Hypoglycemia

Question 1

blood glucose in hypoglycemia

Answer 1

less than 55 or even 40 mg/dL (2.2mM)

Question 2

blood glucose fall abruptly and epinephrine stimulated

anxiety, palpitation, tremor, sweating

Answer 2

adrenergic symptoms

Question 3

characteristics of neuroglycopenia symptoms

Answer 3

gradual decline in blood glucose but epinephrine response not triggered

(headache, confusion, slurred speech, coma)

Question 4

type of hypoglycemia symptoms that can lead to death

Answer 4

neuroglycopenia symptoms

Question 5

transient hypoglycemia can lead to ________ while prolonged hypoglycemia can lead to _________.

Answer 5

cerebral dysfunction; coma even death

Question 6

patient is injected with _____ or _____ to activate liver’s release of glucose into blood

Answer 6

glucagon; epinepherine

Question 7

Glucagon activates what processes?

Answer 7

glycogenolysis and gluconeogensis

Question 8

cortisol activates ______ while epinephrine activates ____/

Answer 8

gluconeogenesis; glycogenolysis

Question 9

systems activated to normalize blood glucose levels

Answer 9

pituitary gland and ACTH; autonomic nervous system; alpha cells of pancreas

Question 10

what happens to type I diabetic patients that are injected with insulin

Answer 10

GLUT 4 activity picks up and muscle and adipose tissue take up glucose then eventually blood glucose level will drop

Question 11

used to treat type I diabetic patients when their blood glucose levels drops and needs to be normalized

Answer 11

glucagon and saline

Question 12

difference between treating type I diabetic patient with glucagon and saline

Answer 12

glucagon will increase blood glucose tremendously with glycogenolysis and gluconeogenesis before normalizing blood glucose while saline will gradually normalize blood glucose

Question 13

common type of hypoglycemia with mild adrenergic symptoms

Answer 13

post prandial hypoglycemia

Question 14

tumor of the pancreatic islet cells

Answer 14

insulinoma

Question 15

difference between post prandial and insulin induced hypoglycemia

Answer 15

post prandial - exaggerated insulin release by body following meal

insulin-induced - injected insulin of diabetic patient or persons with insulinoma

Question 16

how to prevent post prandial hypoglycemia

Answer 16

frequent small meals (though plasma glucose levels returns to normal without eating if otherwise)

Question 17

treatment of insulin induced hypoglycemia

Answer 17

mild - carbs like OJ

severe - glucagon

Question 18

how do you tell if increased insulin is due to endogenous insulin production

Answer 18

insulin made in body has C peptide and proinsulin so they will be increased with increased insulin

injected/ exogenous insulin will have low C peptide and proinsulin with increased insulin

Question 19

most severe fasting hypoglycemia

Answer 19

Von Gierke - deficiency in glucose 6 phosphatase

Question 20

characteristic of patients with Von Gierke

Answer 20

hypoglycemia, hepatomegaly, enlarged kidney, lactic acidosis, gout

Question 21

deficiency in liver phosphorylase

Answer 21

Hers — hypoglycemia but mild

Question 22

deficient in Cori disease AKA limit dextrinosis

Answer 22

debranching enzyme in both liver and muscle

Question 23

what pathways do glucose 6 phosphatase work on

Answer 23

gluconeogenesis and glycogenolysis

Question 24

deficient in hereditary fructose intolerance

Answer 24

aldolase B

Question 25

what pathway needs aldolase B other than fructose metabolism

Answer 25

gluconeogenesis

Question 26

treatment of hereditary fructose intolerance

Answer 26

sucrose, fructose, and sorbitol removed from diet

dietary sorbitol used in liver to form fructose from sorbitol DH

Question 27

deficient in classical galactosemia

Answer 27

GALT - galactose 1-P uridyl transferase

Question 28

galactitol can lead to –>

Answer 28

liver damage, cataracts, severe mental retardation

Question 29

treatment of galactosemia

Answer 29

lactose and galactose removed from diet

Question 30

what happens with fructose 1-P when it accumulates in liver

Answer 30

reduces amount of inorganic phosphate which is needed for ATP synthesis and glycogen phosphorylase

Question 31

where does galactitol accumulate

Answer 31

liver, brain, nerve, lens, kidney

Question 32

seen in blood and urine in MCAD deficiency

Answer 32

dicarboxylic acids and fatty acyl carnitines (medium ones to be specific)

Question 33

damage in what organs can lead to carnitine deficiency

Answer 33

liver and kidney

Question 34

CPT-I deficiency can manifest as

Answer 34

hypoglycemia, hypoketosis, and if severe –> death

Question 35

characteristics of patients with high ethanol levels

Answer 35

high NADH/NAD+ levels, HYPOglycemia, HYPERketosis, lactic acidosis, ketoacidosis

Question 36

factitious hypoglycemia can be seen in patients who…

Answer 36

inject insulin but are non-diabetic or ingest sulfonyurea but are non-diabetic

Question 37

non-diabetic patients that inject insulin have high level of _____ but low levels of _______ and ______ with ______absent

Answer 37

insulin; C peptide; proinsulin; sulfonylurea

Question 38

nondiabetic patients that ingest sulfonylurea have high level of ______, _______, ______ and ________

Answer 38

insulin; C peptide; proinsulin; sulfonylurea

Question 39

sulfonylurea stimulates what from pancreas

Answer 39

endogenous insulin secretion

Question 40

severe form of factitious disorder (mental/personality disorder)

Answer 40

Munchhausen syndrome

Question 41

Patient with diabetes mellitus was on intensive therapy. He missed his treatment in the morning and took a double dose in the afternoon. He collapsed and was brought to the ER. His serum levels showed ______ insulin, _____ C peptide, _______ glucose

Answer 41

high insulin; low C peptide; low glucose