Chemical Pathology 16 - Hypoglycaemia Flashcards
How should hypoglycaemia be managed if the patient is alert and oriented?
Juice and a sandwich
Continuous monitoring and treat cause
How should hypoglycaemia be managed if the patient is drowsy, but not unconscious?
Bucchal glucose (this bypasses 1st pass metabolism) Continuous monitoring and treat cause
How should hypoglycaemia be managed if the patient is unconscious or has a reduced swallow reflex?
IV glucose 20%
Continuous monitoring and treat cause
What are the possible symptoms of hypoglycaemia?
Adrenergic symptoms - tremors and sweating
Neuroglycopaenic symptoms - somnolence and confusion
None - in some type 1 diabetic
What is the body’s physiological response to hypoglycaemia, and which of these responses if the first?
1st - reduced insulin
Then catecholamine release (ACTH, cortisol and GH increase, causes adrenergic symptoms) and increased glucagon
Recall the effects of glucagon
Directly: 1. Decreases peripheral glucose uptake 2. Increases glycogenolysis 3. Increases gluconeogenesis in the liver and kidneys 4. Increases lipolysis This then leads to: 1. Increased glucose 2. Inceased free fatty acids Fatty acids undergo beta oxidation --> ketones
What is the best measure of glucose?
Venous glucose (way better than capillary)
Recall 6 differentials for the cause of hypoglycaemia in a NON-diabetic patient
- Critically unwell pt
- Organ failure
- Hyperinsulinism
- Drugs
- Extreme weight loss
- Factitious
Recall 5 differentials for the cause of hypoglycaemia in diabetic patients
- Medications - these iatrogenically reduce glucose
- Inadequate CHO intake (T1D especially)
- Impaired awareness (eg EtOH)
- Exercise
- In presence of autoimune conditions eg Addissons
What class of drug is gliclazide?
Sulphonylurea
Which 2 classes of oral diabetic drug are most likely to cause a hypo?
Sulphonylureas (eg gliclazide)
GLP-1 agents
Recall 3 non-diabetes drugs that can cause a hypo
Beta blockers (impair adrenergic response so have impaired awareness of symptoms)
Salicylates - impair regulation of glucose
Alcohol
In a neonate with hypoglycaemia but no ketones, what is the likely diagnosis?
Inborn error of fatty acid metabolism
Recall 3 possible causes of hyperinsulinaemic hypoglycaemia
- Insulinoma (islet cel tumour)
- Drugs (eg insulin/ sulphonylurea)
- Islet cell hyperplasia
Recall 3 causes of islet cell hyperplasia in the neonate
- Infant of a diabetic mother
- Beckworth Wiedmann syndrome
- Nesidioblastosis