hours after meals

Question 30

What clinical features help in the diagnosis of spontaneous hypoglycemia?

Answer 30

1. Episodic autonomic symptoms
2. Recurrent seizures, dementia, and bizarre behavior
3. documented fasting hypoglycemia

Question 31

How can you tell if hypoglycemia is due to an insulin-secreting pancreatic islet cell tumor (insulinoma)?

Answer 31

1. measurable plasma insulin and C-peptide levels even after plasma glu <50 mg/dl during 72-hr fasting test
2. no measurable sulfonylurea metabolites