hypoglycaemia

Question 1

consequences of hypo

Answer 1

brain:
cognitive dysfunction
hemiparesis
seizures
coma
psychological (fear)

heart:
MI
arrhythmias

Question 2

what is it

Answer 2

blood glucose level <4.0mmol/L

Question 3

clinical features

Answer 3

shaking/trembling
sweating
palpitations
hunger
headache
double vision and difficulty concentrating
slurred speech
confusion
coma

Question 4

causes of hypo

Answer 4

1. drugs ie insulin, sulphonylureas
2. sepsis
3. acute liver failure
4. adrenal insufficiency
5. insulinoma
6. glycogen storage disease

Question 5

counterregulation of hypoglycaemia in women

Answer 5

there is a difference depending on what stage in their menstrual cycle

Question 6

investigations for hypo

Answer 6

1. check medications
2. serum insulin, C-peptide, pro-insulin
   (exogenous vs endogenous)

high insulin and high C-peptide and proinsulin = endogenous
high insulin and low C-peptide and proinsulin = exogenous

3. 72 hour fast test
4. cortisol 8am (adrenal sufficiency)
5. abdominal CT/MRI/PET (insulinoma)

Question 7

risk factors for severe hypo

Answer 7

impaired hypo awareness (silent)
counter-regulatory failure (C-peptide)
long duration of diabetes/insulin therapy
impaired renal function
autonomic neuropathy
>prior episode of severe hypo

kids
adolescence
elderly
Comorbs
use of CNS depressing agents
excessive alcohol consumption

Question 8

management for mild hypo

Answer 8

ABCDE
eat drink 15/20g fast acting carb ie glucose tablet , fruit juice
AVOID chocolate
eat a slower acting carb after

Question 9

how does exercise affect hypo

Answer 9

‘double hit of hypo’

Question 10

management for severe hypo

Answer 10

ABCDE
200ml 10% dextrose IV
1mg glucagon IM if no iV access
treat seizure if prolonged

Question 11

TF can addisons cause hypo

Answer 11

T