Hypoglycaemia Flashcards
Risks of hypoglycaemia
Diabetes mellitus
Post-gastrectomy or gastric bypass surgery
Alcohol excess
Renal dialysis
Beta blockers
Clinical features of hypoglycaemia
Sweating Tingling lips or extremities Tremor Dizziness Slurred speech.
Clinical signs of hypoglycaemia
Confusion
Tachycardia or tachypnoea
Focal neurology or a reduced consciousness.
Gastric Dumping Syndrome
Complication of gastric bypass surgery
early Gastric Dumping Syndrome
Sudden large passage of hypertonic gastric contents into the small intestine
Intraluminal fluid shift - intestinal distention
N+V
Diarrhoea
Hypovalaemia
Late (1 - 3 hours post prandial)
Surge in insulin production due to ‘dumping’ of food -hypoglycaemia
Mx of gastric dumping syndrome
Small volume and more frequent meals
Avoid simple carbohydrates and separation of eating and drinking
Investigations for hypoglycaemia
Capillary blood glucose (BM)
Mx of hypoglycaemia
Conscious - oral glucose
Dysphagia - buccal glucose
NBM - IV glucose - 1L 10% dextrose over 8hrs
No IV access - intramuscular glucagon
Monitoring hypoglycaemia
Monitor the capillary blood glucose levels every 1-2hrs until stable and ensure patient eats complex carbohydrates (e.g. bread) to maintain their BM.
Intra-Operative Glucose Monitoring
BM measurements every 30 minutes in diabetic patients
Consider variable rate insulin infusion
blood glucose level is <4mmol intra op
intravenous glucose infusion rate should be increased and the insulin infusion stopped. Recheck after 30mins for improvement
