Hypoglycaemia

Question 1

Causes of hypoglycaemia

Answer 1

Too much insulin
Lack of carbohydrates
Malabsorption, diarrhoea, vomitting
(imbalance between glucose supply, glucose utilisation, and existing insulin concentration.)

Question 2

Symptoms of hypoglycaemia

Answer 2

Hunger
Tremor
Sweating
Irritability
Dizziness
Pallor

Severe -> reduced consciousness, coma, death

Question 3

Severe hypoglycaemia treatment

Answer 3

IV dextrose and intramuscular glucagon

Question 4

What level of glucose = hypoglycaemia

Answer 4

<4mmol/l - symptom threshold is variable
Anyone <4 in hospital should be treated

Question 5

Levels of glucose with symptoms

Answer 5

at approximate levels of 3.7 mmol/L, increased glucagon, adrenaline, cortisol and growth hormone secretion occur
when levels of 3.1 mmol/L are reached, autonomic symptoms appear. Cognitive dysfunction occurs at levels of approximately 2.5 mmol/L
levels vary greatly between individuals and can be affected by the antecedent glucose control in any individual

Question 6

What is hypoglycaemia defined as for people with diabetes treated with insulin

Answer 6

<4

Question 7

What is mild hypo

Answer 7

autonomic mediated symptoms are present and the patient is able to self-treat

Question 8

Moderate hypoglycaemia

Answer 8

autonomic AND neuroglycopenic mediated symptoms occur and the patient is able to self-treat

Question 9

Severe hupo

Answer 9

the patient requires the assistance of another person, unconsciousness may occur and the plasma glucose is typically less than 2.8 mmol/L

Question 10

Autonomic symptoms of a hypo

Answer 10

Trembling
Palpitations
Sweating
Anxiety
Hiugner
Nausea
Tingling

Question 11

Neuroglycopenic symptoms of a hypo

Answer 11

Difficulty concentrating
Confusion
Weakness
Drowsiness
Vision cahnges
Difficulty speaking
Headache
Dizziness
Tiredness

Question 12

When does hypoglycaemic unawareness happen?

Answer 12

When threshold for autonomic symptoms becomes lower than neuroglycopenic symtpoms
First signs = confusion or LOC

Question 13

What is most common cause of hypoglycaemia

Answer 13

Insulin and sulfonylureas in treatment of diabetes

Question 14

First line treatment hypoglycaemia

Answer 14

If >4 mmol, small carb snack
<4, if conscious and can swallo, fast acting carb in mouth - glucogel, fruit juice

Question 15

What to avoid in first line hypoglycaemia treatmnet - CKD, acarbose

Answer 15

Orange juice should not be given to patients following a low-potassium diet due to chronic kidney disease, and sugar dissolved in water is not effective for patients taking acarbose which prevents the breakdown of sucrose to glucose. Chocolates and biscuits should be avoided if possible, as they have a lower sugar content and their high fat content may delay stomach emptying.

Question 16

What to do after initial treatment with fast acting glucose in hypo

Answer 16

Repeat every 15 mins up to 3 times
>4 mmol, give long acting carb snack eg two biscuits
If no response -> IM glucagon or dextrose 10% infusion (if not repsonded to glucagon after 10 mins)

Question 17

What should be given to alcoholic patients in a hypo

Answer 17

IV glucose + THIAMINE - minimise risk of wernickes encephalopathy

Question 18

Who should be gievn IV dextrose over IM glucagon in a hypo

Answer 18

who has fasted for a prolonged period or has adrenal insufficiency, chronic hypoglycaemia, or alcohol-induced hypoglycaemia. Glucagon may also be less effective in patients taking a sulfonylurea; in these cases, intravenous glucose will be required.

Question 19

Next steps after hypo if on insulin

Answer 19

Do not miss next insulin injection
Review insulin regime
Check blood glucose conc every 15 mins until over 3.5
Monitoring should continue for 24-48 hours

Question 20

When can hypoglycaemia persist

Answer 20

Hypoglycaemia caused by a sulfonylurea or long-acting insulin, may persist for up to 24–36 hours following the last dose, especially if there is concurrent renal impairment.