Hypoglycemia

Question 1

Clinical definition of hypoglycemia

(for non-diabetics)

Answer 1

1. symptoms consistent with diagnosis
2. symptoms associated with low glucose level
3. symptoms resolve with glucose administration
4. Plasma glucose < or equal to 70mg/dl

Common with: Insulin and sulfonylureas
Not common with: Glitazones, Glinides, and alpha-glucosidase inhibitors

Question 2

Examples of sulfonylureas

Answer 2

1. Chlorpropramide
2. Glyburide
3. Glipizide

Question 3

Two categories of hypoglycemia

Answer 3

1. Neuroglycopenic
2. Autonimic

Adrenergic: anxitey, nervousness, irritability, n/v, palpitations, tremors
Chloingergic: sweating, hunger, paresthesias

Question 4

50% dextrose in water TIV provides how much glucose?

Answer 4

25g of glucose

repeated q15 until if hypogly persists

Question 5

If blood glucose becomes normal after treatment, but still with altered mental status, what do you do?

Answer 5

Provide continuous IV infusion of dextrose, check BG every 30 mins for 2 hrs

Question 6

Somatostatin analog that is able to suppress insulin secretion and immediately negates effects of sulfonylurea

Answer 6

Octreotide

50 to 100micrograms SC after a single hypoglycemic episode

or

Serial SC injections

or constant IV infusion (125micrograms/hr) or 50 microgram bolus with standard therapy

Question 7

Indication of giving octreotide

Answer 7

After initial glucose therapy is intiated for sulfonylurea induced hypogly

Response to glucose is inadequate

primarily used to reduce risk of hypoglycemia

Question 8

Route of administration of glucagon

Answer 8

SC
IM
Intranasal
IV

Question 9

SC injection of glucagon can approximately increase serum glucose by?

Answer 9

100mg/dl

SC is 7-10min slower than IV

Question 10

Adult glucagon dose

Answer 10

1mg SC or IM injection

Question 11

Glucagon contraindication

Answer 11

Heavy alcoholics
Marathon runners
Sulfonylurea induced hypoglycemia

Question 12

Diretcly inhibits insulin secretion from pancreatic B Cells

Answer 12

Diazoxide

Used in refractory sulfonylurea-induced hypoglycemia

AE: hypotension

Question 13

Diazoxide dose

Answer 13

300mg TIV over 30 mins every 4 hours

Question 14

Disposition for hypoglycemic patients

Answer 14

Admission: (+) sulfonylureas, non short acting insulin, meglinitides

Discharge: isolated, accidental, not from hypoglycemic agents, long acting insulin with reliable follow up after a 4 hour observation