Hypoglycaemia

Question 1

what are the symptoms of hypoglycaemia?

Answer 1

• sweating
• palpitations
• tremor
• hunger
• confusion
• drowsiness
• incoordination
• nausea
• headache

Question 2

what are the risk factors for hypoglycaemia?

Answer 2

• insulin-dependent diabetes
• previous history of hypoglycaemic episodes or reduced hypoglycaemia awareness
• impaired renal function
• cognitive dysfunction/dementia
• alcohol misuse
• profound starvation
• increased exercise
• malabsorption (e.g. coeliac disease, bariatric surgery, gastroenteritis)

Question 3

what is the definition of hypoglycaemia, and when should it be treated in hospitalised patients?

Answer 3

• a plasma glucose of less than 3.0 mmol/l
• in hospitalised patients, a blood glucose ≤4.0 mmol/L should be treated if the patient is symptomatic

Question 4

what is the management of hypoglycaemia if the patient is conscious?

Answer 4

• ABCDE
• glucose gel by mouth (e.g. GlucoGel®)
• repeat capillary blood glucose after 10-15 minutes and if the patient is still hypoglycaemic, repeat administration of glucose gel a further 2-3 times
• when the patient is fully alert, provide a longer-acting carbohydrate for the patient to eat (e.g. toast)

Question 5

what is the management of hypoglycaemia if the patient is unconscious?

Answer 5

• ABCDE
• administer intravenous glucose (e.g. 150-160 ml of 10% glucose)
• if intravenous access is not able to be established rapidly, administer glucagon 1mg via the intramuscular or subcutaneous route