Hypoglycemia & Integration of Metabolic Pathways

Question 1

Whipple’s Triad

Answer 1

1. Low plasma glucose
2. Symptoms of hypo-g
3. Resolution of symptoms w tx (food, glucose, glucagon, etc.)

Question 2

Autonomic sx of Hypo-G

Answer 2

Diaphoresis
Hunger
Paresthesias
Tremulousness
Palpitations
Anxiety

Question 3

Neuroglycopenic sx of Hypo-G

Answer 3

Cogn impairment
Visual changes
Behavior changes
Weakness
Lethary
Dizziness
Seizures
Coma

Question 4

Counterregulatory hormone response to hypo-g <80

Answer 4

Dec insulin

Question 5

Counterregulatory hormone response to hypo-g <65-670

Answer 5

Inc glucagon
inc epi
inc GH

Question 6

Counterregulatory hormone response to hypo-g <55-60

Answer 6

Inc cortisol

Question 7

Medications that cause hypo-g

Answer 7

Insulin & SU (inc glucose uptake regardless of plasma [glucose])

Question 8

Beta-hydroxybutyrate

Answer 8

KB

Suggests insulin effect but does not distinguish between endo/exo insulin, or antibody

Question 9

Causes w/ low insulin/effect will have _____ glycogen stores in response to hypo-g

Answer 9

depleted glycogen stores

Question 10

Endogenous hyperinsulinism

Answer 10

SU use

Insulinoma

Question 11

Exogenous hyperinsulinism

Answer 11

Insulin use

Question 12

Insulinoma

Answer 12

Neuroendocrine tumor of pancreatic cells
Typically fasting hypo-g
Rare

Question 13

Non-insulin mediated hypo-g

Answer 13

drugs
EtOH
Liver Dz
Starvation
Adrenal insufficiency
Insulin-R mediated (IGF2, Insulin-R antibodies)

Question 14

DKA characterized by:

Answer 14

hyperglycemia

Question 15

Insulinoma causes low serum _____

Answer 15

Beta-OHB

Question 16

EtOH metab generates high level of ____ & ____

Answer 16

NADH

Acetyl CoA

Question 17

What contributes to both hypo-g & KA?

Answer 17

NADH

Question 18

Gluconeogenesis

Answer 18

Pyruvate–> pyruvate carboxylase –> OAA –> PEPCK –> PEP –>-> F1,6BP –> F1,6bisPase –> F6P

Question 19

Do NADH and/or Acetyl CoA affect gluconeogenesis, and if so, in what direction?

Answer 19

Neither affect it

Question 20

Is thiamin required for glucose metab?

Answer 20

Yes, is a cofactor for PDH and TCA DH’s

Question 21

Is B12 required for glucose metab?

Answer 21

No

Question 22

What can cause excessive hepatic TG?

Answer 22

Excessive lipolysis
Excessive FA synth
Impaired FA ox

Question 23

What normally happens to hepatic TG?

Answer 23

Released as VLDL