Term
| fasting glucose homeostasis: sources of endogenosu glucose production |
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Definition
liver can cause glycogenolysis adn gluconegoensis
Kidney- gluconegenesis. |
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Term
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Definition
nervous system and blodo cells glucose only
heart kidney and msucles |
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Term
| contributosr to gluconeogeonss |
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Definition
| msucle can contribute amino acids, fat cells can contribute ffa and glyerol. |
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Term
| Glycogenolysis main source |
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Definition
| liver, muscle has very small amounts |
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Term
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Definition
| kidney and liver - corey cycle and cluocse alanien cycle to recycel glucose |
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Term
| glucoenegeonsesis process and resources |
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Definition
lactate adn alanien can be converted to ypurvate which can be used to may glucsoe
glycerol enters in a different part of the pathway. also glycogen stores canbe used for gluconegoeesies |
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Term
| FFA role in gluceonegoenesis |
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Definition
NOT a precuros, rather an energy supply- energy wasting but is necescsary to provide fuel for cns.
Glycerol- enters pathway in a spot wherei ti s avialble hwen otehr substratesare not |
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Term
hormonal resposnet o fallign blood sugar:
insulin, norepi, glucagon, and epi |
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Definition
insulin goes down deinhibiting glycogenolysis and gluconegoensis and deinhibition of lipolysis ,
glucagon goes up is glycogenolytic and gluconeogenetic.
epinephrine stimulates glycogneolysis and stimaultes local lipolysis poetntly. |
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Term
| Hypoglycemia definition number |
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Definition
| less than 50 is commonly ussed |
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Term
| awareness of hypoglycemia is variaable dpending on multiple facotrs |
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Definition
| rate of fall time of day alternate fluel sources drugs (bet a blcokers) drmatic lowering of threshodl for symtpoms of hypoglycemia, impaired response of SNS |
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Term
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Definition
| signs and symtpoms, glucose <45, sytmpmos resovle when icnrease glucose levels |
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Term
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Definition
watch out wehn colecitng lbodo hwen yo uleave it out too long, we lose 7 mg/dl/hr for every 10k wbcs.
blood glucose contians 15 percent less thanplasma glucose (rbcs consuem glucose).
venous glucose will obvi be less than arterial glucose , when glucose extraciton increased gap wil lbe bigger |
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Term
| symptoms of hypoglycemia: two categories |
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Definition
symaptehtic: anxiety sweating trmor, tahcycardia hyeprtension light headed.
neuroglycopenia: hunger confusion, aggressive behavior, emmory loss, hypotehrmia, coma, seizures. |
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Term
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Definition
can occur while fasting or post prandially
can occur with or without inapproriateinsulin secretion |
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Term
| reactive hypoglycemia diagnostic features |
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Definition
| occurs after a meal: we need to see glucose <60 , symtposm occuringw he nteh glucose is acutally low, and coutner regulatory reponse- meaning that hebody is sensing that glucose is low and tryign to compensate |
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Term
| reactive glycemia standard type association |
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Definition
| often associated with mild glucose intolerance and a precursor of type II DM. |
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Term
| etiolgoies of hypoglycemia |
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Definition
| epineprhien exposure, carbohydratedeprivation, hyperhtyrdoisim |
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Term
| reactiveh ypoglycemia prognosis |
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Definition
| often spontantously resovles |
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Term
| reactive hypoglycemia insulin/glucose relationship |
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Definition
| insulin release is delayed , this leads to glucose being hgiher than normal, so a large bolus is relased. - too much insulin activity later on |
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Term
| alimenatary hypoglycemia cause |
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Definition
| due to gastric ianbility to contorl glucose release, results in dumpign large amounts of insulin at once. |
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Term
| alimentary glycemia etiology, prognosis |
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Definition
| subset of reactive hypoglycemia asosciated with gastrics urgeyr, hwoever can occur with chornic disease, rarely resovles spontaneously |
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Term
| conditiosn often confused with reactiveh ypoglycemia |
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Definition
| hyperventilation, dumping syndrome, postprandial hypotension, allergy , cardiac (postprandial arrythmias) |
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Term
| problems with reactiveh ypoglycemia definition |
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Definition
| no generally accepted efinition, poorlydefined noraml range, day to day vairatino inGTT, and differential reposnet om eal and GTT among aptients |
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Term
| diagnosis of ractie hypoglycemia |
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Definition
overnight fast to tobatain baseline insulin and glucose
assess with breafkast, if symptoms occur take glucose and insulin,cortisol levels.
If glucosen ormal check for other htings: hypervneitlation, arrythmia, hypoetnsion, |
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Term
| hwo to treat reactive hypoglycemia |
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Definition
| frequent small feedings avoid high glycemc carbs, high fibers (to decrase absorp), alpah glucosidase inhibitors to delay absorption (alpha glucosidase is enteric enzyme). avoidance of veyr lwo cho diets, tobcco and coffee |
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Term
| excessive glucose dispoal |
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Definition
| exhaustive excercsie (i.e. marathon), seizures, pregnancy, drugs, endotoxic shocks, anti-receptor antibodies- which stimulate |
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Term
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Definition
| hormonal deficiency, energy source lacking, high insulin, sulfa drugs, inadequate substrates (lack of fat stores, infants, cachexia, chornic renal failure). |
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Term
| hypoglycemia hormonal causees |
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Definition
adrenal insuficciency- epi.
hypopituatirism- knockign otu eveyrthing
hypothyroidism- functions like epi
glucoagon and adrenergic deficiency |
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Term
| hypoglycemia hepatic dysfunciton |
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Definition
| ESLD, enzyamtic defects or diffuse acute disease . |
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Term
| azotemia and hypoglycemia |
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Definition
malnutrition leading ot loss of msucle mass.
retained toxins leading to SU like activity stimulating b cells
Decreased insulin removal.
decreasedrenal mass for gluconeogenic activity
decreased delivery of precurosrs from skeletal muscle |
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Term
| drugs causing hypoglycemia |
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Definition
bactrim and sulfa drugs,
pentamidine
alcohol
insulin and agents that promote insulin secretion |
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Term
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Definition
metaabolsim of lacate and alanien to pyruvate is impaired because alcohol is utilziing the nad for required for htis activity. Pyruvate also gets converted to lactate instead of glucose utiliazation.
However glycerol conversiotn o glucose is still funcitonal
goljan: glycogen stores get diminsihed as well |
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Term
| insulinoma , most common presenting symtpom, what diseases to consider |
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Definition
lless than 10 eprcent are malignant or multifocal.
(consider mEN-1 and munchhausans)
mostly fasting hypoglycemia with paradoxical glucose intolerance (glucose will actually go up after the meal, this is because with an insulinoma we cant upregulate insulin relase prostprandiallly, it stays at same level all the time) |
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Term
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Definition
inappropriatei nsulin in faceo h ypoglycemia. insulin/glucose> 0.3
check c-peptide and proinsulin to be sure that it is endogenous insulin |
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Term
| relationship of c-peptide and insulin |
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Definition
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Term
| insulinoma diagnosit methods |
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Definition
put person in prolonged fast or other methdos of inducing hypoglycemia, do a urine screen for SU, and c-peptide to check for exogenous insuslin,
Do imaging CAT, mRI, ultrasound, |
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Term
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Definition
| surgery, (chemotherapy , diazoxide and somatostatin analogs may nihibit pancreas) |
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Term
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Definition
feigning disorders, cosnider for insulinomas. self inducedh ypoglycemia
unlike exogenous insulin . Su administration will lead to both insulin and c epptide elevation, hwoever SU can be measured in urine. |
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Term
| treatment of hypoglycemia |
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Definition
DO NOT FEED AN UNCONSIOUCS patient
rapidly absorbable carbs, IV dextrose adn glucoagon |
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Term
alpha cells of pancrease
beta cels of pancreas
delta cells of pancreas |
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Definition
glucagon secreting
insulin secreting
somatosatatin |
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