Hypoglycaemia

Question 1

Hypoglycaemia Definition

Answer 1

Blood glucose below 3, if below 2.5; pathological and requires investigation

Question 2

Diagnosis of Hypoglycaemia

Answer 2

Three criteria (Whipple’s triad)

• Plasma hypoglycaemia
• Symptoms attributable to low blood sugar
• Resolution of symptoms with correction of hypoglycaemia

Question 3

Hypoglycaemia Aetiology

Answer 3

Alcohol, insulin, other drugs, toadstools, ketotic, rare causes

Question 4

Hypoglycaemia Presentation

Answer 4

• Poor correlation between blood glucose and symptoms
• Autonomic; sweating, pins and needles in lips and tongue, hunger, palpitations, -Neuroglycopenic: headache, double vision, confusion, drowsiness

Question 5

3 Presentations of Hypoglycaemia?

Answer 5

Hypoglycaemia, subacute, ketotic

Question 6

Hypoglycaemia Ix

Answer 6

• Confirmed by documentation of Whipple’s triad
• HbA1c
• LFTs
• TFTs
• Insulinoma Ixs

Question 7

Hypoglycaemia Management

Answer 7

• Also treat those less than 4 if they are symptomatic
• Initially 10-20g glucose by mouth
• If unconscious IV 75-80ml 20% glucose
• If at home give glucagon
• Hospitalisation if cause by oral antidiabetic (effects persist for 12-24hrs)
• Once patient is more alert, longer-acting carbohydrate can be given

Question 8

Prolonged Hypoglycaemic Coma Management

Answer 8

• Usually caused by cerebral oedema and follows profound hypoglycaemia lasting more than 5 hours
• Use IV mannitol and dexamethasone with constant glucose monitoring