Hypoglycaemia Flashcards

1
Q

when do non- diabetics start developing symptoms

A

HGT< 3.6 mmol/L

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2
Q

when should diabetics be concerned

A

when their self- monitored HGT< 3.9 mmol/L

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3
Q

what is whipple’s triad used to define

A

hypoglycemia in non- diabetics

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4
Q

whipple’s triad

A
  • symptoms and/or signs of hypoglycemia
    -low serum glucose
    -resolution of symptoms/ signs after administration of glucose
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5
Q

what is diabetics hypoglycemia

A

Abnormally low plasma glucose ,with/without symptoms, that will expose the
individual to harm

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6
Q

causes of hypoglycemia in diabetics

A

*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)

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7
Q

causes of hypoglycemia in non- diabetics

A

*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)

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8
Q

history taking in diabetic

A

current treatment regime?
any treatments changed?
extra meds administered?
missed meals?
exercise regime change?
recent illnesses (eg. CVA,Renal dysfunction) ?

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9
Q

history taking in a non- diabetic

A

recent overdose of medication?
alcohol intake?
recent illnesses?

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10
Q

symptoms of hypoglycemia

A

hunger
sweating
pounding heart
shaking
blurred vision
difficulty concentrating
anxiety
slurred speech
racing thoughts
tingling in the mouth
confusion
unreasonable hunger

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11
Q

effects of hypoglycemia

A

*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

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12
Q

examination

A

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

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13
Q

neuroglycopaenia

A

glucose < 2.6 mmol/L

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14
Q

Signs of neuroglycopaenia (4 C’s)

A

Signs of neuroglycopaenia (4 C’s)

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15
Q

investigations

A
  1. Finger prick glucose and confirmed by lab glucose
  2. Creatinine (U&E)
  3. Further investigations are dictated by the suspected cause of hypoglycaemia.
  4. 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)
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16
Q

management

A

-Based on severity
-Expect a rapid response to glucose within 10 minutes
-Repeat the finger prick glucose after 10 minutes
-Patient may develop permanent neurological complications if hypoglycaemic
> 4hours

17
Q

immediate action options

A
  1. non drug treatment
  2. drug treatment
  3. hypoglycaemia not related to drugs or no cause found
  4. hypoglycemia related to drugs, overdose, alcoholics
18
Q

non drug treatment

A

Stabilise ABCs,do blood gluse,O2 if hypoxic,IV access

19
Q

drug treatment

A

*Thiamine 1-2 mg/kg IV first alcoholic/ malnourished, to avoid Wernicke’s
^^Awake patient → 50g Dextrose or sugar water PO
^^If unconscious → 50ml 50% Dextrose IV
^^If no IV access → Glucagon 1mg IM then 50g Dextrose PO when awake

20
Q

hypoglycaemia not related to drugs or no cause found:

A

Start 5% Dextrose infusion 50-100ml/hr and do glucose 2hrly.
Refer to physician for work-up

21
Q

hypoglycaemia related to drugs, overdose, alcoholics:

A

-Patient must eat
-Perform glucose 2hourly
-↑ concentration of IV fluids if glucose drops again
-Look for co-existing causes
-Adjust diabetic meds if indicated
-Refer if recurrent hypoglycaemia or a 2° cause found

22
Q

referral criteria

A
  • Diabetics with a clear,reversible cause for hypoglycaemia can be managed
    at your facility.
  • All other hypoglycaemic patients need to be referred to a physician.
23
Q

discharge criteria

A
  • Asymptomatic and off all infusions for at least 6hours,depending on cause.
  • Cause identified and corrected
  • Appropriate follow-up arranged