ChemPath: Hypoglycaemia Flashcards
Outline the first step in the management of hypoglycaemia patients in the following states:
- Alert and orientated
- Drowsy/confused but swallow intact
- Unconscious or concerned about swallow
What should be considered if a hypoglycaemic patient is deteriorating or does not appear to be responding to the first step in their management?
IM/SC 1 mg glucagon
What is the benefit of giving glucose sublingually?
Bypasses hepatic first-pass metabolism
How long is it likely to take for IM glucagon to cause an increase in blood glucose?
15-20 mins
Which group of patients may not respond to IM glucagon?
Patients with poor liver glycogen stores
- Starving
- Anorexic
- Hepatic failure
What are some possible consequences of extravasation of IV dextrose?
- Irritation
- Phlebitis
Describe the triad of features that is used to define hypoglycaemia.
- Low glucose
- Symptoms
- Relief of symptoms by administration of glucose
List some symptoms of hypoglycaemia.
Adrenergic:
- Tremors
- Palpitations
- Sweating
- Hunger
Neuroglycopaenic:
- Confusion
- Drowsiness
- Loss of coordination
- Coma
- Seizures
(Sometimes patients may be asymptomatic)
What is a consequence of recurrent episodes of hypoglycaemia?
Hypoglycaemia unawareness (loss of adrenergic symptoms with hypoglycaemia)
Typically affects people on insulin - recurrent hypos
Describe the order in which hormonal compensatory changes in response to hypoglycaemia take place.
- Suppression of insulin
- Release of glucagon
- Release of catecholamines
- Release of cortisol
What are the effects of decreased insulin and increased glucagon?
- Reduce peripheral uptake of glucose
- increase gluconeogenesis
- increase glycogenolysis
- increase lipolysis - FFA and ketone generation
What is the most common cause of hypoglycaemia?
Insulin-induced in diabetics
List some causes of hypoglycaemia in people without diabetes.
- Fasting
- Paediatric
- Critically unwell
- Organ failure
- Gluconeogenesis occurs in the kidneys
- Liver stores glycogen
- Hyperinsulinism
- Post-gastric bypass
- Drugs
- Extreme weight loss
- Factitious (artefact)
List some causes of hypoglycaemia in diabetics.
- Medications (inappropriate insulin)
- Inadequate carbohydrate intake (missed meal)
- Impaired awareness - alcohol
- Illness and infection
- Strenous exercise
- Co-existing autoimmune conditions
- eg. Addisons
List some diabetic medications that can causes hypoglycaemia.
- Insulin
- Oral hypoglycaemics: sulphonylureas, meglinitides, GLP-1 analogues