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Flashcards in Hypoglycemia Deck (25):

name normal blood glucose levels

  • fasting: 70-110 mg/dL 
  • 2 hours postprandial: <120 mg/dL
  • if <55 mg/dL
    • results in hypoglycemia with adrenergic or neuroglycopenia


the half-life of insulin and glucose is ~___ min

4-6 min


post-prandial increase of glucose leads to increase of _____ and decrease of _____

post-prandial increase of glucose leads to increase of insulin and decrease of glucagon


the ____ level drops only 25% and is ready to be raised during fasting

why is _____ always present?

the glucagon level drops only 25% and is ready to be raised during fasting

hypoglycemia is much worse than hyperglycemia, always have basal levels of glucagon since you don't want to waste time synthesizing it in times of need


describe the synthesis of insulin

preproinsulin -> proinsulin -> human insulin

  • preproinsulin has disulfide side groups that need help connecting and creating disulfide bonds
  • the leader sequence is cleaved and this creates proinsulin that has disulfide bonds
  • C-peptide is cleaved in proinsulin to make human insulin


describe the function of the C-peptide

helps to form the disulfide bonds with precision

  • the A-chain has 2 adjacent cysteine residues
    • the first forms the intrachain disulfide bond in the A-chain
    • the second forms the interchain disulfide bond with the B-chain


describe the function of the liver after a meal

  • uptake of dietary sugars slows down the increase of blood glucose
  • insulin stimulates hepatic:
    • glycogen synthesis
    • fatty acids synthesis
    • cholesterol synthesis


describe the function of the liver during fasting

  • release of free glucose into the blood prevents drop of blood glucose
  • glucagon stimulates hepatic:
    • glycogen degradation
    • gluconeogenesis
    • fatty acid degradation 


glycogen is the storage form of glucose and is found in _____

glycogen is the storage form of glucose and is found in cytosolic glycogen granules


glycogen degradation is stimulated by _____ and _____

  • glucagon and epinephrine


the _____ structure of glycogen allows rapid release of many free glucose molecules into the blood

the branched structure of glycogen allows rapid release of many free glucose molecules into the blood


what is needed for gluconeogenesis

  • alanine, lactate and glycerol (provided by the blood)


during fasting, which 2 organs perform gluconeogenesis?

liver and kidney


low blood glucose levels activate which systems?

  • pituitary gland release ACTH -> cortisol (gluconeogenesis)
  • autonomic nervous system releases catecholamines (glycogenolysis) and glucagon (both glycogenolysis and gluconeogenesis)
  • alpha-cells of the pancreas release glucagon


describe adrenergic symptoms

  • occurs abruptly when the blood glucose levels fall 
    • epinephrine is released and is stimulated by the regulation of the hypothalamus
  • symptoms:
    • anxiety
    • palpitation
    • tremors
    • sweating


describe neuroglycopenia symptoms

  • occurs from a gradual decline 
    • the slow decline deprives the brain of glucose but fails to trigger the epinephrine response
  • symptoms:
    • headache
    • confusion
    • slurred speech
    • coma and death


describe insulin injection induced hypoglycemia

  • diabetic patients can accidentally inject too much insulin 
    • activated GLUT-4 lead to glucose uptake into muscle and fat --> hypoglycemia
  • mild treated with OJ, juice, carbs
  • severe treated with glucagon to stimulate glycogenolysis


describe reactive postprandial hypoglycemia

  • exaggerated insulin release following a big meal
    • leads to increased uptake of glucose into muscle + fat
  • small meals recommended


describe hypoglycemia hepatic genetic diseases

  • genetic defects of hepatic enzymes of glycogen degradation and gluconeogenesis lead to reduced release of glucose into the blood during fasting
  • abnormal metabolism of dietary fructose and galactose impairs gluconeogenesis


describe alcohol-related fasting hypoglycemia

  • common in undernourished, longer fasting or dehydrated individuals after consumption of many drinks with high alc. 
  • ethanol metabolism in the liver uses NAD+ and forms NADH which leads to an abnormal high NADH/NAD+ ratio
    • reduces gluconeogenesis


describe insulinoma

  • tumor of the pancreatic islet cells
  • over activates GLUT-4 transporters in muscle and fat cells


contrast blood levels of endogenous insulin synthesis vs exogenous insulin synthesis

  • endogenous:
    • insulin (high)
    • C-peptide (high)
  • exogenous:
    • insulin (high)
    • c-peptide (low)
    • proinsulin (absent)


how do you diagnose factitious hypoglycemia due to insulin injection

  • high levels of insulin
  • low levels of C-peptide
  • (absence of proinsulin)
  • (absence of sulfonylurea)


how do you diagnose factitious hypoglycemia due to sulfonylurea tablet ingestion

sulfonylurea stimulates endogenous insulin synthesis and secretion from pancreas

  • high level of insulin
  • high level of C-peptide
  • presence of proinsulin
  • presence of sulfonylurea


_______ is the most severe form of Factitious disorder

Munchausen Syndrome