2-6: 5/23: Hypoglycemia

Front 1

Majority of glucose goes to _______ postprandialy.

Back 1

Muscle (takes most glucose postprandialy) & Liver (stores in form of glycogen)

Front 2

Postabsorptively, glucose is derived from _____________.

Back 2

FASTING

Mostly from liver:
First by glycogenolysis
Then gluconeogenesis

Kidney: Glucneo

NO glucose going to muscle

Front 3

In postabsorptive state, how long until gluconeogenesis starts?

Back 3

Glycogen depletes in 48-72 hours

Glucneo from alanine

Front 4

Epinephrine promotes _____

Back 4

glycogenlysis

Front 5

Hepatic hypoglycemia occurs when _______.

Back 5

80% of liver parenchyma lost

Front 6

Role of kidney in glucose homeostasis.

How does this differ from the liver?

Back 6

5% glucose production in cortex after ovenight fast
>25% production after 60h fast

Glucneo from GLUTAMINE stimulated by catechols, NOT glucagon
Inhibited by insulin

NO glycogen in renal cortex

Front 7

This hormone is suppressed by catecholamine-alpha adrenergic effect.

Back 7

Insulin

Front 8

This hormone is increased by beta-adrenergic effect.

Back 8

Glucagon

Front 9

______ directly inhibits pancreatic alpha cells.

Back 9

Glucose

Front 10

Glucagon induces direct ______ glycogenolysis.

Back 10

HEPATIC (not renal)

Front 11

Alpha-adrenergic effects

Back 11

Inhibition of insulin release
Increase cerebral blood flow (peripheral vasoconstriction)

Front 12

Beta-adrenergic effects

Back 12

Hepatic and muscle glycogenolysis

Rnela gluconeogenesis

Stimulation of plasma glucagon release

Lipolysis

Impairment of glucose uptake by muscle tissue

Increase in cerebral blood flow (increase IN CARDIAC OUTPUT)

Front 13

This hormone is released in responsen to neuroglycopenia with sympathetic nervous system stimulation.

Back 13

ACTH/Cortisol, GH

Front 14

Elevated plasma cortisol enhances ______

Back 14

Protein catabolism
Gluconeogenesis
Lipolysis

Front 15

Acetylcholine Sympathetic Effects

Back 15

Sweating

Front 16

Acetylcholine Parasympathetic Effects

Back 16

Parasympathetic:
Raises level of pancreatic polypeptide
Increases stomach motility
Produces hunger

Front 17

Energy source for gluconeogenesis.

Back 17

FFA Oxidation
Ketone bodies from adipocytes

Front 18

Tiered Autonomic Responses to Hypoglycemia

Back 18

Glucose = 67: Glucagon, Epi, NE, GH, Ach release

Glucose = 60: Autonomic Syx: Tremor, ANX, palpitations, sweating, hunger

Glucose = 50: Impaired cognition, weakness, lethargy

Glucose = 30: Coma, convulsion

Front 19

Whipple's Triad

Back 19

DEFINE INSULINOMA

Symptoms and signs of hypoglycemia

Glucose level under 45

Reversibility of syx after administration of glucose

Front 20

Fasting hypoglycemia with hyperinsulinemia:
Diabetic causes

Back 20

Inadequate food intake for insulin dose
Stress, illness, menstruation
Exercise

Deficient glucagon response
hypoglycemia unawareness
Renal insufficiency

Front 21

Fasting hypoglycemia with hyperinsulinemia:
Factitious causes

Back 21

Administration of exogenous insulin (suppressed C Peptide)
Sulfonylurea (high C peptide)

Front 22

Autoimmune hypoglycemia:
Causes

Back 22

HLA Class II alleles: Circulating insulin Ab (Japan, Korea)
Insulin is bound to Ab and can't function

Insulin Receptor Ab

Front 23

Medication causes of hypoglycemia

Back 23

Propranolol
Salicylates
Sulfonamides
ACE Inhibitors
Pentamidine

Front 24

What is an insulinoma?
Diagnosis?

Back 24

Insulin secreting tumors of islets of Langerhans
usually benign and single

can present with bizarre behavior (neuro effects)

Dx with 72h fast, terminate when glucose reaches glucose <45
Serum insulin >6
C Peptide >200
Proinsulin is 30-90% of circulating insulin

Front 25

Effect of alcohol on glucose.

Back 25

Decrease in glucneo
Induces hypoglycemia
Neuroglycopenia syx

Hepatic tissue damage also causes low hepatic glucose output! (due to starvation, etc.)

Front 26

Diagnostics for nonpancreatic tumors.

Back 26

Fasting hypoglycemia with insulin <5
Elevation of IGF-II (increased glucose uptake, suppressed insulin secretion-->HYPOGLYCEMIC state)

Front 27

Functional Alimentary Hypoglycemia

Back 27

Pseudohypoglycemia--just feel hypoglycemic, but not really hypoglycemic (after meals)

Front 28

Postgastric bypass causes hypoglycemia by ______.

Back 28

Increased vagal response and secretion of incretins (food is traveling a LOT faster)

Incretins stimulate beta-cell proliferation!

Tx by having pts eat small meals

Front 29

Normal labs for:
Glucose
Insulin
C-Peptide
Proinsulin

Back 29

Glucose: >40
Insulin: <3
C-Peptide: <200
Proinsulin: <5

Front 30

Under what conditions would proinsulin be elevated?

Back 30

Insulinoma
Sulfonyurea

Front 31

Under what conditions would C-peptide be elevated?

Back 31

Insulinoma
Sulfonyurea

Front 32

Diazoxide:
Mechanism
Uses

Back 32

Treats hyperinsulinemia

Stabilized K+ channel, inhibits insulin secretion

Front 33

Ocretoide:
Mechanism
Uses

Back 33

SMS analogue

Treats hyperinsulinemia

Front 34

First line treatment of hyperinsulinemia. Requirement?

Back 34

Glucagon
NEED functional liver