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5 Multiple choice questions

  1. indicative of insulin overdose, accidental or deliberate
  2. from accidental or intentional use of hypoglycaemic agents (sulphonylureas / insulin injections)

    diagnose by measuring patient's serum levels of insulin, C-peptide and proinsulin at time of showing symptoms

    show high serum insulin, low C-peptide, low proinsulin levels
  3. condition where blood glucose level is less than 2.5mmol/L (45mg/dL), symptom of underlying disease, can develop as result of liver diease, hormonal disorder, genetic disorcer, GI tract surgery

    body responds to falling blood glucose levels by stimulating sympathteic nervous system-->induces secretino of epinephrine, cortisol, glucagon-->have collective antagonistic effect on insulin secretion

    first organ to be affected is brain

    symptoms include confusion, dizziness, shaky feelling, hunger, headaches, irritability, pounding heart, racing pulse, pale skin, sweating, trembling, weakness, anxiety

    two division of symptoms: adrenergic and neuroglycopenic

    two regulator mechanisms: pancreatic secretion of glucagon, hypothalamus glucoreceptors

    classified as either reactive hypoglycemia or true organic fasting hypoglycemia

    occurs in insulin-dependent diabetics usually as a result of excess insulin or sulphonylurea administration, strenuous exercise, insufficient carbohydrate ingestion, excess alcohol ingestion
  4. indicative of reactive hypoglycaemia, sulphonylurea overdose--promote pancreatic secretion of insulin
  5. mediated by impaired supply of glucose to brain over extended period of time, following gradual decline in blood glucose concentration, does not elicit epinephrine response, brain cell malfunction when deprived of glucose, cognitive behavior affected, have slurred speech, confusion, seizures, may have coma leading to death if not corrected, slow decline in blood glucose level without sudden release of epinephrine

5 True/False questions

  1. adrenergic symptoms of hypoglycemiaresult of effects of epinephrine (palpitations, tremors, sweating), usually occur following sudden drop in blood glucose levels--catecholamine surge


  2. Whipple's Triadfor diagnosis of hypoglycemia
    1. adrenergic /neuroglycopenic symptoms
    2. blood glucose <50mg/dL at time of symptoms
    3. improvement of symptoms on ingestion of glucose


  3. alcohol induced hypoglycemiaconsumption of large quantities of alcohol after fasting or being malnourished-->risk of becoming hypoglycaemic

    large quantities of alcohol produce large amount of NADH-->favor lactate formation rather than gluconeogenesis


  4. fasting hypoglycemiamay be caused by drug-induced hypoglycaemia or postprandial hypoglycaemia (within 5h of meal), some individuals manifest transitory hypoglycaemic symptoms after eating a large carbohydrate meal--causes exaggerated transient insulin response, does not usually indicate underlying disorder


  5. glucagonomatumor in region of β-cells of islets of Langerhans, associated with excessive insulin production and secretion, mostly benign solitary lesions,usually found in tail of pancreas, treatment by surgery wherever possible