Hypoglycaemia

Question 1

What drug can mask signs of hypoglycaemia?

Answer 1

Non-selectie beta blockers

Question 2

What are the clinical signs of hypoglycaemia?

Answer 2

Neurogenic/autonomic
- Increased sympathetic activity
   > Sweating
   > Tachycardia
   > Pallor
   > Palpitations
   > Anxiety
   > Tremor

• Increased parasympathetic activity
  > Hunger
  > Parathesias
  > N&V

Neuroglyopenic

• Agitation, confusion, behaviour change
• Fatigue
• Seizure, focal neuro signs
• Somnolence > obtundation > stupor > coma > death

Question 3

At what glucose level have sx usually manifested in hypoglycaemia?

Answer 3

2.8 mmol/L

Question 4

What can affect the threshold at which sx of hypoglycaemia appear?

Answer 4

In chronic diabetes, hypoglycaemia associated autonomic failure (HAAF) can make the threshold at which sx occur very variable.

• Recurrent hypoglycaemia > changes in the counter
  regulatory response (ie. decreased epinephrine
  release) > lower glucose threshold needed to
  trigger sx
  => Asymptomatic hypoglycaemia
  => In pt. with HAAF, initial sx of hypoglycaemia
  is often confusion

Question 5

What is the management of hypoglycaemia?

Answer 5

Conscious patient

• Oral glucose 15-20g
• Fasting acting carbs (glucose tablets/gel, juice, candy)

Unconscious patient

• IV dextrose
• IM glucagon (if both oral and IV route unavailable)

** Re-check glucose in 15 minutes

** Suspected severe hypoglycaemia should be tx immediately - do not wait for BSLs

Question 6

What is the glucose level that defines hypoglycaemia?

Answer 6

< 3.9 mmol/L