Hypoglycaemia + Hypo Unawareness Flashcards
Hypoglycaemia
Most common side effect of insulin therapy and Occurs when more insulin is injected than is needed
level 1
A glucose alert value of 3.9 mmol/L (70 mg/dL) or less.
level 2
A glucose level of <3.0 mmol/L (<54 mg/dL) is sufficiently low to indicate serious, clinically important hypoglycemia.
level 3
Severe hypoglycemia, as defined by the ADA, denotes severe cognitive impairment requiring external assistance for recovery
consequences of hypoglycaemia (4)
brain
msk
heart
circulation
Brain (5)
-cognitive dysfunction
-hemiparesis
-seizures
-coma
-psychological- fear of hypo
MSK (4)
-falls
-fractures
-joint dislocations
-driving
Heart (3)
-MI
-cardiac arrythmias
-cardiac failure
Circulation (4)
-inflam
-blood coag abnormalities
-haemodynamic changes
-endothelial dysfunction
risk factors for hypoglycaemia (6)
-impaired awareness
- c-peptide negative
-impaired renal function
-autonomic neuropathy
-genes ( beta receptors, RAS system)
-prior episodes
patient groups at particular risk (5)
-pre school
-adolescence
-elderly
-low socioeconomic status
-excess alcohol consumptipn
clinical presentation (8)
- Pallor
- Sweating
- Tremor
- Palpatations
- Confusion
- Nausea
- Hunger
- Cognitive impaired
investigation (3)
- Quantify awareness with the Gold score or Clarke score
- Note that if symptoms not triggered until plasma glucose <3 mmol/l there is a significantly increased risk of SHG
-Anyone with blood glucose <4mmol/L should be treated
management (3)
- 15-20g oral glucose
- not choco bar or biscuits as fat will slow absorption of glucose, full sugar juice better
- Severe hypoglycaemia (confusion, coma) is managed with IM glucagon (more common outwith healthcare setting) or IV glucose (only in a healthcare setting)
