Hypoglycaemia (2)

Question 1

What is it defined by?

How does it present?

What is Whipple’s Triad?

Answer 1

➊ Glucose < 4

➋ • Shaking
• Sweating
• Headache
• Difficulty concentrating
• Slurred speech
• Confusion
• Loss of consciousness

➌ Signs suggesting hypoglycaemia:
• Symptomatic - Sweating, Shaking, Light-headedness, LOC
• Low glucose level
• Symptoms relieved by giving glucose

Question 2

What are its 3 main causes?
→ What can each be due to?

Answer 2

Hyperinsulinaemia
→ * Endogenous - Insulinoma
* Exogenous - Iatrogenic (Insulin, Sulphonylureas, Sitagliptin), Deliberate

No Hyperinsulinaemia
→ * Endocrine deficiency affecting gluconeogenesis
* Starvation
* IGF2-secreting tumours (rare)

Reactive
→ * Alcohol, Methanol
* Galactosaemia, Hereditary fructose intolerance

Question 3

Investigations:
What are the investigations to do?

How is exogenous differentiated from endogenous insulin production?

Answer 3

➊ * Insulin, C-peptide - distinguishes between exogenous and endogenous insulin production
* Cheking med hx for iatrogenic causes
* Abdominal CT/MRI/PET to localise an insulinoma

➋ * Exogenous - High Insulin, Low C-peptide
* Endogenous - High Insulin, High C-peptide

N.B. C-peptide is a by-product of insulin production.

Question 4

Management:
What should be done if the pt is conscious?

What should be done if the pt is unconscious/seizing?

Answer 4

➊ • A-E
• Give 15-20g of oral supplements such as glucose tablets, can of Coca-Cola, sweets or fruit juice

➋ • A-E
• 200ml 10% Dextrose IV or 1mg Glucagon IM (if no IV access)