Hypoglycemia

Question 1

Definition

Answer 1

1. Low plasma glucose (<3.9 mmol/l)
   or
2. Autonomic or Neuroglycopenic sx

Question 2

Risk Factors

Answer 2

1. Advanced age
2. Uncontrolled T2DM with glucose variability
3. Severe cognitive impairment
4. Hypoglycemia unawareness
5. Poor health knowledge
6. Renal & hepatic impairment
7. Autonomic & peripheral neuropathy
8. Long duration of insulin therapy

Question 3

Autonomic symptoms

Answer 3

1. Trembling
2. Palpitations
3. Sweating
4. Anxiety
5. Nausea
6. Hunger
7. Tingling

Question 4

Neuroglycopenic symptoms

Answer 4

1. Headache
2. Difficulty concentrating
3. Weakness/Stroke-like sx
4. Confusion
5. Drowsiness
6. Difficulty in speech
7. Vision Changes
8. Seizure/Coma

Question 5

Severity

Answer 5

Level 1: BG 3.9 - 3.0 mmol/L or Autonomic sx present, Self-treatable

Level 2: BG < 3.0 mmol/L OR Neuroglycopenic sx begin, Self-treatable

Level 3: Unconscious OR requires assistance from another person for recovery

Question 6

Management for Level 1 & 2

Answer 6

15:15:15 Rule

1. 15 g of oral carbohydrates
2. Repeat DXT/GM in 15 minutes*
3. If not improved repeat another 15 g of oral carbohydrates

*If improved: Have usual meal/snack at that time of the day

Question 7

Management of Level 3

Answer 7

1. IV 20-50 ml Dextrose 50% over 1-3 minutes*
   OR
   IM/SC Glucagon 1mg (if IV access unavailable)
   OR
   1 tbsp honey orally(outside hosp. setting)
2. Repeat DXT/GM in 15 minutes
3. If improved have usual meal/snack at that time of the day
4. If not improving repeat bolus dose
   * IV dextrose maintenance can be given after bolus dose

Question 8

Complication

Answer 8

1. Falls, motor vehicle accidents, or other accidents
2. Dementia
3. Increased risk for CVD mortality
4. Prothrombotic state(increased platelet activation & decrease fibrinolysis)
5. Risk of arrhythmia & sudden cardiac death

Question 9

Hypoglycaemia unawareness

Answer 9

Recent or recurrent hypoglycaemia can decrease normal responses to
hypoglycaemia and lead to defective glucose counter-regulation
and hypoglycaemia unawareness.

Question 10

Extras: brief CBD
Patient unconscious in ward
1. What are the possible causes?
2.What ix to order stat?

Answer 10

1. Hypoglycemia
  Acute ischemic stroke 
  ICB
2. DXT/GM
Urgent CT Brain