Hypoglycaemia

Question 1

What are autonomic features of hypoglycaemia?

Answer 1

Sweating
Palpitations
Tremor
Hunger

Question 2

What are neurological features of hypoglycaemia?

Answer 2

Confusion
Drowsiness
Behavioural changes
Speech abnormalities
Incoordination

Question 3

What are other symptoms of hypoglycaemia?

Answer 3

1. Nausea
2. Headache

Question 4

What is hypoglycaemia?

Answer 4

Hypoglycaemia, or a “hypo”, is an abnormally low level of glucose in your blood (less than four millimoles per litre).

When your glucose (sugar) level is too low, your body doesn’t have enough energy to carry out its activities.

Hypoglycaemia is most commonly associated with diabetes, and mainly occurs if someone with diabetes takes too much insulin, misses a meal or exercises too hard.

Question 5

What are risk factors for hypoglycaemia?

Answer 5

nsulin-dependent diabetes
Previous history of hypoglycaemic episodes or reduced hypoglycaemia awareness
Impaired renal function
Cognitive dysfunction/dementia
Alcohol misuse
Profound starvation
Increased exercise
Food malabsorption issues (e.g. coeliac disease, bariatric surgery, gastroenteritis)

Question 6

What is the numerical classification of hypoglycaemia?

Answer 6

Hypoglycaemia is defined as a plasma glucose of less than 3.0 mmol/l. In hospitalised patients, a blood glucose ≤4.0 mmol/L should be treated if the patient is symptomatic

Question 7

Observations of a patient with acute hypoglycaemia?

Answer 7

A normal respiratory rate is between 12-20 breaths per minute.
Patients with severe hypoglycaemia may develop a slow, irregular pattern of breathing.

A normal SpO2 range is 94-98% in healthy individuals and 88-92% in patients with COPD who are at high-risk of CO2 retention.
Hypoxaemia may occur due to aspiration or bradypnoea in the context of severe hypoglycaemia.

Question 8

What are the treatment options for acute hypoglycaemia if the patient is conscious?

Answer 8

Administer glucose gel by mouth (e.g. GlucoGel®).
Repeat capillary blood glucose after 10-15 minutes and if the patient is still hypoglycaemic, repeat administration of glucose gel a further 2-3 times.
When the patient is fully alert, provide a longer-acting carbohydrate for the patient to eat (e.g. toast).

Question 9

What is the treatment for an acute hypoglycaemic patient that is unconscious?

Answer 9

Administer intravenous glucose (e.g. 150-160 ml of 10% glucose).
If the patient then regains consciousness, switch to using oral glucose as above.
If intravenous access is not able to be established rapidly, administer glucagon 1mg via the intramuscular or subcutaneous route. Glucagon stimulates the conversion of stored glycogen within the liver into glucose. As a result, glucagon is ineffective in patients with depleted glycogen stores (e.g. elderly patients with poor oral intake and patients with eating disorders).

Question 10

How is moderate hypoglycaemia treated?

Answer 10

ingestion of rapid glucose like Lucozade and slower-acting carbohydrates like biscuits

Question 11

How is severe hypoglycaemia treated?

Answer 11

1) IV dextrose (10%)
2) IM glucagon

Question 12

What is a common cause of severe hypoglycaemia in type 1 diabetics?

Answer 12

insulin overdose