Hypoglycaemia

Question 1

Approximately what are the values of hypoglycaemia for diabetics and no diabetics

Answer 1

diabetics: <4
non-diabetics <2.2

Question 2

what is C-peptide

Answer 2

marker of endogenous insulin

Question 3

what is the appropriate response to hypoglycaemia?

Answer 3

low insulin, low C-peptide, high ketones

Question 4

low glucose but high C-peptide. what test should you do?

Answer 4

check urine sulphonylureas

Question 5

hyperinsulinaemic hypoglycaemia with high C-peptide?

Answer 5

-sulphonylurea excess eg. gliclazide (increases insulin release from islet cells)
-insulinoma

Question 6

mutation causing congenital hyperinsulinism?

Answer 6

glucokinase activating mutations

(senses how high blood glucose is to release insulin)

Question 7

hypoinsulinaemic hypoglycaemia with low C-peptide & high ketones?

Answer 7

-alcohol binge with no food
-pituitary insufficiency
-addisons
-liver disease
-fasting

Question 8

hypoinsulinaemic hypoglycaemia with low C-peptide & low ketones?

Answer 8

-non-pancreatic neoplasms (fibromata, fibrosacromata) - secrete big IGF2
-metabolic syndrome infants

Question 9

insulin overdose?

Answer 9

hyperinsulinaemic hypoglycaemia with low c-peptide

Question 10

quinine effect? (antimalarial)

Answer 10

hyperinsulinaemic hypoglycaemia
-stimulates insulin release

Question 11

what is bodys appropriate response to hypoglycaemia?

Answer 11

lower insulin
increase glucagon
SNS activation (thus SNS symptoms with neuroglycopaenia)
stress hormone release (GH, cortisol)
ketone production

Question 12

how to manage hypoglycaemia if alert and ok?

Answer 12

oral juice + sweets
+longer acting (toast)

Question 13

hypoglycaemia: safe swallow but drowsy?

Answer 13

buccal glucogel

Question 14

hypoglycaemia: unconscious?

Answer 14

IV access: IV glucose 20%
no access: IM glucagon