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
- Alert and orientated
- Oral sarbohydrates (e.g. juice/sweets or long-acting forms such as a sandwich)
- Drowsy/confused but swallow intact
- Buccal glucose (e.g. glucogel)
- Unconscious or concerned about swallow
- IV 50 mL 50% glucose
- NOTE: or 100 mL 20% glucose
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?
- Starving
- Anorexic
- Hepatic failure
- These patients will have poor liver glycogen stores that can be accessed by glucagon
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
- Neuroglycopaenic: confusion, coma
What is a consequence of recurrent episodes of hypoglycaemia?
Hypoglycaemia unawareness (loss of adrenergic symptoms with hypoglycaemia)
Describe the order in which physiological compensatory changes in response to hypoglycaemia take place.
- Suppression of insulin
- Release of glucagon
- Release of adrenaline
- Release of cortisol
What effect do these measures have on blood glucose and FFA production?
- Increases blood glucose
- Increases FFAs
- Not all FFAs can be used to generate ATP by beta-oxidation so some of them will become ketone bodies
What investigation may need to be performed to demonstrate hypoglycaemia in an otherwise healthy person?
Prolonged fast
What is the gold standard for measuring blood glucose?
Lab glucose
NOTE: this is collected in a grey top container that has fluoride oxalate
What is the disadvantage of using a blood glucose meter?
Poor prevision at low levels
NOTE: however, it does produce an instant results
List some causes of hypoglycaemia in people without diabetes.
- Fasting
- Paediatric
- Critically unwell
- Organ failure
- 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
- Excessive alcohol
- Strenous exercise
- Co-existing autoimmune conditions
List some diabetic medications that can causes hypoglycaemia.
- Oral hypoglycaemics: sulphonylureas, meglitinides, GLP1 analogues
- Insulin