Hypoglycaemia Flashcards
At which HGT levels do diabetics and non-diabetics become symptomatic of hypoglycaemia?
Diabetics: <3.9mmol/L
Non-diabetics: <3.6mmol/L
How is hypoglycaemia in non-diabetics defined?
According to Whipple’s Triad.
i.e. +signs and symptoms with low serum glucose and the signs and symptoms resolve after glucose administration.
How is hypoglycaemia in diabetics defined?
An abnormally low plasma glucose, with or without symptoms, that may expose the individual to harm.
List causes of hypoglycaemia in known diabetics
- Hypoglycaemic agents (Sulphonylureas or insulin)
- Missed meals or overnight fasting
- Exercise (causes increased glucose use)
- Alcohol ingestion (causes decreased endogenous glucose production
- Increased insulin sensitivity (occurs with exercise and weight loss)
- Decreased insulin clearance (occurs in renal failure)
List causes of hypoglycaemia in non-diabetics
- Drugs (Hypoglycaemica, quinine, overdosing on Beta-blockers, valproate or salicylate)
- Alcohol abuse with malnourishment
- Acute liver failure
- Addison’s disease or Adrenal crisis
- Myxoedema
- Severe sepsis or Malaria (Infection)
- Starvation and malnutrition
- Pseudohypoglycaemia (if there’s delayed measurement of a sample in someone with leukocytosis, thrombcytosis or erythrocytosis)
Important aspects of history in known diabetic presenting with hypoglycaemia
- Current treatment regime
- Any change in treatments
- Are they taking any extra medication
- Have they missed any meals
- Any changes in exercise regime
- Any recent illness
Important aspects of history in non-diabetic presenting with hypoglycaemia
- Any recent overdose in medication
- Excessive alcohol intake
- Any recent illness
List the common symptoms of hypoglycaemia
- Hunger
- Heart palpitations
- Blurred vision
- Sweating
- Shaking
- Loss of concentration
List the symptoms of hypoglycaemia found in diabetics
- Anxiety
- Slurred speech
- Tingling mouth
- Confusion
- Unreasonable anger
List the signs of neuroglycopaenia (occurs in people with glucose <2.6mmol/L)
- Confusion
- Convulsions
- CVA-like symptoms (Focal deficits or Slurred speech)
- Coma
List investigations necessary in hypoglycaemia
- Finger prick glucose, confirmed with lab glucose
- Creatinine (U&E)
- Investigations to rule in or rule out a suspected cause
- Insulin and C-peptide levels to be taken before treatment
How are insulin and C-peptide levels interpreted?
- Low C-peptide with high insulin indicates exogenous insulin use
- High C-peptide with high insulin indicated endogenous insulin production
Describe the general management of a hypoglycaemic episode
- Non-drug:
- Stabilise ABCs
- Give O2 if hypoxic
- Obtain IV access
- Drugs:
- Give 1-2mg/kg of Thiamine as initial treatment in alcoholics or malnourished individuals (Prevent Wernicke’s)
- If patient is awake, give 50g Dextrose or sugar water orally
- If patient is unconscious, give 50ml 50% Dextrose via IV
- If there is no IV access, give 1mg Glucagon, injected intramuscularly, followed by 50g Dextrose orally when they wake up
Describe the management of hypoglycaemic episodes with unknown causes
- Start 5% Dextrose infusion at 50-100ml/hr and obtain 2hrly glucose values
- Refer to physician for work-up
Describe the management of hypoglycaemic episodes due to drugs, overdose or alcohol abuse
- Patient must eat
- Obtain 2hrly glucose values
- If glucose drops, increase concentration of IV fluids
- Look for co-existing causes
- Adjust diabetic meds if indicated
- Refer if hypoglycaemia is recurrent or a secondary cause is found
