DM: Hypoglycaemia

Question 1

Outline the pathophysiology of hypoglycaemia

Answer 1

Low glucose = <2.6mmol/L

Question 2

Outline the aetiology of hypoglycaemia?

Answer 2

Overdose of subcut insulin or oral hypoglycaemic drug

Gastric dumping syndrome

Decompensated liver disease

Tumour = that produces insulin

Adrenal insufficiency = bloods (low Na, high K, low cortisol), ACTH

Beta-blockers

Question 3

What are the signs and symptoms of hypoglycaemia?

Answer 3

Sweating

Tingling lips

Tingling extremities

Tremor

Dizziness

Slurred speech

Pallor

Confusion

Tachycardia

Tachypnoea

Seizure, coma

Question 4

How would you investigate hypoglycaemia?

Answer 4

A-E assessment = BM

Assess for liver disease

Assess nutritional intake

C-peptide level = in a pt that doesn’t take insulin, does not rise in presence of exogenous insulin (insulinoma)

GH

IGF-1

Cortisol

Insulin

Ketones

Question 5

How would you manage hypoglycaemia?

Answer 5

Conscious = oral glucose (10g GlucoGel or 120ml Lucozade), monitor BM every 1-2hrs, ensure pt eats complex carbs (bread). If no improvement IV glucose 1L 10% over 8hrs

Unconscious = protect airway, high flow O2, IV 100ml 20% glucose stat, if any delay obtaining IV access 1mg IM glucagon. When consciousness returns 1L 10% glucose over 8 hrs

Question 6

What are the complications of hypoglycaemia?

Answer 6

LOC

Seizures

Death

Question 7

What are the potential dangers of giving insulin?

Answer 7

Hypoglycaemia

Allergic reaction

Question 8

What are the common types of insulin used by patients with diabetes?

Answer 8

Rapid acting = humalog, novolog, apidra = 10-30 mins

Short acting = regular = 30-1hr

Intermediate acting = NPH = 1.5 - 4hrs

Long acting = lantus, levemir = 24hrs