Hypoglycaemia Flashcards
What is hypoglycaemia?
Hypoglycaemia occurs when blood glucose concentration falls below the normal fasting glucose level (<3.3mmol/L).
What is the normal fasting glucose range?
4.0-5.8mmol/L
What are the common causes of hypoglycaemia in diabetes?
- Excess insulin
- Sulfonylureas (e.g. gliclazide)
- Viral illness
- Alcohol
- Too much exercise
What are non-diabetic causes of hypoglycaemia?
- Drugs (e.g. indomethacin, quinine, sulfonamide, IGF-1, lithium)
- Alcohol consumption
What are the autonomic symptoms of hypoglycaemia?
- Sweating
- Palpitations
- Tremor
- Hunger
What are the neurological symptoms of hypoglycaemia?
- Confusion
- Drowsiness
- Dizziness
- Weakness
- Incoordination
- Behavioural changes
- Speech abnormalities
- Seizures
What are the non-specific symptoms of hypoglycaemia?
- Fatigue
- Nausea
- Headache
What is Whipple’s triad for diagnosing hypoglycaemia?
- Symptoms/signs of hypoglycaemia
- Low blood glucose
- Resolution of symptoms with correction of glucose
What is the first step in managing a conscious patient with hypoglycaemia?
Glucose gel by mouth (e.g. GlucoGel)
What should be done if a conscious patient with hypoglycaemia shows no change after the first glucose gel?
Repeat BM after 10-15 mins, if no change, repeat glucose gel further 2-3 times.
What should be provided to a fully alert patient after hypoglycaemia treatment?
Longer-acting carbohydrate (e.g. toast)
What is the initial treatment for an unconscious patient with hypoglycaemia?
- Glucagon 1mg
- IV glucose (150ml 10% glucose)
What is neonatal hypoglycaemia?
Neonatal hypoglycaemia is defined as <2.6mmol/L glucose in newborns.
It can be normal in term babies as transient hypoglycaemia.
What is transient hypoglycaemia?
Transient hypoglycaemia occurs in the first 24 hours with no consequence, as newborns can utilize alternative fuels like ketones and lactate.
List the risk factors for neonatal hypoglycaemia.
- Preterm birth (<37 weeks)
- Maternal/gestational diabetes
- Intrauterine growth restriction
- Hypothermia
- Neonatal sepsis
What are the possible clinical features of neonatal hypoglycaemia?
- Asymptomatic
- Autonomic symptoms:
- ‘jitteriness’
- Irritable
- Tachypnoea
- Pallor
- Neurological symptoms:
- Poor feeding/sucking
- Weak cry
- Drowsy
- Hypotonia
- Seizures
- Other:
- Apnoea
- Hypothermia
What should be done for asymptomatic neonatal hypoglycaemia?
- Encourage normal feeding
- Monitor blood glucose
What is the management for symptomatic neonatal hypoglycaemia?
- Admit to neonatal unit
- IV infusion of 10% dextrose
