Hypoglycemia

Question 1

which hormones increase serum glucose?

Answer 1

glucagon 
cortisol 
growth hormone 
adrenaline 
NE

Question 2

how do you differentiate hypoglycemia due to overproduction or getting too much exogenous insulin?

Answer 2

C peptide

Question 3

what is the normal response of the alpha cells of the pancreas to decreasing glucose levels?

Answer 3

increase in glucagon

Question 4

what does glucagon do to the liver and adipose tissue in response to low glucose levels?

Answer 4

liver - stimulation of glycogenolysis and gluconeogenesis

adipose tissue - stimulates fat breakdown

Question 5

how does hypoglycemia relate to the adrenergic system?

Answer 5

activates adrenergic response

Question 6

what are the autonomic signs and symptoms of hypoglycemia?

Answer 6

sweating
anxiety
tachycardia

Question 7

what are the neuroglycopenia signs and symptoms of hypoglycemia?

Answer 7

mental status changes 
confusion 
lack of concentration 
abnormal behavior 
blurry vision 
coma

Question 8

what are the etiologies of post prandial hypoglycemia?

Answer 8

• post gastric resection
• islet cell tumor
• glycogen storage disease
• hereditary fructose intolerance
• galactosemia

Question 9

how does alcohol affect gluconeogenesis? how does it affect glycogenolysis? what is the overall effect?

Answer 9

inhibitor

promote

alcoholics can flood their serum with glucose, but cannot replenish it

Question 10

what is the whipple triad?

Answer 10

• symptomatic
• hypoglycemic
• relief of symptoms after restoration of normoglycemia

Question 11

patients who are found to have hypoglycemia at time of diagnosis should have what blood tests done?

Answer 11

• glucose
• insulin
• C peptide
• beta hydroxybutyrate
• proinsulin
• sulfonylurea

Question 12

what is the rationale for a 72 fast?

Answer 12

• a normal person should be able to regulate their blood glucose over this time period
• someone with an insulinoma will have an overproduction of insulin and become symptomatic

Question 13

what are the provocative tests for diagnosing hypoglycemia?

Answer 13

tolbutamide

glucagon

Question 14

what imaging is done for hypoglycemia?

Answer 14

• abdominal CT or MRI
• ultrasound, transabdominal or endoscopic
• arterial calcium stimulation: to distinguish focal abnormality vs diffuse process

Question 15

what test is used to distinguish focal abnormality vs diffuse process?

Answer 15

arterial calcium stimulation

Question 16

what is the acute management for hypoglycemia?

Answer 16

• oral glucose IF patient is conscious
• IV glucose 50% followed by IV drip dextrose
• glucagon IV or SQ

Question 17

what is the treatment for an islet cell tumor?

Answer 17

surgical resection

Question 18

what is the treatment for post gastric surgery hypoglycemia?

Answer 18

increase frequency of meals