Hypoglycaemia Flashcards
what is hypoglycaemia?
blood glucose <3.0mmol/L
what are the clinical features of hypoglycaemia?
- shaking/trembling
- sweating
- palpitations
- hunger
- headache
- double vision
- difficulty concentrating
- slurred speech
- confusion
- coma
what are the causes of hypoglycaemia?
- drugs
- acute liver failure
- sepsis
- adrenal insufficiency
- insulinoma
- glycogen storage disease
what drugs can lead to hypoglycaemia?
- insulin
- sulphonylureas
- GLP-1 analogues
- DPP-4 inhibitors
- beta-blockers
- alcohol
what investigations should be done in a patient with hypoglycaemia?
- check medication for drug cause
- serum insulin, C-peptide and proinsulin
- 72 hour fast test
- 8am cortisol and/or synACTHen testing
- abdominal CT/MRI/PET
why is C-peptide and proinsuline checked?
to distinguish between exogenous and endogenous insulin
was test results are seen in endogenous production?
- high insulin
- high c-peptide and proinsulin
was test results are seen in exogenous production?
- high insulin
- low c-peptide and proinsulin
why is a 72 hour fast test done post hypoglycaemia?
to demonstrate episodic hypoglycaemia
why is an 8am cortisol and/or synACTHen test done post hypoglycaemia?
to check for adrenal insufficiency
what is imaging done in hypoglycaemia?
to localise an insulinoma
how is mild hypoglycaemia managed?
still conscious
- ABCDE
- 15-20g of fast acting carbohydrate (e.g. glucose tablet, coca-cola)
- AVOID chocolate
- eat some slower acting carbohydrate afterwards
how is severe hypoglycaemia managed?
e.g. seizures, unconscious
- ABCDE
- 200ml 10% dextrose IV
- no IV = 1mg/kg glucagon IM
- treat seizure if prolonged or repeated
why is chocolate not appropriate in mild hypoglycaemia?
high fat content which delays glucose uptake
