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13 Cards in this Set
- Front
- Back
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What is severe and major HG?
Most commonly occurs when? Most common causes of HG in the ER? Most common in the hospital? |
severe - episodes requiring another person's help
major - hospitalization or medical help tx of DM ER - insulin, sulfa, EtOH, sepsis hospital - drugs, critical illness - renal failure |
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Incidence of HG in a pt w/ T1 DM on average:
What % of diabetics will have a severe episode of HG with seizure/coma? When does HG occur? What happens when BS falls? |
<50-60 mg/dl - 10%; symptomatic 2/week, severe temporary disabling once a year
25% decreased glucose production, increased use, combination increased SNS activity, gluconeogenesis in liver |
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Prevention/correction of HG involves what?
First defense against falling glucose? 2nd defense? 3rd defense? |
decreased insulin and increased glucose CR factors
decreased insulin secretion - threshold is ~80 mg/dl increase glucagon increase epinephrine - critical when glucagon is deficient |
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Defective glucose counter-regulation is due to what?
These 3 mechanisms are increased and decreased in what type of DM? What CR hormones stimulate glycogenolysis and gluconeogenesis? |
combination of absent glucagon and attenutated response to epi
increased - T1 DM; decreased - advanced T2 DM Glucagon, epi, GH cortisol |
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What is Whipple's triad?
Threshold of HG in men/women? How useful are finger sticks in HG? HG should be in the differential in a patient with what S/S? |
S/S of HG, low BS, relief of S/S after BS is raised
men - <50; women - <45 not very useful - not accurate confusion, altered LOC, seizures |
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Two categories of clinical manifestations of HG?
Neurogenic symptoms are from what? |
Neuroglycopenic - behavioral changes, confusion, fatigue, HA, visual changes, LOC, seizures, coma, death
Neurogenic - palpations, tremors, anxiety, HTN, tachycardia, sweating, diaphoresis autonomic response - adrenergic, cholinergic - |
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Most common cause of fasting HG?
other drugs? What are some critical illnesses that can cause HG? |
EtOH - symptoms mistaken for drunkeness
Sulfa, insulin, pentamidine (toxic to pancreatic beta cell), quinine hepatitis, liver failure, renal failure, heart failure, sepsis, starvation |
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What are some endocrine deficiencies that can cause HG?
Risk factors with insulin? What is the difference between insulin mediated and non-insulin mediated HG? |
hypopituitarism, Addison's, GH, glucagon/epi (T1 DM), post-prandial reactive (gastric surgery)
missing meals, dosing incorrectly, exercise, EtOH, renal failure (decreased insulin clearance) Insulin mediated - insulin levels not suppressed, usually high non-insulin mediated - insulin levels decreased (EtOH, organ failure, etc) |
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Lab levels for insulin mediated HG?
How to tell if excess insulin is exogenous or not? |
BS <50, insulin >6 mu/ml
exogenous - high insulin, low C-peptide; <200 pmo/l endogenous - high insulin, high C-peptide; >200 pmo/l |
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Where do insulinomas arise?
S/S of insulinoma? Dx for insulinoma? Tx? |
usually in islet cells of pancreas
Whipple's triad + increased plasma insulin, C-peptide, proinsulin, no sulfa in blood/urine, hCG increased CT/MRI, arteriography, octreotide scan surgery, chemo (streptozocin, 5-FU), diazoxide - inhbits insulin secretion |
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Non B-cell tumors cause what type of HG? What type of tumors?
Why does HG occur? What is post-prandial (reactive,idiopathic) HG? Clinical presentation? |
fasting HG - mesenchymal (liver, carcinoid)
overproduction of IGF-II HG 1-5 hrs post food ingestion - asynchronous/excessive insulin secretion impaired glucose tolerance - delayed insulin response to glucose load |
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When does factitious HG usually occur?
How can you tell? |
health care workers, people w/ access to DM medicines - self administration of insulin, etc
High insulin, normal/low C-peptide, measure sulfonylureas in blood, urine |
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How do you treat urgent HG?
Other treatments? |
oral - glucose tablets, candy, sugar, fruit juice
IV - 50 cc 50% glucose (25 g), then 1 L D5 or D10 Glucagon SQ/IM - stimulate glycogenolysis monitor BS, risk reduction, flexible insulin doses, diet, change to selective BB's, decrease EtOH use |
