Hypoglycaemia

Question 1

Definition?

Answer 1

Glucose <3mmol/L

Question 2

Causes?

Answer 2

insulinoma - increased ratio of proinsulin to insulin
self-administration of insulin/sulphonylureas
liver failure
Addison’s disease
alcohol

Question 3

Signs/Symptoms?

Answer 3

Autonomic: sweating, palpitations, shaking, hunger, anxiety, tachycardia.
Confusion
Drowsiness
General: malaise, headache, nausea

Question 4

Investigations?

Answer 4

Bloods: FBC, U&E’s, cortisol, c-peptide (low c-peptide exogenous insulin, high c-peptide endogenous insulin)

Question 5

Mx if conscious? (4)

Answer 5

15-20g quick acting carbohydrate e.g. 4-5 glucotabs or glucogel/hypostop gel, lucozae, fruit juice

Repeat blood glucose

if glucose <4mmol/L repeat glucotabs up to x3.

If no improvement after 3 times, consider IM glucagon or IV 10% glucose

Question 6

Mx if unconscious patient?

If no IV access?

Answer 6

ABCDE
IV access 75-100 ml 20% glucose or 150 - 200 ml 10% glucose

IM glucagon

Repeat blood glucose after 10-15 mins

Question 7

What should be given before glucose if chronic alcohol use?

Answer 7

Thiamine