Hypoglycaemia Flashcards
What is the threshold for hypoglycaemia?
Plasma glucose < 2.8 mmol/L
Must be treated quickly to avoid risk of brain damage
=> Defined using the Whipple’s Triad:
- Symptoms of hypoglycaemia at time of low glucose
- Low plasma glucose
- Symptoms relieved by glucose
What are the risk factors of hypoglycaemia?
- Age
- Gender - female
- Insulinoma
- Exogenous insulin
- Excessive alcohol consumption
What is the main cause of hypoglycaemia in diabetics?
- Overdose on medication (insulin + sulfonylurea)
What are the causes of hypoglycaemia in non-diabetics?
Mneumonic EXPLAIN
EX - Exogenous drugs
P - Pituitary insufficiency
L - Liver failure (failure of hepatic gluconeogenesis)
A - Addinsons disease (impaired counter regulation of insulin)
I - Islet cell tumour
N - Non pancreatic neoplasm
What categories can the clinical features of hypoglycaemia fall into?
- Autonomic
- Neuroglycopenic
What are the autonomic symptoms?
- Sweating
- Anxiety
- Hunger
- Dizziness
- Palpitations
- Tremor
What are the neuroglycopenic symptoms?
- Personality change
- Drowsiness
- Confusion
- Coma
- Visual issues
- Seizures
What is the main investigations is suspected Hypoglycaemia?
- Insulin and C peptide measurement (C peptide only raised in causes of high endogenous insulin)
- Screening for sulphonylurea metabolites
What is the emergency management of Hypoglycaemia?
- What is the state of the patient?
=> Conscious + orientated and able to swallow:
- Give 15-20g of carbs snack, recheck glucose levels after 20 mns
=> Conscious + uncooperative
- Squirt glucose gel between gums ad teeth
=> If unconscious, start IV glucose and glucagon
Once glucose above 4 mmol/L and patient as recovered, start long acting carbohydrate
What is the number one symptom of hypoglycaemia?
Hunger
What are the signs of hypoglycaemia during sleep?
- Crying out or nightmares
- Sheets damp from sweating
- Waking up feeling confused or irritable
What class of drugs reduce hypoglycaemic awareness?
B blockers
