Hypoglycemia Flashcards Preview

Biochemistry Post Midterm > Hypoglycemia > Flashcards

Flashcards in Hypoglycemia Deck (44):
1

What is hypoglycemia charcterized by?

BGL less than 55 or even 40 (2.2 mM)

2

when do adrenergic symptoms usually occur?

when the blood glucose levels fall abruptly and epinephrine release is stimulated (regulated by hypothalamus)

-anxiety, palpitation, tremor, sweating

3

when do neuroglycopenia symptoms usually occur?

from a gradual decline in blood glucose, often below 40 mg/dL. the slow decline deprives the brain of glucose, but fails to trigger the epinepherine response.

-headache, confusion, slirred speech, coma, death

4

how can the symptoms of hypoglycemia be resolves?

administering glucose

5

what can transcient hypoglycemia lead to?

cerebral dysfunction

6

what can prolonged, severe hypoglycemia cause?

come and death

7

what are injections with glucagon or epinephrine used for?

treatment in order to released glucose from the liver into the blood

8

at low BGL, what systems are working to normalize the BGL?

-pituitary gland ACTH
-ANS
-directly, via the low serum BGL acting on the alpha cells of the pancreas

9

what is released in response to low BGL?

catecholamines + cortisol

adrenergic and neuroglycopenia symptoms

10

what are the 2 types of hypoglycemia related to blood insulin levels?

-postprandial hypoglycemia
-insulin-induced hypoglyemia

11

what is postprandial hypoglycemia?

due to exaggerated insulin release in people

12

what is insulin induced hypoglyemia ?

in patients treated with insulin or in patients with insulinoma

13

what is the second most common hypoglycemia?

postprandial hypoglycemia

14

in postprandial hypoglycemia, what type of hypoglycemia do you get with what type of symptoms?

transicent hypoglycemia

adrenergic symptoms (mild)

15

with postprandial hypoglycemia, how do plasma glucose levels return to normal?

w/o eating

16

how is postprandial hypoglycemia prevented?

frequent small meals

17

how is mild hypoglycemia with insulin induced hypoglycemia treated?

with oral administration of carbs like OJ

18

how is severe hypoglycemia with insulin induced hypoglycemia treated?

glucagon administration

19

what is insulinoma?

tumor of pancreatic islet cells

20

why is there severe hypoglycemia with insulinoma?

during fasting due to uptake of glucose into muscle and fat cells

21

with an insulinoma, abnormally high levels of what do what?

insulin

block the action of the fasting state hormones

22

what will a patient with insulinoma present with?

high insulin levels
C peptide and proinsulin in blood

*indicators of increased endogenous insulin production

23

what can hypoglycemia often indicate?

serious medical problems - hereditary
alcohol intoxication

24

what diseases is hypoglycemia found in?

glycogen storage diseases
abnormal fructose/galactose metabolism
abnormal metabolism of FA degradation
abnormal carnitine shuttle during fasting

25

why is severe fasting hypoglycemia found in Von Gierke's disease?

glucose cannot be released into the blood by the liver, due to hereditary deficiency of G-6-Phosphatase

26

what else do you find in patients with Von Gierke's disease?

extremely high levels of glycogen in liver and kidney
lactic acidemia
gout

27

what diseases is milder hypoglycemia during fsating found?

Hers disease - deficiency of liver phosphorylase
cori disease - deficiency of deb ranching enzyme - limit dextrinosis

*both are GSD

28

why is severe hypoglycemia found after ingestion of fructose in patients with hereditary fructose intolerance ?

due to deficiency of aldolase B

fructose -1-P accumulates in the liver which leads to reduced cellular levels of inorganic phosphate.

pi is needed as example for ATP synthase and glycogen phosphorylase

29

what has to be removed from the diet in peolpe with HFI?

sucrose
fructose
sorbitol - is used in liver to form fructose catalyzed by sorbitol DH

30

why is there severe hypoglycemia in patients after ingesting galatose with Classical galacotsemia?

hereditary deficiency of galatose 1-P uridyltransferase (GALT)

leads to galatose-1-P and galactitol

31

where does galatitol accumulate?

in the liver
in the nerve
lens
kidney

causes liver damage, severe mental retardation and cataracts

32

what has to be removed from diet in people with CG?

lactose and galactose

33

why is there severe hypoglyemia during fasting in hereditary defects in Beta oxidation?

Medium chain FA Co! DH are needed to provide energy for gluconeogenesis during fasting - deficiency can lead to death

34

what does MCAD deficiency lead to (levels)?

high levels of medium chain FA carnitines
dicarboxylic acids in blood and urine

35

why is there severe hypoglyemia during fasting with defects in carnitine shuttle?

-due to carnitine deficiency
-due to hereditary deficiency of CPT1 in liver

36

why is there hypoglycemia with alcohol ingestion?

high ethanol in heptocytes = high NADH/NAD+ ratio in cytosol - gluconeogenesis doesn't work!

37

what should you measure if factitious hypoglycemia is suspected?

insulin
C-peptide
proinsulin
detection fo sulfonylurea in blood

38

what is sulfonylurea used for?

treatment for DM type II

acts by stimulating endogenous insulin secretion from pancreas

39

what does endogenous insulin production leads to high levels of?

insulin
C-peptide
proinsulin

40

what does exogenous administration of insulin show ?

high levels of insulin
low levels of C-peptide and low proinsulin

41

what results are found in factitious hypoglycemia involving injecting insulin without having DM?

high insulin
low C peptide
low proinsulin
sulfonylura is absent

42

what results are found in factitious hypoglycemia involving sulfonylurea consumption in non DM?

high insulin
high C peptide
high proinsulin
high sulfonylurea levels

43

what types of disordered are factitious disorders?

mental/ personality

44

what is the most severe form of factitious disorders?

Munchhausen syndrome

stimulation of disease is central activity of these patients