Hypoglycaemia Flashcards
when do non- diabetics start developing symptoms
HGT< 3.6 mmol/L
when should diabetics be concerned
when their self- monitored HGT< 3.9 mmol/L
what is whipple’s triad used to define
hypoglycemia in non- diabetics
whipple’s triad
- symptoms and/or signs of hypoglycemia
-low serum glucose
-resolution of symptoms/ signs after administration of glucose
what is diabetics hypoglycemia
Abnormally low plasma glucose ,with/without symptoms, that will expose the
individual to harm
causes of hypoglycemia in diabetics
*hypoglycaemic agents (sulphonylureas,insulin)
*missed meals or overnight fasting
*↑ glucose utilisation (exercise)
*↓ endogenous glucose production (alcohol ingestion)
*↑ insulin sensitivity (weight loss, ↑ exercise)
*↓ insulin clearance (renal failure)
causes of hypoglycemia in non- diabetics
*Drugs (insulin,oral hypoglycaemics, quinine, chloroquine, β-blocker/Valproate/Salicylate Overdose)
*Alcohol abuse in combination with malnourishment
*Pituitary insufficiency
*Acute liver failure
*Addison’s disease,Adrenal crisis
*Myxoedema
*Tumors (Insulinoma , retroperitoneal sarcoma)
*Starvation and malnutrition
*Infection (Severe sepsis, Malaria)
*Anxiety disorders
*Cardiogenic shock
*Pseudohypoglycaemia (delayed measurement of a sample in the presence of leukocytosis,
thrombocyosis or erythrocytosis)
history taking in diabetic
current treatment regime?
any treatments changed?
extra meds administered?
missed meals?
exercise regime change?
recent illnesses (eg. CVA,Renal dysfunction) ?
history taking in a non- diabetic
recent overdose of medication?
alcohol intake?
recent illnesses?
symptoms of hypoglycemia
hunger
sweating
pounding heart
shaking
blurred vision
difficulty concentrating
anxiety
slurred speech
racing thoughts
tingling in the mouth
confusion
unreasonable hunger
effects of hypoglycemia
*inflammation
- increased IL6
-increase VEGF
-increase CRP
*endothelial dysfunction
-decrease vasodilation
*sympathoadrenal response
-rhythm abnormalities
-hemodynamic changes
^^increase adrenaline- increase contractility
^^increase oxygen- increase workload
*blood coagulation abnormalities
-increase neutrophils activation
-increase platelet activation
-increase factor VII
examination
Signs of sympathetic overactivity
Look for precipitants: liver failure,renal impairment,sepsis
Well controlled diabetics have more frequent hypoglycaemic episodes and
can become desensitized to sympathetic symptoms
β-blockers can blunt the sympathetic symptoms
neuroglycopaenia
glucose < 2.6 mmol/L
Signs of neuroglycopaenia (4 C’s)
Signs of neuroglycopaenia (4 C’s)
investigations
- Finger prick glucose and confirmed by lab glucose
- Creatinine (U&E)
- Further investigations are dictated by the suspected cause of hypoglycaemia.
- Attempt to take blood samples prior to treatment in all non-diabetic patients
for insulin and C-peptide levels.- A low C-peptide and high insulin level indicate exogenous insulin
- A high C-peptide and insulin indicate endogenous insulin
(eg. surreptitious drug [sulphonylurea] ingestion or insulinoma)