Flashcards in Clinical Approach to Diabetes and Hypoglycemia Deck (48)
What are the 2 endocrine emergencies?
1. DKA= hyperglycemia, acidosis, and ketosis
2. hyperosmolar nonketoitic coma
What causes the mortality in DKA?
- acidosis and dehydration
How do you treat DKA?
- fluids (normal saline) and insulin
How do you treat hyperosmolar nonketotic coma?
What is hypoglycemia?
- neuroglycopenic and/or neurogenic symptoms
- low plasma glucose (less than 70 mg/dL
- symptom relief after administration of carbohydrates
What are the symptoms of hypoglycemia?
- neurogenic (autonomic)= trembling, palpitations, sweating, anxiety, hunger, nausea, tingling.
- neurglycopenic= confusion, weakness, drowsiness, vision changes, difficulty speaking, headache, dizziness.
Who is at risk to develop hypoglycemia?
- autonomic neuropathy
- DM with a beta blocker
- deficiencies in counter-regulatory hormones
What is reactive hypoglycemia?
- post-prandial symptoms, which are usually ADRENERGIC responses.
How do we treat reactive hypoglycemia?
- frequent small meals
- propantheline bromide or calcium channel blockers
- acarbose (delays carbohydrate absorption)
What is alimentary hypoglycemia?
- occurs following GI surgery or vagotomy.
- a short-circuited GI tract results in increased carbohydrate absorption.
How do you resolve alimentary hypoglycemia quickly?
What is fasting hypoglycemia?
- wake up with a glucose less than 70.
- neuroglycopenic symptoms including stroke may occur.
*more serious implications than reactive hypoglycemia.
Are most islet cell tumors malignant or benign?
What is factitious hypoglycemia?
- hypoglycemia that doesn't make sense. Typically in patients with access to insulin or sulfonylureas, making themselves hypoglycemic.
*will see low c-peptide levels, bc it is being taken exogenously.
What is the most common cause of drug induced hypoglycemia?
- alcohol= reduces gluconeogenesis acutely.
Can renal disease cause hypoglycemia?
- YES bc the kidneys are necessary for insulin clearance.
What does the workup involve for hypoglycemia?
- exclude drug induced
- pre-existing hepatic or renal disease
- pituitary or adrenal disease
- retroperitoneal tumor
- carbohydrate or meal induced