Hypoglycaemia

Question 1

describe how hypoglycaemia impacts a patients hospital experience

Answer 1

increased length of hospital stay and higher mortality both during and after admission

Question 2

how is hypoglycaemia defined for patients undergoing diabetes treatment

Answer 2

blood glucose < 4mmol/L

Question 3

what types of treatment is hypoglycaemia a complication of

Answer 3

insulin therapy and drug therapy with drugs such as gliclazide, glipizide, glimepiride, glibenclamide

Question 4

what is hypoglycaemia caused by

Answer 4

a mismatch between plasma insulin and glucose conc.

Question 5

what is the physiological mechanism the body responds to hypoglycaemia with

Answer 5

defence reactions called counter regulation

Question 6

what hormones are involved in the autonomic response to hypoglycaemia

Answer 6

adrenaline, glucagon, cortisol, growth hormone

Question 7

what is the livers physiological response to hypoglycaemia

Answer 7

liver acts as a glucose store, liver will release glucose into blood when levels are low

Question 8

how can glucose release into the blood be impaired in hypoglycaemia

Answer 8

when glycogen levels are low

Question 9

what types of patients likely have low glycogen

Answer 9

malnourished, have recurrent hypoglycaemia, have severe liver disease, those who have consumed excessive alcohol

Question 10

what autonomic symptoms can be felt in patients with hypoglycaemia

Answer 10

trembling, anxiety, palpitations, numbness or tingling(peripheries/lips), irritability, hunger, pale/sweaty, afraid

Question 11

what types of symptoms are felt first in hypoglycaemia

Answer 11

autonomic

Question 12

when do neuroglycopenic symptoms of hypoglycaemia occur

Answer 12

as blood glucose falls towards 2mmol/L and brain becomes short of glucose

Question 13

what neuroglycopenic symptoms can be felt by patients with hypoglycaemia

Answer 13

problems with weakness/concentration/co-ordination/vision, slurred speech, loss of consciousness, seizures

Question 14

what treatment is used for hypoglycaemia patients who can swallow

Answer 14

15-20g of quick acting carbs
eg 60ml glucojuice, 4-5 glucotabs or 150-200ml fruit juice
(avoid fruit in renal failure)

Question 15

what treatment is used for hypoglycaemia patients who can swallow but are drowsy or confused

Answer 15

1.5 - 2 tubes of glucose gel, squeezed into mouth and between gums

Question 16

what are the 2 main treatment options for patients with hypoglycaemia that are unconscious

Answer 16

IV glucose OR subcutaneous/IV glucagon

Question 17

what non-pharmacological management is also used for hypoglycaemia patients who are unconscious

Answer 17

ABC, contact Dr immediately and stop IV insulin if running

Question 18

what should be done after hypoglycaemia treatment to prevent recurrence

Answer 18

check blood glucose 15mins after, if still <4mmol/L further fast-acting glucose needed