A to E: Disability - Hypoglycaemia Flashcards

1
Q

Define hypoglycaemia

List four causes

A

Blood glucose <4 mmol/L

ExPLAINEd causes

  • Exogenous insulin
  • Pituitary failure
  • Liver failure
  • Addison’s disease
  • Insulinoma
  • Neoplasm
  • Exogenous drugs: eg. sulfonylreas; alcohol
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2
Q

Give four clinical features of hypoglycaemia

A
  • ‘Adrenergic’ features
    • Sweating; tremor
    • Palpitations
    • Pins and needles
    • Double vision
  • Pallor; cold sweat
  • Hunger
  • Altered behaviour; consciousness; convulsions
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3
Q

When are diabetic patients most at risk of hypoglycaemia?

A
  • Before meals
  • During the night
  • During exercise
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4
Q

What is hypoglycaemic unawareness?

A

Reduced awareness and warning signs of hypoglycaemia.

Associated with longer duration of diabetes, and recurrent hypoglycaemia.

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5
Q

Define mild, moderate, and severe hypoglycaemia

A
  • Mild:
    • Conscious
    • Orientated
    • Able to swallow
  • Moderate:
    • Conscious
    • Confused/disorientated or aggressive
    • Able to swallow
  • Severe (any of):
    • Unconscious/having a fit
    • Very aggressive
    • NBM
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6
Q

What should be given to a symptomatic pt with blood glucose >4 mmol/L?

A

Give a small carbohydrate snack for symptom relief

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7
Q

Outline the initial management of mild hypoglycaemia

A
  • Stop any IV insulin
  • 20g of fast-acting glucose: eg. juice; tablets
  • Reassess CBG at 10 mins, if still <4 mmol/L
    • Repeat fact-acting glucose up to 3 times
    • Consider: IV glucose 10% 200ml over 15min or 1mg glucagon IM

Do not omit subsequent doses of insulin

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8
Q

Outline the initial management of moderate hypoglycaemia

A

If capable and cooperative ➔ treat same as mild

  • Stop any IV insulin
  • 2 tubes of GlucoGel/Dextrogel
  • Reassess CBG at 10 mins, if still <4 mmol/L
    • Repeat GlucoGel/Dextrogel up to 3 times
    • Consider 1mg glucagon IM
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9
Q

Outline the management of severe hypoglycaemia

A
  • ABC assessment
  • Stop any IV insulin
  • IV glucose 10% 150-200ml or IM glucagon 1g
  • Reassess CBG at 10 mins, if still <4 mmol/L
    • Repeat IV glucose
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10
Q

Outline the further managment of hypoglycaemia once hypoglycaemia is corrected

A

Once BM >4 mmol/L:

  • 20g long acting carbohydrate
    • 40g if glucagon IM used
    • IV glucose if NBM
  • Monitor BM over 48h
  • Hypoeducation or refer to diabetes nurse
  • Medication/insulin review

Do not omit subsequent doses of insulin

Restart any IV insulin

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11
Q

How can nocturnal hypoglycaemia be minimised?

A
  • Bedtime snack
  • If taking BD mixed insulin
    • NPH at bedtime rather than before dinner
  • Reduce dose of insulin before dinner
  • Change rapid insulin to long-lasting at night
  • Insulin infusion pump: can give infusion at night
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12
Q

Advise how to avoid hypoglycaemic episodes

A
  • Carry glucose - liquids can be taken when drowsy
  • Education for patient and relatives
  • Reduce alcohol
  • Avoid heavy carbohydrate intake
    • Avoids rebound hyperglycaemia
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