[14] Hypoglycaemia

Question 1

What are the categories of symptoms of hypoglycaemia?

Answer 1

Autonomic

Neuroglycopenic

Question 2

At what glucose levels do the autonomic symptoms of hypoglycaemia occur?

Answer 2

2.5-3

Question 3

What are the autonomic symptoms of hypoglycaemia?

Answer 3

Sweating 
Anxiety
Hunger
Tremor
Palpitations

Question 4

At what glucose levels do the neuroglycopenic symptoms of hypoglycaemia occur?

Answer 4

<2.5

Question 5

What are the neuroglycopenic symptoms of hypoglycaemia?

Answer 5

Confusion 
Drowsiness
Seizures 
Personality change
Focal neurology

Question 6

At what glucose level does a hypoglycaemic coma occur?

Answer 6

<2.2

Question 7

What diabetes medications cause fasting hypoglycaemia?

Answer 7

Usually insulin or sulphonylureas

Question 8

Give 3 examples of when diabetes medications can cause hypoglycaemia

Answer 8

Exercise
Missed meal
Overdose

Question 9

What are the causes of fasting hypoglycaemia in non-diabetics

Answer 9

Exogenous drugs
Pituitary insufficiency
Liver failure
Addison's 
Islet cell tumours (insulinomas)
Immune 
Other neoplasms

Question 10

Give an example of an immune cause of fasting hypoglycaemia

Answer 10

Insulin receptor antibody production in Hodgkins lymphoma

Question 11

Give an example of a non-pancreas neoplasm that can cause fasting hypoglycaemia

Answer 11

Fibrosarcomas

Question 12

How is fasting hypoglycaemia investigated?

Answer 12

72 hour fast with monitoring

Blood tests

Question 13

What is looked for in blood tests in fasting hypoglycaemia?

Answer 13

Glucose
Insulin
C-peptide
Ketones

Question 14

What can cause hyperinsulinaemic hypoglycaemia?

Answer 14

Drugs

Insulinoma

Question 15

What drug causes hyperinsulinaemic hypoglycaemia with raised C-peptide?

Answer 15

Sulphonylureas

Question 16

What drug causes hyperinsulinaemic hypoglycaemia with normal C-peptide?

Answer 16

Insulin

Question 17

What causes fasting hypoglycaemia with low insulin and no ketones?

Answer 17

Non-pancreatic neoplasm

Insulin recetor antibodies

Question 18

What causes fasting hypoglycaemia with decreased insulin and increased ketones?

Answer 18

Alcohol binge with no food
Pituitary insufficiency
Addison’s

Question 19

What % of insulinomas are benign?

Answer 19

95%

Question 20

What are insulinomas?

Answer 20

ß-cell tumours

Question 21

Where are insulinomas usually seen?

Answer 21

In MEN1

Question 22

How do insulinomas present?

Answer 22

Fasting or exercise induced hypoglycaemia

Question 23

What is found on investigation in insulinomas?

Answer 23

Hypoglycaemia with increased insulin

Question 24

What effect does exogenous insulin have on C-peptide in insulinomas?

Answer 24

None - it doesn’t suppress it

Question 25

What imaging may be used in investigation of insulinomas?

Answer 25

MRI | EUS pancreas

Question 26

How are insulinomas managed?

Answer 26

Excision

Question 27

What causes post-prandial hypoglycaemia?

Answer 27

Dumping post-gastric bypass

Question 28

How is hypoglycaemia managed when the patient is alert and orientated?

Answer 28

Oral carbohydrate

Question 29

Give an example of a rapid acting oral carbohydrate

Answer 29

Lucozade

Question 30

Give an example of a long acting oral carbohydrate

Answer 30

Toast

Question 31

How is hypoglycaemia managed when the patient is drowsy/confused, but still has intact swallow?

Answer 31

Buccal carbohydrate

Question 32

Give two examples of buccal carbohydrates

Answer 32

Hypostop | Glucogel

Question 33

What should be considered in a patient with hypoglycaemia that is drowsy/confused, but with an intact swallow?

Answer 33

IV access

Question 34

How should hypoglycaemia be managed in a patient who is unconscious, or there are concerns regarding their swallow?

Answer 34

IV dextrose

Question 35

What dose of IV dextrose is given in hypoglycaemia?

Answer 35

100ml 20% glucose

Question 36

How is deteriorating, refractory, insulin-induced, or no-access hypoglycaemia managed?

Answer 36

1mg glucagon IM or SC

Question 37

What are the problems with giving IM or SC glucagon in hypoglycaemia?

Answer 37

Won't work in alcoholics Short duration of effect (20 mins) Insulin release may lead to rebound hypoglycaemia