Hyper and hypoglycaemia

Question 1

Give 4 symptoms of diabetes other than polydipsia and polyuria

Answer 1

• Blurred vision
• Unexplained weight loss
• Repeated infections
• Tiredness

Question 2

Give the diagnostic criteria for diabetes for a symptomatic patient.

Answer 2

• HbA1C >48
• Fasting glucose >7
• IGTT >11.1
• Random glucose >11.1

Question 3

Which values diagnose impaired fasting glucose and impaired glucose tolerance?

Answer 3

• IGTT 7.8-11.1

- Fasting glucose 6.1-7

Question 4

Give the biochemical diagnostic criteria for DKA

Answer 4

• pH <7.3
• Plasma glucose >11mM
• Blood ketones >3M (2+ in urine)

Question 5

Give the symptoms of DKA

Answer 5

Rapid onset

• Confusion
• Kussmaul breathing
• Abdominal pain
• Nausea
• Vomiting

Precipitants include infection, surgery, missed insulin doses, trauma.

Question 6

Describe the management of DKA

Answer 6

• A to E approach. Call senior help early +/- ITU involvement
• Fluids: 0.9% saline SBP<90 give 500ml in 15 mins. SBP >90 give 1 litre one 1 hour.
• Insulin: only start after fluids. Ensure K+ not <3.5. 0.1 unit/ Kg/ Hr.
• Monitoring: glucose and K+ hourly. Can give KCl to raise K+ levels. Catheterise for urine output
• Resolution is when Ktones <0.6 and pH >7.3

Question 7

Describe the biochemical diagnostic criteria for hyperosmolar hyperglycaemic state.

Answer 7

• pH >7.3, osmolarity >320mOsm, blood glucose >30mM

Question 8

Describe the onset and symptoms of hyperosmolar hyperglycaemic state

Answer 8

• Slow onset over few days, patient acutely unwell with confusion and clinical dehydration.

Question 9

Describe the management of HHS

Answer 9

• A to E approach
• Fluids: 0.9% saline over 1 hr
• IV insulin: if >1mmol/L ketones. 0.05 units/ kg/ hr
• Serial U+Es and glucose readings.

Question 10

Give 3 causes of hyperinsulinaemic hypoglycaemia

Answer 10

• Insulin overdose
• Sulphonylurea excess
• Insulinoma

Question 11

Give 4 causes of hypoinsulinaemic hypoglycaemia in presence of ketones

Answer 11

• Alcohol binge with no food
• Pituitary insufficiency
• Addison’s
• Liver failure

Question 12

Give cause of hypoinsulinaemic hypoglycaemia in absence of ketones

Answer 12

• Non-pancreatic neoplasms: Fibrosarcomata, fibromata.

Question 13

What occurs in non-islet tumour hypoglycaemia

Answer 13

• Tumour causes paraneoplastic syndrome, secreting big IGF-2 which binds to IGF1 and insulin receptor.
• Reduced glucose, insulin, C-peptide, FFA and ketones.