Question

Mr. Murdock’s physician wants to further evaluate his hypoglycemia, including endocrine function that may impact his body’s ability to control his blood sugar. You have already completed testing as part of an oral glucose tolerance testing, which you will need to answer the following questions. During a two day hospital admission, in which Mr. Murdock was closely monitored and fully compliant with all instruction, additional testing was performed

Endocrinology – A fasting specimen

Insulin = 42 mIu/L

C-peptide = 9.8 ng/mL

Glucagon = 111 pg/mL

Endocrinology – A specimen 2 hours post prandial

Insulin = 43 mIu/L

C-peptide = 9.8 ng/mL

Glucagon = 45 pg/mL

Toxicology

A urine drug screen (immunoassay) comes back for positive for marijuana, and negative for all other drugs of abuse.

Finally, Mr. Murdock’s hypoglycemia was persistent during the stay, except for short periods following eating.

1. Make a table of your glucose tolerance test results. You should have found a fasting glucose of 48, a 1 hour glucose of 128, and a 2 hour glucose of 88. If your results were within 10% of those values, you have earned credit for this question. If not, what about your technique could you have improved in order to improve your accuracy?

Results: Fasting 41.4

1hour 113.6

2hour 74.8

2. What is the function of glucagon?

3. What are the reference ranges for insulin, C-peptide, and glucagon?

4. What is the cause of Mr. Murdock’s persistent high insulin, high C-peptide, and hypoglycemia?

5. What is the most likely reason that Mr. Murdock might self medicate with marijuana?

Answer 1

2 Glucagon is a polypeptide hormone that is synthesized by a-cells of the pancreatic islets,opposes most actions of insulin,secreted as blood glucose levels drop and it serves to maintain bloodglucose levels by activating hepatic glucose synthesis and breakdown of liver glycogen.it maintains blood glucose levels during the fasting state,promotes the breakdown of triglycerides to fatty acids in adipose tissue-this releases free fatty acids into the circulation and promotes oxidationof fatty acids for energy in liver and other tissues,thus sparing glucose.Ketone bodies are formed from catabolism of some fattyacids in liver and this provides another non-glucose energy source.Glucagon secretion is inhibited by insulin secretion and by elevated blood glucose.Both occur after a high carbohydrate meal.

3 Reference range for insulin

Fasting -

Insulin level greater than 25mlUL

Insulin level SI units 30-230ml U/L

30 minutes after glucose administration

30 -230 mlU/L

208-1597pmol/L

1 hour after glucose administration

18-276mlU/L

125-1917pmol/L.

2 hour after glucose administration

16-166mlU/L

111-1153pmol/L

Greater than or equal to 3 hours after glucose administration

greater than 25mlU/L

Greater than 174pmol/L

C-peptide.

0.8 -3.1ng/ml

Glucagon

50 -100pg/ml

4 Endocrine disorders cause spontaneous hypoglycaemia,because decreased delivery of gluconeogenic precursors to liver and or decreased induction of n methyl transferase.Recent studies found a significant link between the regular use of marijuana and better blood sugar control.So from this we can decipher that it is not the use of marijuana that triggers the disease.

5 Tolerance and dependence to marijuana occurs with chronic exposure to the drug.So he might experience withdrawl symptoms once he stopped using Marijuana.