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Hypoglycemia - Coggle Diagram
Hypoglycemia
Counter-Regulatory Hormones
Glucagon: Promotes gluconeogenesis and glycolysis to release glucose into the blood
Epinephrine: Decreases glucose clearance and increases glucose production by kidneys
Cortisol
Growth Hormone
Causes of Hypoglycemia
Hyperinsulism
Pancreatic Beta cell tumour
Can be associated with MEN1, Localization (CT, MRI, DOTATE), Endoscopic US
Insulin Autoimmunity
3rd most likely cause of hypoglycemia in Japan due to insulin antibodies
Non-insulin pancreatogenous hypoglycemia
Results from beta cell hyperplasia
Oral hypoglycemic Agents
Insulin
Without Hyperinsulism
Ciritical Illness, Hormone Deficiency, Non-beta cell tumour, malnutrition
Non-Beta cell Tuour: Solid tumors that stimulates insulin receptor and inhibits glucagon and GH
Postprandial Hypoglycemia
Due to delayed insulin response, not dangerously low hypoglycemia
Dumping Syndrome
Early Dumping: Rapid fluid shift sinto bowel
Late Dumping: Hyperinsulinemic response leading to hypoglycemia
Management: Meet with dieticianl small frequent meals, well balanced diet, avoid/limit sugary foods, eat food if consuming alcohol
Pharmacotherapy
Acarbose: Inhibits alpha-glucosidase which is needed to absorb carbs
Diazoxide: Opens ATP sensitive potassium cells in beta islet cells to prevent insulin secretion
Components of Whipple's Triad
Biochemical Hypoglycemia
Hypoglycemic Symptoms
Autonomic: Anxiety, palpitations, Tremor, Diaphoresis, hunger, Parasthesias,
Neuroglycopenic Symptoms: Cognitive impairment, psychomotor abnormaltiies
Relief following glucose administration
Investigations
Serum C-Peptide: Released by beta cells with insulin but not present in exogenous insulin
Serum Insulin: Most will detect endogenous and exogenous insulins
Beta-hydroxybutyrate: used as energy by some cells when sugar levels are low