Hypoglycemia - Non-Diabetic Hypoglycemia Non-Diabetic...

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Non-Diabetic Hypoglycemia Non-Diabetic Hypoglycemia Medical Grand Rounds May 14, 2004 Dr. William Harper Assistant Professor of Medicine, McMaster University. Endocrinologist, Hamilton General Hospital www.drharper.ca
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Hypoglycemia: Hypoglycemia: case based case based 1. Diagnostic approach to hypoglycemia 2. Iatrogenic hypoglycemia 3. Tumor-associated hypoglycemia
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Case 1 Case 1 18 year old male Prior ADHD, school suspension-fighting LOC, SZ, CBG 1.8 mM Stepfather T2DM: glyburide Grandfather T2DM: insulin
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Hypoglycemia: Symptoms Hypoglycemia: Symptoms Sympathoadrenal: diaphoresis, warmth, anxiety, tremor, nausea, hunger, palpitations/tachycardia Neuroglycopenic: Fatigue, dizziness, H/A, visual disturbance, drowsiness, difficulty speaking, inability to concentrate, amnesia, abnormal behaviour, mood changes, loss of consciousness, seizure, focal neurological deficit
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Response to Hypoglycemia Response to Hypoglycemia Blood Glucose Symptoms < 3.3 mM Sweating, tremor, anxiety, palpitations, hunger 2.8 – 3.1 mM Early cognitive dysfn. (confusion, mood changes) 2.5 – 2.8 mM Lethargy, obtundation < 1.7 mM Coma < 1.1 mM Convulsions …Death
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Response to Hypoglycemia Response to Hypoglycemia Blood Glucose Hormonal response < 4.4 mM Insulin to low levels 3.6 - 3.9 mM < 3.3 mM < 2.5 mM Pancreas: no insulin release
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Hypoglycemic Disorders Hypoglycemic Disorders Fasting vs. Post-prandial Appearance: healthy vs. sick Hyper-insulinemic vs. Hypo-insulinemic
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Post-prandial Hypoglycemia Post-prandial Hypoglycemia Sympathoadrenal symptoms only: 2° to refined sugars/simple CHO Alimentary Surgery (gastrectomy, etc) Dumping syndrome fluid shifts Dysglycemia IFG, IGT, Early Type 2 DM 4-5h after
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Post-prandial Hypoglycemia Post-prandial Hypoglycemia Neuroglycopenic symptoms: Unripe ackee fruit Bariatric surgery? Insulinoma, islet hypertrophy Non-insulinoma pancreatogenous hypoglycemia (NIPHS)
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Post-prandial Hypoglycemia Post-prandial Hypoglycemia Non-insulinoma pancreatogenous hypoglycemia (NIPHS) Adult nesidioblastosis (islet hypertrophy) Postprandial severe neuroglycopenia 72h fast negative Rare, M > F (insulinoma F > M) Ca+ stimulation test Rx: partial pancreatectomy
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Hypoglycemia Symptoms (only adrenergic) after eating? Symptoms after fasting
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This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Hypoglycemia - Non-Diabetic Hypoglycemia Non-Diabetic...

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