Hypoglycaemia

Question 1

What is hypoglycaemia?

Answer 1

Plasma glucose <3mmol/L

Question 2

What is the physiological response to hypoglcyaemia?

Answer 2

Alpha cells detect low glucose levels and secrete glucagon
Glucagon acts on the liver to stimulate glycogen breakdown and gluconeogenesis to increase glucose levels
Adrenal glands release adrenaline which further stimulate increase in blood glucose levels
This response can take time

Question 3

What are the symptoms of hypoglycaemia?

Answer 3

Autonomic (due to high adrenaline)

• anxiety
• tremor
• pallor
• sweating
• tachycardia
• palpitations
• hunger

Neuroglycopenic

• confusion
• drowsiness
• slurred speech
• lack of coordination
• seizures
• coma

Question 4

What is the management of hypoglycaemia in a conscious patient?

Answer 4

10-20g oral glucose

• can be a drink/food/gel
• wait 15mins and re check blood sugar levels
• if still low then repeat again
• once symptoms resolving then give a long acting carbohydrate e.g. sandwich

Question 5

What is the management of hypoglycaemia in an unconscious patient?

Answer 5

Can have thick glucose gels which can dissolve in the mouth

IM glucagon 1mg (500mcg if <8)

In hospital IV 20% dextrose 50-100ml up to 20mins

Then once resolving give long acting carbohydrate e.g. sandwich

Question 6

What are the causes of hypoglycaemia?

Answer 6

Tumours e.g. insulinoma
Liver failure
Kidney failure
Hypothyroidism
Addisons disease
Alcohol excess
Overuse of insulin or sulphonylureas
Skipping meals or excess exercise