Hypoglycaemia

Question 1

What is hypoglycaemia?

What are the related symptoms?

Answer 1

Plasma glucose <3mmol/L => rapid onset

=> most common endocrine emergency

Autonomic symptoms: sweating, anxiety, hunger, tremor, palpitations, dizziness

Neuroglycopenic symptoms: confusion, drowsiness, visual trouble, seizures, coma, personality change i.e. aggressive, restlessness, incoherence

Question 2

What are the causes of fasting hypoglycaemia?

Answer 2

Main cause : insulin or sulphanyluria treatment in a diabetic e.g. due to increased activity, missed meal, accidental / non-accidental overdose

Non-diabetics: EXPLAIN

EX = Exogenous drugs i.e. insulin or oral hypoglycaemic ; body-builders may misuse insulin to help stamina ; alcohol e.g. binge with no food ; aspirin poisoning ; ACEi ; Beta blocker

P = Pituitary insufficiency

L = Liver failure

A = Addison’s disease

I = Insulinoma (islet cell tumour) and immune hypoglycaemia

N = Non-pancreatic neoplasms

Question 3

How do you investigate hypoglycaemia?

Answer 3

Whipple’s triad:

1. Signs & symptoms of hypoglycaemia
2. Low plasma glucose
3. Resolution of signs & symptoms post glucose rise

=> take drug Hx and exclude liver failure

=> Bloods: glucose, insulin, C-peptide & plasma ketones if symptomatic

Question 4

Interpreting results:

1. Hypoglycaemia hyperinsulinaemia causes:
   => Insulinoma
   => Sulfonylureas
   => Insulin injection (if no detectable C-peptide - only released with endogenous insulin)
2. Low insulin, high ketones causes:
   => Alcohol
   => Pituitary insufficiency
   => Addison’s disease
3. Low insulin, low ketones causes:
   => Non-pancreatic neoplasms
   => Anti-insulin receptor antibodies

Answer 4

INFO CARD

Question 5

How do you treat hypoglycaemia?

Answer 5

Conscious orientated patient:
=> Give 15-20g of quick acting carbohydrate snack i.e. 200ml of orange juice
=> Recheck blood glucose after 15mins
=> Repeat snack up to 3x

Conscious but uncooperative patient:
=> Squirt glucose gel between teeth & gums

Unconscious patients or those not responding to oral glucose:
=> IV glucose 10% at 200ml/h if conscious
=> IV glucose 10% at 200ml/15mins if unconscious
=> Glucagon 1mg IV/IM
=> Expect prompt recovery

*Once blood glucose >4mmol/l and patient has recovered => give long acting carbohydrate i.e. slice of toast