Hypoglycemia Flashcards
What value defines Hypoglycemia
Blood glucose <4mmol/L
What are the features of Hypoglycemia
Shaking Sweating Palpitation Slurred speech Confusion Coma
What causes Hypoglycemia
Anti-diabetic drugs Beta blockers Alcohol Acute liver failure Sepsis Adrenal insufficiency Insulinoma
What drugs can cause hypoglycemia
Beta blockers Insulin DPP4 inhibitor GLP1 Analogue Sulphonyureas
What Initial Investigations would you do to a hypoglycemic patient
Check meds for drug causes
Distinguish the presence of exogenous and endogenous Insulin
What would you test to look for the presence of insulin
Serum Insulin, C-peptide and Proinsulin
What is endogenous insulin production
High Insulin, Proinsulin and High C-Peptide
What is Exogenous production of insulin (EXO IS LOW)
High Insulin,Proinsulin and low C-Peptide
What other investigations would you do to a hypogycemic patient
72hr Fast Test (episodic?) SynACTHen test (ADrenal insufficiency?) Abdominal imaging (Insulinoma)
What is the first management Approach to Hypoglycemia
ABCDE
How do you manage a conscious Hypoglycemic patient
ABCDE
Take 20g fast acting Carbs
Avoid Chocolate
Eat slow acting carbs after
How do you manage a hypoglycemic patient who is unconscious or in seizure
ABCDE
200ml 10% IV dextrose
-If IV not available give 1mg Glucagon IM (not with alcohol caused)
Treat seizure
What is the gold standard test for diagnosing hypoglycemia
72 Hr fast
