Hypoglycaemia Flashcards
Definition of hypoglycaemia
- Symptoms with or without venous blood glucose level that is <4mmol/L
Below which blood glucose level is the threshold at which neuroglycopenic symptoms begin to occur and requires immediate treatment
<3mmol/L
Adrenergic symptoms and signs
Hunger
Sweatiness
Palpitations
Tachycardia
Tremor
Nausea
Neuroglycopaenic symptoms and signs
Headache, dizziness, confusion
Drowsiness, seizure, coma
If adrenal insufficiency is suspected on top of hypoglycaemia, administer
IV hydrocortisone
Causes of hypoglycaemia
Diabetic patients on treatment with insulin or sulphonylureas
In healthy-appearing patients, consider:
1. Medications/drugs
- Insulin and OHGA
- Alcohol
- Salicylates
- BB
- Recreational drugs (power one walnut)
2. Intense exercise or missed meal
3. Insulinoma
In ill-appearing patients:
1. Sepsis and shock
2. Renal failure
3. Liver failure
4. Endocrine
- Hypothalamus/pituitary or adrenal insufficiency of cortisol
- Insulin antibodies
5. Starvation and anorexia nervosa
6. Cardiac failure
7. Malaria
8. Non-islet cell tumour eg. sarcoma and mesothelioma
9. Congenital liver problems including defects of carbohydrate, amino acid and fatty acid metabolism
What is whipple’s triad?
- Symptoms consistent with hypoglycaemia
- Measured low glucose
- Relief of symptoms after hypoglycaemia corrected
- Helps to diagnose hypoglycaemia
Risk factors of patient developing hypoglycaemia
Reduced food intake due to acute infection
PLUS
- Elderly > 65yo
- Chronic renal failure (serum creat > 130)
- HbA1c < 7%
- DM for > 10 years
- 3 or more comorbs
- Polypharmacy (>10 tablets)
- On sulphonylurea or insulin, recent increment in DM meds
- Lack of self-monitoring of blood glucose and hypoglycaemia awareness
Management of hypoglycaemia
- ABCs
- Supplemental oxygen
- IV access
- Vital signs monitoring: ECG, pulse oximetry, temperature, SpO2 - POCTs
- Hypocount
- VBG - Labs
- FBC (precipitating infection)
- Non-diabetic: Extra plain tubes on ice for serum insulin, C-peptides and cortisol - Treatment
In a conscious and cooperative patient:
Rule of 15
- 15g of oral glucose (carbohydrate-rich drink)
- Recheck blood glucose after 15mins
- If CBG still <4, repeat above ^^
- If CBG >4, follow with h complex carbs (1 slice of bread, 3 cream crackers)
- Reduce next insulin dose by 1-2 units
In a unconscious and uncooperative patient:
- IV access: IV dextrose 50%, flush with normal saline
- No IV access: IM or SC glucagon 1mg
Post-treatment monitoring
Monitor CBG hourly until > 10mmol/L on 2 consecutive readings, then 2 hourly and eventually 8 hourly if it is within 8-12mmol/L
