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Hypoglycemia > HYPOGLYCEMIA IN NON-DM > Flashcards

HYPOGLYCEMIA IN NON-DM Flashcards

UPTODATE

1
Q

What glucose value indicates hypoglycemia in a symptomatic patient with diabetes?

A

Less than 70 mg/dL (3.89 mmol/L)

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2
Q

What should be done if a glucose test cannot be performed for a symptomatic patient suspected of hypoglycemia?

A

Treat as if hypoglycemia is confirmed

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3
Q

What actions should be taken in SUPERVISED FASTING TEST if the glucose is low (<55 mg/dL) and the patient does not have diabetes?

A

Draw blood for glucose, insulin, C-peptide, and an oral hypoglycemic agent screen, and then treat

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4
Q

When should treatment not be delayed for a patient with suspected symptomatic hypoglycemia?

A

If rapid blood glucose measurement is not available or blood for diagnostic studies cannot be collected

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5
Q

What should be administered to a conscious patient with a low glucose value who is able to drink and swallow safely?

A

A rapidly absorbed carbohydrate (e.g., glucose tablets, fruit juice, honey, table sugar)

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6
Q

What should be done if a patient with hypoglycemia has altered mental status, is unable to swallow, or does not respond to oral glucose administration within 15 minutes?

A

Give an IV bolus of 12.5 to 25 g of glucose (25 to 50 mL of 50% dextrose)

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7
Q

After administering an IV bolus of glucose, when should a blood glucose measurement be taken?

A

10 to 15 minutes after the IV bolus

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8
Q

How should glucose be administered if a patient cannot take it orally or parenterally?

A

Give glucagon 1 mg IM or subcutaneously

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9
Q

When should patients with ingestion of a long-acting hypoglycemic agent, recurrent hypoglycemia during observation, and those unable to eat be admitted?

A

Admit in these cases

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10
Q

What is the preferred means of maintaining glucose levels after an initial IV bolus of glucose?

A

Continuous IV infusion of glucose (e.g., 10% dextrose in water)
Rate 75-150ml/hr.

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11
Q

When should a blood glucose measurement be taken after the initial IV bolus and how frequently should it be monitored?

A

10 to 15 minutes after the IV bolus, and every 30 to 60 minutes thereafter until stable (minimum of 4 hours)

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12
Q

What type of glucose should be given to patients taking alpha-glucosidase inhibitors ( acrobose) with symptomatic hypoglycemia?

A

Pure glucose (dextrose)

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13
Q

What laboratory findings indicate hypoglycemia in a non-DM patient taking exogenous insulin?

A

Low glucose,
Low C-peptide
Low beta-hydroxybutyrate

high insulin

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14
Q

What laboratory findings suggest hypoglycemia caused by an insulinoma, NIPHS, or PGBH?

A

Low glucose,Low beta-hydroxybutyrate high insulin, high proinsulin high C-peptide.

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15
Q

What laboratory findings indicate hypoglycemia in a non-DM patient taking oral hypoglycemic agents?

A

Low glucose,
Low BHB
HI insulin
Hi c-peptide

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16
Q

What diagnostic sign suggests autoimmune hypoglycemia?

A

Low glucose, HI insulin, presence of GAD antibodies

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17
Q

What role does growth hormone play in the body’s response to hypoglycemia?

A

Growth hormone helps prevent hypoglycemia.

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18
Q

Which THYROID condition can worsen hypoglycemia by reducing gluconeogenesis and glycogenolysis?

A

Hypothyroidism

But rarely cause hypos

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19
Q

What can contribute to more severe or prolonged hypoglycemia episodes when caused by another factor?

A

Hormone deficiency, CORTOSOL DEF, HYPOTHYROIDISM

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20
Q

Which individuals are more prone to hypoglycemia?

A

Infants and children with primary adrenal insufficiency

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21
Q

What is the term for persistent hyperinsulinemic hypoglycemia in infants?

A

Persistent hyperinsulinemic hypoglycemia of infancy (PHHI)

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22
Q

Which hormone deficiency can increase the chances of hypoglycemia in individuals with type 1 diabetes?

A

Adrenal insufficiency

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23
Q

What are the autonomic symptoms of hypoglycemia?

A

Sweating, weakness, palpitations, trembling, hunger, and paresthesias

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24
Q

What are the neuroglycopenic symptoms of hypoglycemia?

A

Irritability, drowsiness, confusion, and vision changes

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25
Q

What is the most common cause of persistent hypoglycemia in infants?

A

Congenital hyperinsulinism

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26
Q

What causes endogenous hyperinsulinism?

A

Beta cell tumor (insulinoma)

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27
Q

What is the term for hypoglycemia caused by an underlying illness or medication?

A

Secondary hypoglycemia

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28
Q

What is the diagnostic assessment required for individuals suspected of having hypoglycemia?

A

A diagnostic assessment is required for healthy individuals experiencing hypoglycemia

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29
Q

What should be investigated when autonomic symptoms occur with a fingerstick glucose measurement of <65 mg/dL?

A

Other causes of autonomic symptoms

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30
Q

What should be investigated when autonomic symptoms occur with a fingerstick glucose measurement of ≥65 to 79 mg/dL?

A

Underlying hypoglycemic disorder

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31
Q

How should home blood glucose monitoring be done?

A

Using fingersticks and a glucose meter.

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32
Q

When should continuous glucose monitoring be used?

A

It should not be used in the evaluation of hypoglycemic symptoms in individuals without diabetes.

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33
Q

What factors determine the duration of continued monitoring for hypoglycemic symptoms?

A

Factors include frequency of symptoms and clinical suspicion for an underlying hypoglycemic disorder.

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34
Q

What are the options for supervised testing in the evaluation of hypoglycemia?

A

Supervised testing can entail a supervised fast, mixed meal test, or evaluation during a spontaneous episode of hypoglycemia.

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35
Q

When should a supervised test be selected for evaluating hypoglycemia?

A

It depends on the timing of symptoms in relation to meals.

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36
Q

How should hypoglycemia be evaluated in asymptomatic adults without diabetes mellitus?

A

Repeat laboratory glucose measurement with exclusion of analytical errors.

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37
Q

What glucose level indicates a hypoglycemic disorder in asymptomatic adults?

A

If laboratory glucose is less than 40 mg/dL (2.2 mmol/L).

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38
Q

What does a low glucose level in individuals aged ≥40 years usually warrant?

A

Further evaluation to determine the underlying cause.

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39
Q

What can cause artifactual hypoglycemia?

A

If an antiglycolytic agent is not present in the blood collection tube or there is leukocytosis, erythrocytosis, or hemolysis.

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40
Q

What type of testing should be done for individuals who report the loss of symptomatic response to hypoglycemia over time?

A

They should undergo additional evaluation to assess impaired awareness of hypoglycemia.

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41
Q

Which drugs are reported to cause hypoglycemia?

A

Cibenzoline, Gatifloxacin, Pentamidine, Quinine, Indomethacin, and Glucagon (during endoscopy) are among the drugs reported.

42
Q

Which drugs have been identified with more than 25 cases of hypoglycemia?

A

Angiotensin-converting enzyme inhibitors, Angiotensin receptor antagonists, Beta-adrenergic receptor antagonists, and others.

43
Q

What are the symptoms suggestive of adrenal insufficiency?

A

Weakness, fatigue, weight loss, hyponatremia, and orthostasis.

44
Q

What should be done if adrenal insufficiency is suspected as the cause of hypoglycemia?

A

Perform appropriate diagnostic testing to confirm.

45
Q

What should be done if hypoglycemia is caused by medication or alcohol use?

A

Remove exposure to the suspected agent and assess if hypoglycemia resolves.

46
Q

What individuals may not require further evaluation for hypoglycemia?

A

Those with a history of bariatric surgery, access to insulin or other glucose-lowering agents, and no recurrent, severe episodes of neuroglycopenic symptoms.

47
Q

What is hypoglycemia?

A

Hypoglycemia is low glucose, proinsulin, and C-peptide levels caused by various factors.

48
Q

What are the possible causes of hypoglycemia?

A

Possible causes of hypoglycemia include insulinoma, autoimmune hypoglycemia, noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS), and post-gastric bypass hypoglycemia.

49
Q

How can insulinoma be diagnosed?

A

Insulinoma can be diagnosed through the measurement of proinsulin levels and specialized testing for insulin analogs.

50
Q

What is the significance of elevated proinsulin levels?

A

Elevated proinsulin levels suggest the presence of insulinoma/proinsulinoma.

51
Q

How can insulin- or IGF-mediated causes of hypoglycemia be excluded?

A

They can be excluded by observing an increase in blood glucose concentration ≤25 mg/dL after glucagon administration.

52
Q

What is considered a normal fasting glucose value in (SOME) healthy, young adults?

A

Fasting glucose values between 40 to 60 mg/dL (2.2 to 3.3 mmol/L) can reflect normal physiology.

53
Q

What further evaluation is required if antibodies are negative?

A

If antibodies are negative, further evaluation is needed for insulinoma through tumor localizing studies.

54
Q

What is the fasting duration required for an adequate supervised fast?

A

The supervised fast should be continued for 72 hours or until the laboratory glucose level reaches <55 mg/dL (3 mmol/L).

55
Q

What should be considered if BHB level is >2.7 mmol/L during a supervised fast?

A

If BHB level is >2.7 mmol/L, ketogenesis is not suppressed.

56
Q

What should be done if glucose values after a glucagon challenge are uninterpretable?

A

Repeat the supervised fast and measure glucose values again.

57
Q

What does a rise of ≤25 mg/dL in glucose levels after a glucagon challenge indicate?

A

A rise of ≤25 mg/dL in glucose levels after a glucagon challenge suggests an underlying hypoglycemic disorder is unlikely.

58
Q

What symptoms are associated with hypoglycemia?

A

Symptoms of hypoglycemia include autonomic responses, sweating, weakness, tachycardia, palpitations, tremor, nervousness, hunger, and paresthesias.

59
Q

What are the diagnostic features of hypoglycemia?

A

Diagnostic features of hypoglycemia include an acute change in mental status, coma, irritability, confusion, seizure, loss of consciousness, and visual disturbance.

60
Q

How can blood glucose concentration be measured for diagnostic evaluation of hypoglycemia?

A

Blood glucose concentration can be measured as soon as possible using a meter and strips.

61
Q

What are the symptoms of hypoglycemia?

A

Low glucose (<65 mg/dL or 3.6 mmol/L) with hypoglycemia symptoms.

62
Q

What is Whipple’s triad?

A

Improvement of symptoms after treating hypoglycemia to confirm Whipple’s triad.

63
Q

What is the suggestive plasma C-peptide concentration for an insulinoma?

A

Plasma C-peptide concentration above 0.2 nmol/L is suggestive of an insulinoma.

64
Q

What is the suggestive plasma proinsulin concentration for an insulinoma?

A

Plasma proinsulin concentration above 5 pmol/L is suggestive of an insulinoma.

65
Q

What is the suggestive plasma beta-hydroxybutyrate concentration for an insulinoma?

A

Plasma beta-hydroxybutyrate concentration below 2.7 mmol/L is suggestive of an insulinoma.

66
Q

What should be done if a patient accidentally observes low blood sugar symptoms?

A

The patient should have glucose, insulin, C-peptide, beta-hydroxybutyrate, and proinsulin levels tested.

67
Q

What is the choice of test for determining the etiology of hypoglycemia?

A

Testing may include glucose level, insulin level, C-peptide level, beta-hydroxybutyrate level, and proinsulin level.

68
Q

What testing is done under medical supervision during a spontaneous episode of low blood sugar?

A

Glucose level, insulin level, C-peptide level, beta-hydroxybutyrate level testing is done.

69
Q

What test is conducted for fasting-related symptoms of hypoglycemia?

A

A supervised fast is conducted.

70
Q

What test is recommended for postprandial symptoms of hypoglycemia?

A

A mixed meal test is recommended.

71
Q

What factors determine the choice of test for hypoglycemic patients?

A

The patient’s clinical history and logistical factors determine the choice of test.

72
Q

What can be indicated by a plasma C-peptide concentration below 0.2 nmol/L?

A

Insulin deficiency can be indicated.

73
Q

What can be indicated by a plasma proinsulin concentration below 5 pmol/L?

A

Insulin deficiency can be indicated.

74
Q

What can be indicated by a plasma beta-hydroxybutyrate concentration above 2.7 mmol/L?

A

Normal people
None IGF/ insulin mediated

75
Q

What types of tests are done for fasting hypoglycemia?

A

Supervised fast and Mixed meal test

76
Q

Can supervised fast be done as an outpatient or inpatient?

A

Yes

77
Q

What should be done if the glucose level is below 55 mg/dL?

A

More blood samples should be taken to measure insulin, proinsulin, C-peptide, and betahydroxybutyrate (BHB) levels

78
Q

What is screened for in the oral hypoglycemic agents test?

A

Oral hypoglycemic agents

79
Q

What is the purpose of the mixed meal test?

A

To test for postprandial hypoglycemia

80
Q

What is the procedure for the mixed meal test?

A

Patient consumes a non-liquid meal and is observed for up to five hours

81
Q

What should be done if the glucose levels are low and hypoglycemic symptoms are present during the mixed meal test?

A

Additional blood samples should be taken

82
Q

What should be measured in the mixed meal test?

A

Insulin and C-peptide levels

83
Q

What should be screened for in non-diabetic hypoglycemia?

A

Oral hypoglycemic agents

84
Q

What are the possible causes of hypoglycemia in a patient with history of malignancy?

A

Endogenous hyperinsulinism, factitious illness, organ dysfunction.

85
Q

What is the next step if both conditions apply: patient has acute or chronic endogenous hyperinsulinism and hypoglycemia is a possible etiology?

A

Proceed with supervised testing.

86
Q

When should further evaluation usually not be needed for hypoglycemia?

A

If hypoglycemia is likely caused by factitious illness or organ dysfunction.

87
Q

What may suggest underlying adrenal insufficiency in a patient with hypoglycemia?

A

Personal or family history of autoimmunity.

88
Q

What type of testing is recommended for the evaluation of hypoglycemia in adults without diabetes mellitus?

A

Supervised testing.

89
Q

What are some symptoms that indicate a high clinical suspicion for an underlying hypoglycemic disorder?

A

Autonomic symptoms such as sweating, nervousness, and paresthesias.

90
Q

What are some symptoms that indicate a high clinical suspicion for an underlying hypoglycemic disorder?

A

Neuroglycopenic symptoms such as irritability, confusion, and vision changes.

91
Q

What is the duration of an outpatient supervised fast for hypoglycemia evaluation?

A

Approximately 20 to 24 hours.

92
Q

What is the purpose of supervised tests for hypoglycemia evaluation?

A

To provoke hypoglycemia and enable etiologic evaluation for insulin or insulin-like growth factor-mediated causes.

93
Q

Where is the supervised fast for hypoglycemia evaluation usually performed?

A

Inpatient or outpatient setting.

94
Q

What are the criteria that must be met to diagnose a true hypoglycemic disorder?

A

Whipple’s triad: symptoms of hypoglycemia, low plasma glucose concentration, symptoms resolve after raising glucose level.

95
Q

What are the clinical manifestations of hypoglycemia?

A

Autonomic symptoms (tremor, palpitations, anxiety), neuroglycopenic symptoms (dizziness, weakness, confusion), and behavioral changes.

96
Q

What are the signs of hypoglycemia?

A

Diaphoresis, pallor, elevated heart rate, modestly elevated systolic blood pressure, decreased diastolic blood pressure, increased pulse pressure.

97
Q

What are the neuroglycopenic manifestations of hypoglycemia?

A

Cognitive impairment and behavioral changes.

98
Q

What is the lower limit of normal blood glucose (BG) according to LAB?

A

70 mg/dL.

99
Q

What can cause hypoglycemia in ill or medicated individuals?

A

Drugs (insulin, alcohol, others), critical illnesses (hepatic, renal, or cardiac failure, sepsis), hormone deficiency (cortisol, glucagon, and epinephrine), nonislet cell tumor.

100
Q

What can cause hypoglycemia in seemingly well individuals?

A

Endogenous hyperinsulinism (insulinoma, functional beta cell disorders), accidental, surreptitious, or malicious hypoglycemia.

101
Q

What are some hormonal causes of hypoglycemia?

A

Cortisol deficiency, hypothyroidism, and/or growth hormone deficiency.

Hypoglycemia (1 decks)

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