Hypoglycaemia

Question 1

what constitutes hypoglycaemia?

Answer 1

Non- DM- HGT<3.6 mmol/L
DM - HGT<3.9 mmol/L

non-DM:
Whipple’s Triad -S+S hypoglycaemia
- low serum glucose
- resolution of S+S after
administration of glucose

DM : abnormally low plasma glucose w/w/out symptoms = exposes individual to harm

Question 2

what are the causes of hypoglycaemia in DM?

Answer 2

• hypoglycaemic agents (sulphonylureas, insulin)
• missed meals / overnight fasting
• increased glucose utilisation (exericise )
• decreased endogenous glucose production (alcohol ingestion)
• increased insulin sensitivity ( LOW , inc exercise)
• decreased insulin clearance (renal fxn)

Question 3

what are the causes of hypoglycaemia in non-DM?

Answer 3

sgdgdg

Question 4

what are the symptoms of hypoglycaemia?

Answer 4

hunger
palpitations
blurred vision
difficulty concentrating
shaking
sweating

= sympathetic overactivity

well controlled DM = have more freq hypogly episodes = become desensitised to sympathetic symptoms
Beta blockers can blunt sympathetic symptoms

Question 5

what are the signs of neuroglycopaenia ?

Answer 5

glucose < 2.6 mmol/L
4Cs

• confusion
• convulsions
• CVA-like ( slurred spech/ focal deficits )
• coma

Question 6

What are the investigations that must be conducted?

Answer 6

• finger prick glucose test + confirmed lab glucose
• creatinine (U&E)
• non- DM= attempt take bloods before tx for insulin + c-peptide
• low c-peptide + high insulin= exogenous insulin
• high c-peptide + insulin = endogenous insulin

Question 7

how is hypoglycaemia managed?

Answer 7

based severity
rapid response to glucose w/in 10 minutes
repeat finger prick after 10 minutes
may dev permanent neuro complications of lasts > 4hrs

Drug tx
- Thiamine 1-2 mg/kg IV first if alcoholic/malnourished (avoid Wernicke’s)
- awake patient- 50g Dextrose / sugar H2O PO
- unconscious pt- 50ml 50% Dextrose IV
- no IV access- glucagon 1mg IM then 50 g Dextrose PO when awake

Hypoglycaemia not related to drugs / no cause
- 5% Dextrose infusion 50-100ml/hr
- glucose test 2hrly
- workup

Hypoglycaemia releated drugs, overdose, alcoholics
- pt eat
- glucose 2hrly
- inc concentration of IV fluids if glucose drops again