Hypoglycaemia

Question 1

Definition of hypoglycaemia

Answer 1

• Symptoms with or without venous blood glucose level that is <4mmol/L

Question 2

Below which blood glucose level is the threshold at which neuroglycopenic symptoms begin to occur and requires immediate treatment

Answer 2

<3mmol/L

Question 3

Adrenergic symptoms and signs

Answer 3

Hunger
Sweatiness
Palpitations
Tachycardia
Tremor
Nausea

Question 4

Neuroglycopaenic symptoms and signs

Answer 4

Headache, dizziness, confusion
Drowsiness, seizure, coma

Question 5

If adrenal insufficiency is suspected on top of hypoglycaemia, administer

Answer 5

IV hydrocortisone

Question 6

Causes of hypoglycaemia

Answer 6

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

Question 7

What is whipple’s triad?

Answer 7

1. Symptoms consistent with hypoglycaemia
2. Measured low glucose
3. Relief of symptoms after hypoglycaemia corrected

• Helps to diagnose hypoglycaemia

Question 8

Risk factors of patient developing hypoglycaemia

Answer 8

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