HypOglycemia
Inherited cause of hypoglycemia?
Autosomal dominant, Multiple Endocrine Neoplasia, type I involves tumors of the 3P's: Anterior Pituitary, Parathyroid, and Pancreatic Islet cells. Insulinoma→ hypoglycemia
Low risk meds for hypoglycemia?
Biguanides, Thiazolidinesdiones, Alpha-glucosidase inhibitors, Clugcagon-like peptide 1 receptor agonists, Dipeptidyl-peptidase-IV inhibitors
Diagnosis of hyperinsulinemia d/t insulinoma?
CT/MRI
Treatment algorithm of hypoglycemia?
Consume 15g fast acting carbs, wait 15 min check sugar. <70mg/dL, repeat 15g carbs, recheck 15 min. >70 mg/dL, have a light snack
Most common cause of hyporglycemia?
Drug induced via Anti-hyperglycemia meds
Risk factors for hypoglycemia in diabetics?
Excessive insulin doses, Increased Glucose utilization (stress, exercise), increased insulin sensitivity (weight loss, good glycemic control), reduced endogenous insulin production (after alcohol consumption), reduced insulin clearance (renal disease)
Urgent treatment of hypoglycemia?
Food, Oral glucose tabs 20g, IV glucose 25mg, IM glucagon are all options
Reactive hypoglycemia?
Hypoglycemic syndromes, with NORMAL sugar levels, that occur after a meal. Usually resolves with diet changes after the elimination of sugary foods
Alcohol's effect on insulin?
In diabetics AND non-diabetics, alcohol inhibits gluconeogenesis
Highest risk med for hypoglycemia?
Insulin, then sulfonylureas, meglitinides.
Symptoms of Hypoglycemia?
Irritability, fatigue, headache, seizures, somnolence, stupor/coma, anxiety, hunger, shakiness, tachycardia, hunger, diaphoresis.
Diabetics should avoid:
Missing/delaying meals, Eating less than planned, vigorous exercise with out carbs, Taking too much medicine, Drinking alcohol, blood glucose <70mg/dL
When to do a workup for hypoglycemia?
ONLY when Whipple's Triad is present
Glucagon's role in hypoglycemia?
Second defense against hypoglycemia, kicks in at 65-70 mg/dL
Treatment of hyperinsulinemia d/t insulinoma?
Surgical resection, Diazoxie or Octreotide
Epinephrine's role in hypoglycemia?
Third defense against hypoglycemia, a critical factor when glucagon is deficient. Kicks in at 65-70mg/dL
Who is at risk for hypoglycemic episodes?
Type 1 diabetics, because they are reliant on insulin
Insulin's role in hypoglycemia?
-first defense against hypoglycemia, primary regulator of glucose, kicks in at 80-85 mg/dL
Diabetic loss of regulatory mechanisms?
1. Insulin id decreased with lowering glucose levels. 2. Decreased insulin secretion stimulates glucagon to be released. 3. Epinephrine is release to initiate sympathoadrenal response
Whipple's Triad=
1. Symptoms consistant with hypoglycemia. 2. A low plasma glucose concentration (measured by lab) 3. Relief of symptoms after plasma glucose is increased (all three criteria are required for dx)
Symptoms of hypoglycemia occur at?
<55mg/dl
Definition of hypoglycemia?
<60mg/dl
Hypoglycemia definition in diabetics?
<70mg/dl