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30 Cards in this Set
- Front
- Back
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hypoglycemia that requires assistance of another person
hypoglycemia that requires medical assistance or hospital admission |
severe hypoglycemia
major hypoglycemia |
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3 most common causes of emergency room hypoglycemia
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**drugs #1 (insulin)** sulfonylreas)
alcohol sepsis |
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organ that clears insulin
failure in this organ is precursor to hypoglycemia |
kidney
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% of diabetics that suffer an episode of severe, temporarily disabling hypoglycemia in a given year
% of diabetics that die of complications related to hypoglycemia |
25%
2-4% |
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branch of the nervous system that is activated a blood glucose levels fall
What is released? |
sympathetic ANS
- catecholmines and hepatic gluconeogenesis |
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blood glucose threshold for a decrease in insulin secretion
threshold for counter regulatory hormones |
80 mg/dl
68 mg/dl |
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first defense against hypoglycemia
second at what threshold? third? What is effected in T1DM? |
1st: insulin decrease
2nd: glucagon increase at <68mg/dl 3rd: epinephrine increase All three are effected in T1 DM |
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whipples triad
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symptoms of hypoglycemia
low plasma glucose relief after glucose is raised |
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glucose level threshold for symptoms (men and women)
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men: 50 mg/dl
women 45 mg/dl |
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hypoglycemia should be considered in any patient that presents w/ ____
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CNS manifestations of confusion, altered consciousness (LOC) or seizures
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two categories of clinical manifestation of symptoms of hypoglycemia
Explain the breakdown of each |
a. neuroglycopenic (behavioral changes, confuion, fatigue, heacache, visual symptoms, LOC, seizures, coma, death)
b. neurogenic (autonomic) i. andrenergic- palpations, tremors, nervousness, anxiety, increase heart rate, hypertension ii. cholinergic- sweating, diaphoresis, hunger, paresthesias |
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most common cause of fasting hypoglycemia
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alcohol
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interesting that this hormone level is increased in the blood of patients w/ malignant insulinoma
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HCG
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diagnosis of insulinoma
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by CT/MRI for 1-2 cm tumors
arteriography for smaller tumors |
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preferred treatment for insulinoma
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surgical excision
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tumors that induce hypoglycemia due to over production of insulin like growth factor (IGF II)
What do they occur with? |
non beta cell tumors
(occurs with mesenchymal tumors such as hepatoma, carcinoid) |
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treatment for urgent patient that cannot take glucose orally
What is ineffective with alcohol induced alcohol induced HG and why? |
50 cc 50% glucose followed by 1000 cc D5 or D10W
- or glucagon SQ of IM-stimulate glycogenolysis (ineffective in alcohol induced HG due to glycogen depletion) |
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General outlined Causes of hyglycemia in adults?
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1. drugs
2. critical illness 3. hormone deficiency 4. Non-islet cell tumor 5. Endogenous hyperinsulinism 6. Accidental, surreptitious or malicious hypoglycemia |
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Most common causes of HG occurring in a hospitalized patient are
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- drugs
- critical illness- particularly renal failure |
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If both glucagon and epi=deficiencies are present the person has a ____ greater risk of developing what?
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25x of developing HG
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What blood test may not be super accurate for hypoglycemia?
What blood disorders could show hypoglycemia? |
finger stick
- if pt has polycythemia vera, leukemia or thrombocythemia - plethera of blood cells use the blood sugar |
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pt with confusion altered level of consciousness (LOC) or seizures alwys consider?
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hypoglycemia
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examples of critical illnesses that lead to hypoglycemia
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– Hepatitis, hepatic failure
– Renal failure – Heart failure – Sepsis – Starvation |
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Insulin mediated HG vs. non insulin mediated HG
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insulin mediated- (insulin high sugar low) insulin levels are not suppressed. Either exogenous insulin or endogenous “insulin” excess (diabetic or surreptitious or insulinoma)
NON-insulin mediated HG- insulin levels suppressed (alcohol, deficiency of counterregulatory hormones, critical organ failure, insulin like factor- IGF II in non beta cell, mesenchymal tumors) |
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Exogenous insulin- shows what findings for?
1. cpeptide |
high insulin but low c-peptide (less than 200pmo/l)
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Endogenous insulin- shows what findings for?
1. cpeptide |
- high insulin and increased C-peptide >200 points to insulinoma or oral sulfonylureas
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gender breakdown and age of insulinoma?
Associated with? |
- 60% of cases occur in woman, 50 y/o
• May be associated with MEN 1 |
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dx labs of insulinoma?
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Whipple Triad Plus:
– Increase plasma insulin values greater 60 uU/ml – Increase C-peptide – Increase proinsulin – No sulfonylurea in urine or blood – Human chorionic gonadotropin (hCG) increased with malignant insulinoma |
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If you do chemo (not #1 treatment for insulinoma) what type of chemo would you use?
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streptozocin
fluorouracil |
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Attention seekers may do what to get factitious HG
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factitious HG- health care workers with access to diabetic meds-
look for no increase in C-peptide - measure sulfonylureas in blood |
