Hypoglycemia (DJ) Flashcards
What are the 2 types of spontaneous hypoglycemia?
fasting
postprandial
What are risk factors for iatrogenic hypoglycemia?
- skipped or insufficient meals
- unaccustomed physical exertion
- misguided therapy
- alcohol
- drug overdose
Why do recurrent episodes of hypoglycemia increase the risk for severe hypoglycemia?
they impair recognition of the symptoms of hypoglycemia
What are autonomic symptoms of hypoglycemia?
tremulousness, sweating, palpitations, hunger
What causes the symptoms of autonomic hypoglycemia?
Increased secretion of counterregulatory hormones (e.g., epinephrine)
What are the symptoms of neuroglycopenia?
impaired concentration, irritability, blurred vision, lethargy and development of seizure or coma
What are the warning symptoms for neuroglycopenia?
autonomic symptoms of hypoglycemia
What is hypoglycemia unawareness?
defective glucose counterregulation, which results in a blunting of autonomic symptoms and counterregulatory hormone secretion during hypoglycemia
What is a serious consequence of hypoglycemia unawareness?
seizures or coma without the usual warning symptoms of hypoglycemia
What type of patient is at risk for hypoglycemia unawareness?
patients undergoing intensive diabetes therapy
_________ should be obtained, whenever feasible, to confirm hypoglycemia.
Plasma or capillary blood glucose
Severe hypoglycemia is an indication for:
supervised treatment
which should be guided by patient’s mental status
What are 3 ways to treat/manage iatrogenic hypoglycemia?
- Readily absorbable carbohydrates
- Intravenous dextrose
- Glucagon
Hypoglycemia associated with acarbose or miglitol therapy should preferentially be treated with:
glucose
alpha-glucosidase inhibitors block digestion of disaccharides and complex carbs
What is IV dextrose indicated for?
- severe hypoglycemia
- patients with altered consciousness
- during restriction of oral intake
Aggressive and prolonged IV dextrose infusion, together with close clinical observation, is warranted in:
- sulfonylurea overdose
- elderly
- patients with defective counterregulation
What is glucagon indicated for?
initial therapy for severe hypoglycemia in patients who:
- can’t maintain oral intake
- you can’t get immediate IV access
What is a frequent side effect of glucagon?
vomiting
Can patients with hypoglycemia unawareness regain the warning symptoms?
yes, with slight relaxation in glycemic control and scrupulous avoidance of hypoglycemia
(whatever that means; they sound contradictory to me)
What CV drugs are contraindicated in patients with hypoglycemia unawareness?
beta-adrenergic blockers (affect perception of hypoglycemia symptoms)
Fasting hypoglycemia can be caused by:
- inappropriate insulin secretion
- toxic effects of alcohol
- severe hepatic or renal insufficiency
- hypopituitarism
- glucocorticoid deficiency
- ingestion of sulfonylurea
Postprandial hypoglycemia often is suspected, but seldom proven, in patients with:
vague symptoms occurring one or more hours after meals.
Alimentary hypoglycemia tends to occur in what patients?
history of partial gastrectomy or intestinal resection
When do the symptoms of alimentary hypoglycemia develop?
1-2 hours after eating
What is one possible cause of alimentary hypoglycemia (particularly in gastric bypass patients)?
proliferation of insulin-secreting islet beta-cells (nesidioblastosis)
**Possibly related to excessive secretion of incretins (GLP-1 and GIP)
By what mechanism does alimentary hypoglycemia occur?
too rapid glucose absorption resulting in a robust insulin response
What may help reduce symptoms of alimentary hypoglycemia?
- frequent, small meals with reduced carbohydrate content
2. alpha-glucosidase inhibitors
What is functional hypoglycemia?
presence of symptoms possibly suggestive of hypoglycemia, which may or may not be confirmed by plasma glucose measurement
When do the symptoms of functional hypoglycemia develop?
3-5 hours after meals
What clinical features help in the diagnosis of spontaneous hypoglycemia?
- Episodic autonomic symptoms
- Recurrent seizures, dementia, and bizarre behavior
- documented fasting hypoglycemia
How can you tell if hypoglycemia is due to an insulin-secreting pancreatic islet cell tumor (insulinoma)?
- measurable plasma insulin and C-peptide levels even after plasma glu <50 mg/dl during 72-hr fasting test
- no measurable sulfonylurea metabolites
