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Roomies Collab Deck 2: Endocrinology and NeuroPsych > Hypoglycaemia > Flashcards

Hypoglycaemia Flashcards

1
Q

For inpatients with diabetes, what blood-glucose concentration is considered hypoglycaemia that requires treatment?

A

Less than 4 mmol/litre

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2
Q

Which two diabetes drugs most commonly cause hypoglycaemia?

A

Insulin

Sulfonylureas

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3
Q

What must be excluded in any patient with diabetes who presents acutely unwell, drowsy, unconscious, unable to co-operate or with aggressive behaviour or seizures?

A

Hypoglycaemia

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4
Q

What are the three options to treat hypoglycaemia in a diabetic?

A
  1. Oral fast-acting carbohydrate (glucose is preferred)

OR if hypoglycaemia unresponsive OR oral route cannot be used

  1. Glucagon IM injection (1 mg/mL)

OR if hypoglycaemia prolonged OR unresponsive to glucagon after 10 minutes

  1. Glucose 10% IV infusion (adults + children)
    - Child: 5 mL/kg (glucose 500mg/kg)
    - Adult: 150-200 mL infused over 15 minutes

OR Glucose 20% infusion (adults)
- Adult: 75-100 mL infused over 15 minutes

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5
Q

What is the first-line treatment for adults with symptoms of hypoglycaemia who have a blood-glucose concentration greater than 4 mmol/L?

A

A small carbohydrate snack (e.g. slice of bread)

OR

A normal meal (if due)

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6
Q

What should be used to treat a patient with a blood-glucose concentration less than 4 mol/L, who is conscious and able to swallow?

A

Fast-acting carbohydrate by mouth

  • Glucose liquid (Lift, Glucojuice)
  • Glucose tablets
  • Glucose 40% gels (Glucogel, Dextrogel, Rapilose)
  • Pure fruit juice
  • Sugar (sucrose) dissolved in an appropriate volume of water
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7
Q

Why should you treat patients with hypoglycaemia (blood-glucose concentration < 4 mmol/L) with chocolate and biscuits?

A

Lower sugar content and high fat content may delay stomach emptying

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8
Q

How many times can you repeat giving hypoglycaemia (blood glucose < 4 mmol/L) patient who can swallow fast-acting carbohydrates by mouth?

A

3 treatments in total

10-15 minutes apart

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9
Q

A patient with hypoglycaemia (blood glucose < 4 mmol/L) has been given fast-acting carbohydrate by mouth but the blood-glucose concentration remains less than 4 mmol/L. What do you do next?

A

Repeat treatment (fast-acting carbohydrate by mouth) after 10-15 minutes

Up to a maximum of 3 treatments in total

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10
Q

When treating hypoglycaemia (blood-glucose < 4mmol/L) with fast-acting carbohydrate by mouth, how many minutes do you wait before repeating the dose (if blood glucose remains < 4 mmol/L)?

A

10-15 minutes

Up to a maximum of 3 treatments in total

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11
Q

Once a patient who have hypoglycaemia (blood-glucose < 4 mmol/L) has recovered and their blood-glucose concentration is above 4 mmol/L, what is the next step?

A

Provide a snack with a long-acting carbohydrate to prevent blood glucose from falling again

  • Two biscuits
  • One slice of bread
  • 200-300 mL of milk (NOT alternative forms of milk)

Insulin should NOT be omitted if due, but the dose regimen may need review

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12
Q

A patient with diabetes recently had an episode of hypoglycaemia, should they omit an insulin dose that is due?

A

NO

Insulin should NOT be omitted if due, but the dose regimen may need review

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13
Q

If a patient with hypoglycaemia (blood glucose < 4 mmol/L) does not respond to fast-acting carbohydrate by mouth (3 treatment cycles), what is the next step?

A

IM glucagon

OR

Glucose 10% IV infusion

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14
Q

In alcoholic patients with hypoglycaemia, what should be given with IV glucose?

A

Thiamine supplementation

To minimise the risk of Wernicke’s encephalopathy

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15
Q

In alcoholic patients with hypoglycaemia, which do you give first, glucose or thiamine?

A

Thiamine

The concern is that an excessive carbohydrate load will lead to the build up of toxic metabolites when the activity of these enzymes is reduced because of thiamine deficiency

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16
Q

(?) is a polypeptide hormone produced by the alpha cells of the islet of Langerhans, which increases blood-glucose concentration by mobilising glycogen stored in the liver.

A

Glucagon

17
Q

Glucagon is a polypeptide hormone produced by the (?) cells of the islet of Langerhans, which increases blood-glucose concentration by mobilising glycogen stored in the liver.

A

alpha

18
Q

Glucagon is a polypeptide hormone produced by the alpha cells of the islet of (?), which increases blood-glucose concentration by mobilising glycogen stored in the liver.

A

Langerhans

19
Q

Glucagon is a polypeptide hormone produced by the alpha cells of the islet of Langerhans, which increases blood-glucose concentration by mobilising (?) stored in the liver.

A

glycogen

20
Q

Glucagon is a polypeptide hormone produced by the alpha cells of the islet of Langerhans, which increases blood-glucose concentration by mobilising glycogen stored in the (?).

A

liver

21
Q

Which patients can you NOT treat hypoglycaemia with glucagon? (5)

A
  1. Fasted for a prolonged period
  2. Adrenal insufficiency
  3. Chronic hypoglycaemia
  4. Alcohol-induced hypoglycaemia
  5. Taking a sulfonylurea (glucagon may be less effective)

1-4: glucagon is ineffective in patients whose liver glycogen is depleted

22
Q

If a patient has a decreased level of consciousness caused by hypoglycaemia, what should be used for treatment by a family member or friend?

A

IM glucagon

23
Q

If a patient receiving IV insulin becomes hypoglycaemia and unconscious, what should you do?

A
  1. STOP IV insulin
  2. IM glucagon

(If no response after 10 minutes)
3. Glucose 10% IV or 20% IV

24
Q

Why do we not use glucose 50% IV infusion to treat hypoglycaemia?

A

Hypertonic - increases the risk of extravasation injury
AND
Viscous - difficult to administer

25
Q

What are three examples of long-acting carbohydrate that should be given as soon as possible once the hypoglycaemic patient has recovered and their blood-glucose concentration is above 4 mmol/L (if they did not receive glucagon)?

A
  1. Two biscuits
  2. One slice of bread
  3. 200-300 mL of milk (NOT alternative milk)
26
Q

Why do hypoglycaemic patients treated with glucagon require a larger portion of long-acting carbohydrate once they have recovered and their blood glucose is more than 4 mmol/L?

A

To replenish glycogen stores

e.g. four biscuits, two slices of bread, 400-600 mL of milk (NOT alternative milk)

27
Q

What are three examples of long-acting carbohydrate that should be given as soon as possible once the hypoglycaemic patient, who was treated with glucagon, has recovered and their blood-glucose concentration is above 4 mmol/L?

A
  1. Four biscuits
  2. Two slices of bread
  3. 400-600 mL of milk (NOT alternative milk)
28
Q

What should be given to patients who have recovered from hypoglycaemia and now have a blood-glucose concentration above 4 mmol/L AND are nil by mouth?

A

Glucose 10% IV infusion

29
Q

If you stopped an IV infusion of insulin because the patient became hypoglycaemia, when should you re-start the IV insulin?

A

Blood glucose concentration is above 3.5 mmol/L
(concurrent glucose 10% IV infusion should be considered)

Once you stop the IV insulin you should be checking the blood-glucose concentration every 15 minutes

30
Q

How long may a hypoglycaemc episode persist for if it was caused by a sulfonylurea or long-acting insulin?

A

24-36 hours following the last dose

Especially if there is concurrent renal impairment

31
Q

How long should you continue to monitor the blood-glucose concentration of a patient following a hypoglycaemia episode?

A

24-48 hours

32
Q

Dose equivalence:

1 unit of glucagon =

A

1 mg of glucagon

33
Q

What is the contra-indication for the use of glucagon?

A

Phaeochromocytoma

34
Q

What is a common side effect of glucagon?

A

Nausea

Vomiting is uncommon

35
Q

IV infusion of glucagon should NOT be added to infusion fluids containing (?)

A

calcium

Precipitation may occur

36
Q

Prolonged administration of glucose solutions without electrolytes can lead to (?) and other electrolyte disturbances

A

hyponatraemia

Do NOT give alone except when there is no significant loss of electrolytes

37
Q

Why are IV injections containing more than 10% glucose not given to children?

A

Irritant

Injections containing more than 10% glucose can be irritant and should generally be given into a central venous line.

Roomies Collab Deck 2: Endocrinology and NeuroPsych (49 decks)

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