Hypoglycaemia

Question 1

What is hypoglycaemia considered to be in diabetics?

Answer 1

<4.0 mmol/L

Question 2

What is considered to be hypoglycaemia in non diabetics?

Answer 2

<2.2 mmol/L

Question 3

What is hyperinsulinaemic hypoglycaemia?

Answer 3

Insulin overdose

Can be due to sulfonylurea excess or insulinoma

Question 4

What can cause hyperinsulinaemic hypoglycaemia?

Answer 4

Sulfonylurea excess

Insulinoma

Question 5

What is hypoinsulinaemic hypoglycaemia?

Answer 5

Can present with or without ketones

Question 6

What can cause hypoinsulinaemic hypoglycaemia with ketones?

Answer 6

Alcohol binge with no food

Pituitary insufficiency

Addison’s

Liver failure

Question 7

What can cause hypoinsulinaemic hypoglycaemia without ketones?

Answer 7

Non pancreatic neoplasms
- Fibrosarcomata
- Fibromata

Question 8

How will a non-islet tumour present?

Answer 8

Hypoglycaemia:

Low glucose, low insulin, Low FFA, Low ketones

These tumours secrete ‘big IGF-2’ mimics insulin by binding IGF-1

Question 9

What do non-islet tumours secrete?

Answer 9

Big IGF-2 (mimics isulin)

Question 10

If someone has hypoglycaemia with high insulin and low C peptide?

Answer 10

Exogenous insulin is too high - patient isnt taking the right amnt of insulin

Question 11

How to manage hypoglycaemia in scenario:

patient can swallow?

Answer 11

Gluctotabs - short acting

2nd line: sandwich

If both arent working consider the ‘not swallowing management’

Question 12

How to manage hypoglycaemia in scenario:

patient cannot swallow?

Answer 12

IV access possible: Glucose 10% 100ml IV over 10 mins

No IV access: IM glucagon