DM Hypoglycaemia W1

Question 1

What is the object of insulin therapy?

Answer 1

Eliminate symptoms of hyperglycaemia without producing hypoglycaemia

Question 2

Problems with insulin

Answer 2

Activation of the immune response - as insulin can provoke an immune response in the body with the production of antibodies which potentially in long-term can activate the insulin

The injection site - as it can cause lipohypertrophy and bruising/redness/scarring and this can be caused by technique

Weight gain is also a problem because insulin itself causes the patient to be hungry

Biggest risk is hypoglycaemia

Question 3

What is hypoglycaemia?

Answer 3

A blood glucose level of less than 4mmol/L

(four is the floor)

Question 4

Signs and symptoms when you get to less than 3mol/L

Mild

Answer 4

Mild: palpitations, tremor, hunger and sweating, numbness and tingling, blurred vision, fatigue, headache

these are adrenergically mediated and if on a beta blocker then they may not experience these symptoms so do not rely on these symptoms to guess if someone is having a hypo

Question 5

Signs and symptoms when you get to less than 3mol/L

Moderate

Answer 5

Moderate: behaviour changes i.e. restlessness, agitation, irritability, drowsiness (but rousable), confusion, slurred speech - if untreated can lead to severe

Question 6

Signs and symptoms when you get to less than 3mol/L

Severe

Answer 6

Severe: very agitated/aggressive, unconscious, unresponsive, seizure, coma

Question 7

Treatment of mild

Answer 7

15 to 20 g rapid absorbed sugar

The person is aware and can treat themselves

For example, 2 teaspoons of sugar

Question 8

Treatment of moderate

Answer 8

1.5 to 2 tubes of glucose gel

Aroused but need help

Question 9

Treatment of severe

Answer 9

IM glucagon or IV glucose

Lack of consciousness

Question 10

Causes of hypo

Answer 10

• Incorrect dosing of insulin at night time
• Delayed/missed meals
• Alcohol (inhibits glucogenesis)
• More exercise than usual
• Heat/stress