Hypoglycaemic reaction Flashcards
how might a patient first present in a hypoglycaemic reaction
hunger, sense of weakness/ fatigue , nervousness if first time, profuse sweat
level 1 classification of hypoglycaemia
A glucose alert value of 3.9 mmol/L (70 mg/dL) or less. This need not be reported routinely in clinical studies, although this would depend on the purpose of the study
level 2 hypoglycaemia classification
A glucose level of <3.0 mmol/L (<54 mg/dL) is sufficiently low to indicate serious, clinically important hypoglycemia
level 3 hypoglycaemic reaction
Severe hypoglycemia, as defined by the ADA, denotes severe cognitive impairment requiring external assistance for recovery
consequences of hyporglycaemia in the brain
Cognitive dysfunction
Hemiparesis
Seizures
Coma
Psychological (fear of hypoglycaemia
consequences of hypoglycaemia in msk
Falls
Fractures
Joint dislocations
Driving accidents
consequences of hypoglycaemia in circulation
inflammation
Blood coagulation abnormalities
Hemodynamic changes
Endothelial dysfunction
consequences in the heart of hypoglycaemia
Myocardial infarction
Cardiac arrhythmias
Cardiac failure
glucagon role in hypoglycaemia
provides initial counterregulatory response by acting on the liver to increase hepatic glucose production
risk factors for severe hypoglycaemia
impaired hypoglycaemia awareness
counteregulatory failure
long duration of diabetes/ insulin therapy
impaired renal function
autonomic neuropathy
low hba1c
genes
prior episode of hypoglycaemia
patient groups at risk for hypoglycaemia
preschool age
adolescence
elderly
comorbidities
low socioeconomic status
excessive alcohol consumption
over ambitious attitidue
use of CNS- depressing agents
clinical factors associated with hypoglycaemia
excess or poorly timed insulin
less food consumption
exercise
sleep
alcohol
can too much insulin cause a hypo
yes
management of hypoglycaemia
-15-20g oral glucose
Severe hypoglycaemia (confusion, coma) is managed with IM glucagon or IV glucose
