Hypoglycaemia Flashcards
What are the causes of hypoglyacmiea?
Common – Diabetics who have taken too much insulin, patients taking sulfonylureas
Others – Alcohol, Renal/Hepatic Failure, insulinoma, insulin like growth factor producing tumours, long term starvation e.g. Anorexia
What will you find on a history of hypoglycemia?
Symptoms:
Initially - Palpitation, sweating, tremors, hunger, anxiety, poor concentration
Later - Headache, Double Vision, Confusion, Coma, Seizures, Slurred speech
Whipple’s triad = Symptoms + Low Glucose + Symptoms resolve after glucose
Risk Factors:
Diabetics taking insulin or sulfonylureas
Specific Questions to ask:
Any new medication changes or not taken any medications
Any meals missed if on insulin etc, any vomiting or any alcohol use with insulin
Liver/Renal Failure
Alcoholism
What will you find on examination of a patient with hypoglycemia?
Many signs generic and of little diagnostic value, but may find any of the below
End of the bed:
Confusion
Loss of co-ordination
Hands:
Tachycardia
Arrhythmia
Blood pressure abnormality
Head:
Blurred vision - Glucose variations
Chest:
Dyspnea
Tachypnea
Acute pulmonary oedema
What investigations will you order in hypoglycemia?
Investigations: Not usually required if there is an obvious cause like insulin or sulfonylurea use
Bedside:
Glucose – Diagnostic
Bloods:
Serum Glucose - Low
HBa1c – Shows glucose levels over the last 3 months, see if they are normally running low or if there is a pattern
FBC - Looking for an underlying infection
LFT - Rule out liver failure as cause
U&E - Rule out renal failure as cause
TFT’s – Thyroid problems can precipitate hypoglycaemia
Serum Pro-insulin or C-peptide - Raised in endogenous insulin production
Serum Sulfonylureas – Only if taking Sulfonylureas
Imaging:
MRI Pancreas - If insulinoma suspected
Special Tests:
72 hour fast - Used if insulinoma suspected (Normally insulin levels should drop in fasting, if they do not there is an extra source)
What is the treatment of hypoglycemia?
What is the treatment:
Resuscitation:
A-E approach
Get IV Access/Give O2 to maintain sats of 94+ /Attach 12 lead ECG
Assessment with AMPLE history and brief examination
Get help - Medical reg on call
Frequent Observations - Constant or 15 minutely
Medical:
10-20g glucose orally (200ml Juice/Lucozade or glucose gel)
Repeat blood glucose every 15 mins and if still low repeat oral glucose up to 3 times
If not responding to the above, give 10% dextrose at 200ml/hr
If unconscious start with IV dextrose at 10% 200ml/15mins or Glucagon 1mg IV or IM.
Once glucose >4 give a complex carbohydrate e.g. toast for longer term cover
Lifestyle:
2 major hypos may cause loss of license, need to inform the DVLA
Work out the cause of the hypo and try to adjust drugs/avoid precipitants
Make sure the patient carry’s a snack with them
What is Hypoglycaemia ?
Hypoglycaemia is symptomatic when blood glucose <2.2mmol/L, although patients with diabetes, who often have higher levels of blood glucose, may notice symptoms earlier
