Hypoglycaemia

Question 1

Definition?

Answer 1

Low blood glucose or variability in blood glucose levels presenting with associated symptoms.

Question 2

RF?

Answer 2

• Middle age
• Female
• Insulinoma
• Exogenous insulin/diabetes

Question 3

Epidemiology?

Answer 3

Age: middle aged
Sex: Female
Ethnicity:
Prevalence:

Question 4

Aetiology?

Answer 4

• Diabetes related
• Insulin excess
• Increased sensitivity to insulin
• Decreased insulin clearance
• Fasting
• Alcohol
• Exercise
• Acute illness
Non-diabetes
illness
drugs
hormones
endogenous insulin
autoimmune 
genetic

Question 5

CP?

Answer 5

• Confusion, agitation, behavioural changes
• Fatigue
• Seizure
• coma
• SNS-Tremor, pallor, anxiety, tachycardia, sweating and palpitations
• PSNS-hunger, parasthesias, N and V
• Whipple’s triad-symptoms of hypoglycaemia, low plasma glucose, symptoms resolved once glucose has been delivered.

Question 6

Pathophysiology?

Answer 6

• Insulinoma is a rare neuroendocrine tumor of insulin producing beta cells. Nesidioblastosis is hypertrophy of insulin-producing beta cells in the pancreas. Insulin autoimmune hypoglycemia is a condition that most often occurs in patients with other autoimmune conditions such as lupus. Autoantibodies bind to insulin or the receptor and dissociate such that circulating insulin becomes available to bind to the receptor upon dissociation from the antibodies causing hypoglycemia

• Non islet tumor hypoglycemia is a rare condition caused by production of large amounts of aberrant forms of insulin-like growth factor 2 (IGF-2) by a tumor, which bind to the insulin receptor and cause hypoglycemia.
• In ill, hospitalized patients, spontaneous hypoglycemia that is not caused by drugs portends a poor prognosis and can occur when poor nutrition is combined with advanced organ failure (especially liver, kidney, or heart failure) and/or sepsis.
• Pseudohypoglycemia occurs when processing of blood specimens in untreated test tubes is delayed and cells, such as red blood cells and leukocytes (especially if increased, as in leukemia or polycythemia), consume glucose. Poor circulation to the digits can also cause erroneously low fingerstick glucose measurements. Factitious hypoglycemia is true hypoglycemia induced by nontherapeutic administration of sulfonylureas orinsulin

Question 7

I-first line?

Answer 7

• Exam
• Serum glucose
• LFT
• U and E
• Serum insulin
• Serum C-peptide
• Serum b-hydroxybutyrate, sulphonylurea
• TSH
• Cortisol

Question 8

I-second line?

Answer 8

• Investigate underlying cause-hormones, diabetes, malignancy

Question 9

M-first line?

Answer 9

• Diet and lifestyle
• Supportive care-IV glucose/glucagon-alcohol/meds, malnutrition
Surgery or first line tumour therapy

Question 10

M-second line?

Answer 10

• Medical therapy /chemo/radio for tumours

* Manage underlying condition

Question 11

P?

Answer 11

• Good, with few complications linked to illness or treatments

Question 12

C?

Answer 12

• Seizure
• Coma
• DM