HYPOGLYCEMIA

Define hypoglycemia in terms of blood glucose level.

→ Answer: Blood glucose level less than 70 mg/dL.

What is the normal action of insulin in glucose metabolism?

→ Answer: Transport of glucose into the cells and glycogenesis.

What is the most common acute complication of insulin therapy?

→ Answer: Hypoglycemia.

During which period of insulin action does hypoglycemia most commonly occur?

→ Answer: During the peak of insulin action (1–3 hours after Regular insulin injection).

How many mg/dL of blood sugar is considered clinically significant hypoglycemia?

→ Answer: Below 70 mg/dL.

Enumerate the three main causes of hypoglycemia (IFA).

→ Answer: Insulin excess, Food deficiency, and Activity/exercise excess.

What are the three letters (mnemonic) representing causes of hypoglycemia?

→ Answer: IFA (Insulin, Food, Activity).

Which insulin-related cause of hypoglycemia occurs when a patient receives more insulin than required?

→ Answer: Insulin overdose or excessive insulin dose.

Hypoglycemia that occurs before meals is often due to what reason?

→ Answer: Delayed meals or omitted snacks.

Which insulin can cause midmorning hypoglycemia when its peak effect occurs?

→ Answer: Morning Regular insulin.

Which insulin can cause late afternoon hypoglycemia due to its peak?

→ Answer: Morning NPH insulin.

Which insulin causes midnight hypoglycemia if bedtime snack is omitted?

→ Answer: Evening or pre-dinner NPH insulin.

What physical factor can lead to hypoglycemia if no extra carbohydrate is taken?

→ Answer: Excessive physical activity.

At what blood glucose level do symptoms usually start to appear?

→ Answer: Around 70 mg/dL.

At what level is severe hypoglycemia typically defined?

→ Answer: Below 50 mg/dL.

Why is it important to always correlate blood sugar levels with symptoms?

→ Answer: Because symptoms correspond to the degree of glucose fall and guide treatment.

What is the term for brain glucose deprivation responsible for most symptoms of hypoglycemia?

→ Answer: Neuroglycopenia.

What are the adrenergic (mild) signs and symptoms of hypoglycemia? (Mnemonic STTPHN)

→ Answer: Sweating, Tremors, Tachycardia, Palpitations, Hunger, Nervousness.

What are the moderate neuroglycopenic signs and symptoms? (Mnemonic HDC)

→ Answer: Headache, Dizziness, Confusion, plus slurred speech and impaired coordination.

What are the severe manifestations of hypoglycemia? (Mnemonic SUN)

→ Answer: Seizures, Unconsciousness, Neurologic deficits.

Which system is affected in moderate to severe hypoglycemia?

→ Answer: Central Nervous System (CNS).

What hormone surge causes the adrenergic warning signs in mild hypoglycemia?

→ Answer: Epinephrine and norepinephrine (adrenergic response).

What type of symptoms do patients with autonomic neuropathy lose due to decreased adrenergic response?

→ Answer: Adrenergic (warning) symptoms.

What term describes patients who do not feel early signs of hypoglycemia because of neuropathy?

→ Answer: Hypoglycemia unawareness.

In chronic DM with autonomic neuropathy, why might hypoglycemia not be detected early?

→ Answer: Decreased adrenergic response to low glucose levels.

What self-monitoring method must all diabetic patients learn to detect hypoglycemia early?

→ Answer: Self-monitoring of blood glucose (SMBG).

What is the immediate treatment for mild hypoglycemia?

→ Answer: Give 15–20 g of fast-acting carbohydrate (juice, regular soda, glucose tablets).

How many grams of carbohydrate should be given initially?

→ Answer: 15–20 grams.

What is the standard rule for treating hypoglycemia with carbohydrates?

→ Answer: The “15/15 Rule” — give 15 g CHO, wait 15 minutes, recheck BG.

Name at least 3 examples of fast-acting carbohydrate sources.

→ Answer: Orange juice, regular soda, glucose tablets, or hard candy.

What should be done 15 minutes after giving initial treatment?

→ Answer: Recheck blood glucose.

After blood sugar normalizes, what snack should be offered if the next meal isn’t soon?

→ Answer: A complex carbohydrate or small meal.

What is the first-line emergency drug for unconscious hypoglycemic patients without IV access?

→ Answer: Glucagon.

What is the standard adult dose of glucagon for severe hypoglycemia?

→ Answer: 1 mg.

What is the route of glucagon administration in emergencies?

→ Answer: Subcutaneous (SQ) or intramuscular (IM).

Before giving glucagon, what preparation step is required?

→ Answer: Mix glucagon powder with diluent.

How long before glucagon begins to act?

→ Answer: 8–10 minutes.

How long does glucagon’s effect last?

→ Answer: 12–27 minutes.

How long may it take for the patient to regain consciousness after glucagon?

→ Answer: Around 20 minutes.

What common side effect of glucagon requires turning the patient to the side?

→ Answer: Nausea and vomiting.

What drug is used in the hospital for unconscious hypoglycemia with IV access?

→ Answer: Dextrose 50% in water (D50W).

How many mL of D50W is given IV for severe hypoglycemia?

→ Answer: 25–50 mL IV.

What must be checked before giving D50W IV?

→ Answer: IV line patency.

Why must the IV line be patent before giving D50W?

→ Answer: D50W is an irritant and can cause tissue damage if extravasated.

What are two side effects of D50W administration?

→ Answer: Headache and injection site pain.

What is the target fasting blood glucose for diabetics?

→ Answer: 80–130 mg/dL.

What is the target A1c level?

→ Answer: Less than 7%.

Define the basal-bolus insulin regimen.

→ Answer: Basal insulin + mealtime boluses of rapid or short-acting insulin.

What type of insulin is used as basal insulin?

→ Answer: Intermediate or long-acting insulin.

What type of insulin is used for mealtime boluses?

→ Answer: Rapid or short-acting insulin.

What insulin is used in continuous subcutaneous insulin infusion (CSII) pumps?

→ Answer: Rapid-acting insulin (e.g., lispro).

What is the typical initial Lantus dose for a 50-kg patient?

→ Answer: 5–10 units/day (approx. 0.5 unit/kg/day).

What is the difference between Dawn phenomenon and Somogyi effect at 3–4 a.m.?

→ Answer: Dawn = high 3–4 a.m. glucose; Somogyi = low 3–4 a.m. glucose.

Which condition shows low 3–4 a.m. glucose followed by rebound hyperglycemia?

→ Answer: Somogyi effect.

Which condition shows persistent early morning hyperglycemia without nocturnal hypoglycemia?

→ Answer: Dawn phenomenon.

What causes the Somogyi effect?

→ Answer: Excess evening insulin dose.

What causes the Dawn phenomenon?

→ Answer: Insufficient evening insulin dose.

How is the Somogyi effect managed?

→ Answer: Decrease the evening insulin dose.

How is the Dawn phenomenon managed?

→ Answer: Increase the evening insulin dose.

What mnemonic helps recall the difference between Somogyi and Dawn?

→ Answer: Somogyi = “So much insulin”; Dawn = “Decreased dose needed.”

What is the key principle in preventing hypoglycemia?

→ Answer: Consistency in meal timing, insulin administration, and exercise.

Why should snacks be taken between meals or at bedtime?

→ Answer: To counteract insulin peaks and prevent hypoglycemia.

During which phase of insulin does hypoglycemia occur?

→ Answer: During its peak action.

What should all diabetic patients on insulin wear for safety?

→ Answer: ID bracelet or medical identification.

What should patients and family members be educated to recognize?

→ Answer: Signs and symptoms of hypoglycemia.

What drugs can mask the symptoms of hypoglycemia?

→ Answer: Beta blockers.

What class of oral hypoglycemics can cause hypoglycemia?

→ Answer: Sulfonylureas (e.g., glipizide).

Why should DM patients always carry glucose tablets or sweet drinks?

→ Answer: For immediate treatment of hypoglycemia.

What food type should be avoided for acute hypoglycemia and why?

→ Answer: High-fat desserts (fats delay glucose absorption).

What should be reported to the healthcare provider after a hypoglycemic episode?

→ Answer: All hypoglycemic events for insulin/OHA dose adjustment.

What hormone is secreted by pancreatic alpha cells and used to treat hypoglycemia?

→ Answer: Glucagon.

What is the mechanism of action of glucagon?

→ Answer: Stimulates hepatic glycogenolysis to increase blood glucose.

What mnemonic represents the counterregulatory hormones in Somogyi effect?

→ Answer: GCC — Glucagon, Cortisol, Catecholamines.

What does RTT stand for in relation to insulin tachyphylaxis?

→ Answer: Rapidly diminishing response to successive doses.

What term means reduced response to repeated doses of insulin?

→ Answer: Tachyphylaxis.

What is the purpose of maintaining consistent meal and insulin timing?

→ Answer: To prevent hypoglycemia and stabilize glucose control.

What home practice ensures safety during exercise for diabetics?

→ Answer: Taking extra snacks or monitoring BG before/after exercise.

What should be done if a patient experiences recurrent nocturnal hypoglycemia?

→ Answer: Check 3–4 a.m. blood sugar and adjust evening insulin.

At what time should blood sugar be checked to distinguish Somogyi vs. Dawn?

→ Answer: Around 3–4 a.m.

What hormones cause rebound hyperglycemia after nocturnal hypoglycemia?

→ Answer: Glucagon, cortisol, and catecholamines.