[14] Hypoglycaemia Flashcards
What are the categories of symptoms of hypoglycaemia?
Autonomic
Neuroglycopenic
At what glucose levels do the autonomic symptoms of hypoglycaemia occur?
2.5-3
What are the autonomic symptoms of hypoglycaemia?
Sweating Anxiety Hunger Tremor Palpitations
At what glucose levels do the neuroglycopenic symptoms of hypoglycaemia occur?
<2.5
What are the neuroglycopenic symptoms of hypoglycaemia?
Confusion Drowsiness Seizures Personality change Focal neurology
At what glucose level does a hypoglycaemic coma occur?
<2.2
What diabetes medications cause fasting hypoglycaemia?
Usually insulin or sulphonylureas
Give 3 examples of when diabetes medications can cause hypoglycaemia
Exercise
Missed meal
Overdose
What are the causes of fasting hypoglycaemia in non-diabetics
Exogenous drugs Pituitary insufficiency Liver failure Addison's Islet cell tumours (insulinomas) Immune Other neoplasms
Give an example of an immune cause of fasting hypoglycaemia
Insulin receptor antibody production in Hodgkins lymphoma
Give an example of a non-pancreas neoplasm that can cause fasting hypoglycaemia
Fibrosarcomas
How is fasting hypoglycaemia investigated?
72 hour fast with monitoring
Blood tests
What is looked for in blood tests in fasting hypoglycaemia?
Glucose
Insulin
C-peptide
Ketones
What can cause hyperinsulinaemic hypoglycaemia?
Drugs
Insulinoma
What drug causes hyperinsulinaemic hypoglycaemia with raised C-peptide?
Sulphonylureas
What drug causes hyperinsulinaemic hypoglycaemia with normal C-peptide?
Insulin
What causes fasting hypoglycaemia with low insulin and no ketones?
Non-pancreatic neoplasm
Insulin recetor antibodies
What causes fasting hypoglycaemia with decreased insulin and increased ketones?
Alcohol binge with no food
Pituitary insufficiency
Addison’s
What % of insulinomas are benign?
95%
What are insulinomas?
ß-cell tumours
Where are insulinomas usually seen?
In MEN1
How do insulinomas present?
Fasting or exercise induced hypoglycaemia
What is found on investigation in insulinomas?
Hypoglycaemia with increased insulin
What effect does exogenous insulin have on C-peptide in insulinomas?
None - it doesn’t suppress it
What imaging may be used in investigation of insulinomas?
MRI
EUS pancreas
How are insulinomas managed?
Excision
What causes post-prandial hypoglycaemia?
Dumping post-gastric bypass
How is hypoglycaemia managed when the patient is alert and orientated?
Oral carbohydrate
Give an example of a rapid acting oral carbohydrate
Lucozade
Give an example of a long acting oral carbohydrate
Toast
How is hypoglycaemia managed when the patient is drowsy/confused, but still has intact swallow?
Buccal carbohydrate
Give two examples of buccal carbohydrates
Hypostop
Glucogel
What should be considered in a patient with hypoglycaemia that is drowsy/confused, but with an intact swallow?
IV access
How should hypoglycaemia be managed in a patient who is unconscious, or there are concerns regarding their swallow?
IV dextrose
What dose of IV dextrose is given in hypoglycaemia?
100ml 20% glucose
How is deteriorating, refractory, insulin-induced, or no-access hypoglycaemia managed?
1mg glucagon IM or SC
What are the problems with giving IM or SC glucagon in hypoglycaemia?
Won’t work in alcoholics
Short duration of effect (20 mins)
Insulin release may lead to rebound hypoglycaemia
