Hypoglycaemia

Question 1

Definition

Answer 1

Plasma glucose < 3 mmol/L

Question 2

Risk factors

Answer 2

Middle age
Female
Insulinoma
Alcohol
Adrenal insufficiency
Liver failure

Question 3

Aetiology

Answer 3

Diabetic drugs - SULFONYLUREAS or INSULIN (sulfonylureas stimulate insulin production and secretion)
Ex - EXOGENOUS STEROIDS
P - PITUITARY INSUFFICIENCY
L - LIVER FAILURE
A - ADDISONS
I - INSULINOMA
N - NON-PANCREATIC NEOPLASM e.g. fibrosarcomas

Question 4

Pathophysiology

Answer 4

Not enough glucose to the brain (neuroglycopenia)
Normally insulin would switch off and glucagon and adrenaline would be triggered with glucose levels below 3.6
Growth hormone and cortisol secretion triggered by glucose levels below 3.3

Question 5

Signs and Symptoms

Answer 5

Autonomic
- Sweating
- Anxiety
- Hunger
- Tremor
- Palpitations
- Dizziness
- Irritability
- Pallor
Neuroglycopenic
- Confusion
- Drowsiness
- Visual trouble
- Seizures
- Coma
- Reduced GCS
- Death

Question 6

Diagnosis

Answer 6

Fingerpick blood sample during attack
- if insulin is high
= insulinoma
= sulfonylurea
= insulin administration
NO C PEPTIDE PRESENT as only present with endogenous insulin
- if insulin is low
= non-pancreatic neoplasm
= anti-insulin receptor antibodies
- if insulin low + excess ketones
= alcohol
= addisons
= pit. insufficiency

Question 7

Treatment

Answer 7

Oral sugar + long lasting starch - 15g
Check after 15 mins - if not above 4 give another
- if cannot swallow = 50% GLUCOSE IV or IM GLUCAGON

Question 8

Criteria

Answer 8

Whipples Triad = true hypoglycaemia when:
- Symptoms
- Low serum glucose
- Symptoms resolve when administered glucose