Hypoglycemia

Question 1

What is wipple’s triad

Answer 1

Hypoglycemia symptoms
Low plasma glucose concentrations
Relief of symptoms once glucose is raised

Question 2

Causes of hypoglycemia

Answer 2

Drugs
 Alcohol
 Critical organ failure
 Sepsis
 Hormone deficiency
 Non-beta cell tumors
 Insulinoma
 Prior gastric surgery

Question 3

Neruoglycopenic symptoms of hypoglycemia

Answer 3

Behavioral changes
Confusion
Fatigue
Seizure
Loss of consciousness
Cardiac arrhythmias
Death

Question 4

What are neuro/autonomic symptoms of hypoglycemia

Answer 4

Palpitations
Tremors
Anxiety
Sweating
Hunger
Paresthesia

Question 5

What are coagulopathic and inflammatory responses to hypoglycemia

Answer 5

Increase platelet aggregation
Reduce fibrinolytic balance
Increase intravascular coagulations
Reduces nitric oxide
Compromised mediated arterial vasodilatory mechanism

Question 6

What are hypoglycemia causes in healthy appearing adults

Answer 6

Insulinoma
Functional beta cell disorder
Autoimmune hypoglycemia
Improper use of medication

Question 7

What are hypoglycemia causes in ill appearing adults

Answer 7

Ill appearing
Drugs
Alcohol
Critical illness
Cortisol deficiency
Non-beta cell tumors

Question 8

What are cause of hypoglycemia in non-diabetic adults

Answer 8

Alcohol Induced: Several days after ethanol binge
Pharmaceutical Rx: ACEi, ARBS, beta adrenergic receptors, quinoline antibiotics & sulfa drugs
Hormone Deficiencies: Cortisol deficiency.
Glucagon and epinephrine deficiencies

Question 9

What types of critical illness can cause hypoglycemia

Answer 9

Renal failure: Reduced clearance of insulin & mobilization of gluconeogenic precursors
Hepatic failure: Compromised endogenous glucose production
Cardiac failure: Possibly related to hypoxemia and hepatic congestion
Sepsis: Increased glucose utilization. Glucose production fails to keep up.Cytokine induced inhibition of gluconeogenesis
Lack of dietary intake

Question 10

What are examples of non-islet cells that can cause hypoglycemia

Answer 10

Hepatoma
Adrenal cortical carcinoma
Carcinoids

Question 11

Causes of non-islet cell tumors

Answer 11

Overproduction of insulin-like growth factor II (big IGF-II)

Question 12

Diagnosis of non-islet cell tumors

Answer 12

Elevated plasma ratios of IGF-II : IGH-I
Elevated free IGF-II

Question 13

Treatment plan for non-islet cell tumors

Answer 13

Achieve normal glycemic state
Surgery seldomly possible
Reduction of tumor bulk
Embolization, chemotherapy or radiation
Glucocorticoid, GH or both

Question 14

What is endogenous hyperinsulinism

Answer 14

Functional beta cell disorder
Antibodies to insulin or to insulin receptor
Beta-cell secretagogue

Question 15

Causes of endogenous hyperinsulinism

Answer 15

Insulin secretion despite hypoglycemia

Question 16

Diagnosis of endogenous hyperinsulinism

Answer 16

Elevated plasma insulin, >3 μU/mL
Elevated C-peptide, >0.6 ng/mL
Elevated proinsulin, > 5 pmol/L
Low plasma glucose, <55 mg/dL

Question 17

What is the treatment for endogenous hyperinsulinism

Answer 17

Corticosteroid therapy
Small frequent low carbohydrate meals

Question 18

What happens in endogenous hyperisulinemia to cause hypoglycemia

Answer 18

Typically a beta cell tumor that secretes insulin

Question 19

How to diagnose a beta cell tumor in endogenous hyperisulinemia

Answer 19

CT or MRI
US

Question 20

Treatment plan for solitary vs unresectable beta cell tumors

Answer 20

Solitary: Surgical resection
Unresectable: diaxoside or Octreotide