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CDE Exam > Hypoglycemia (continued. Some In Type 1 Deck) > Flashcards

Hypoglycemia (continued. Some In Type 1 Deck) Flashcards

1
Q

Goals of treatment of hypo (3)

A

1- detect and treat quickly with fast rise of BG to safe level (do not over treat as weight gain and hyper can occur)

2-eliminate risk of injury

3- relieve symptoms quickly

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2
Q

15G of glucose raises BG by how much in how long?

A

2.1 mmol/l in 20 minutes.

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3
Q

20G of oral glucose will raise the BG level by what in how long?

A

3.6mmol/l at 45 minutes

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4
Q

How does glucose gel compare to 15 G CHO in its ability to raise BG?

A

It’s quite slow. Has to be swallowed. Only increases BG by 1mmol/l in 20 minutes.

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5
Q

If patient is taking an alpha glucosidase inhibitor, how do you treat hypo?

A

Must use glucose/dextrose tablets.
Milk or honey
Ie: has to be a monosaccharide as the mechanism of action prevents the breakdown of polysaccharides into glucose.

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6
Q

How should a diabetic patient be assessed for fitness to drive?

A

This must be done on an individual basis. Individuals should be encouraged to that an active Role in assessing their fitness to drive. In general they are fit to drive if they are medically fit, knowledgable about BG control and are able to avoid hypo episodes.

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7
Q

Example of 15G CHO to treat MILD to MODERATE hypo

A

Preferred treatment:

15G glucose tablets
15mls or 3 tsp/3 packets of sugar dissolves in water
5 cubes of sugar

Others:
6 lifesavers
150mls juice or pop
1 TBSP honey

Note: milk and juice are slower

Once recovered, have the usual meal or snack. If it’s > 1 hour away, have a snack with 15G CHO and protein source should be consumed.

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8
Q

After taking 15G of CHO for hypo symptoms, what should a patient do?

A

Re test BG in 15 minutes and re-treat with another 15 g carbohydrate if the BG level remains <4

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9
Q

How should severe hypo be treated in a conscious person?

A

20G CHO. Then retest in 15 minutes. If still below 4 then give another 15G

Once recovered, have the usual meal or snack. If it’s > 1 hour away, have a snack with 15G CHO and protein source should be consumed.

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10
Q

How do you treat severe hypo in unconscious person?

A

No IV access: 1mg glucagon sc or IM. Call emergency services.

IV access: 10-25G glucose IV (20-50cc D50W) over 1-3 minutes.

**individuals at risk of severe hypo should have support persons trained in glucagon admin

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11
Q

What are the 12 risk factors for severe hypoglycemia in a person on insulin or SU

A 
1- prior episode of severe hypo
2- current low A1C  <6
3- hypoglycemia unawareness
4- long duration of diabetes 
5- adolescence and preschool age (unable to detect or treat on their own) 
6-Autonomic neuropathy
7. CKD
8. Low economic status food insecurity 
9.  Low health literacy. 
10. Pregnancy
11. Elderly. 
12.  Cognitive impairment.
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12
Q

Symptoms of nocturnal hypo

A 
Tingling of lips and tongue
Headache
Difficulty getting up in am
Nightmares
Night sweats.
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13
Q

Describe the Dawn Phenomenon

A

Temporary rise in BG in am, thought to be due to wearing off of previous days insulin or natural timing of growth hormone production.

Note:Somogyi effect proposed that dawn phenomenon was a rebound hyper due to low night hypo. This has mostly been proven wrong with conditions blood glucose monitoring systems.

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14
Q

How much will

Glucagon increase BG and in how long?

A

3-12mmol/l in 60 minutes.

Patient usually will wake up within 15 minutes. If delayed there is no contraindication to another dose, but IV glucose must be considered by physician.
When patient wakes up give them 15G rapid CHO followed by CHO source food.

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15
Q

What is the dose of glucagon for adults and kids?

A

Adults and kids > 20kg or age 5 give 1mg either sc or IM.
Less than 20kg or younger than 5 give 0.5mg.
Admin in thigh or deltoid.

Glucagon is less effective in patients who have consumed alcohol.

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16
Q

If glucagon clear or cloudy when mixed?

A

Clear. Should not be used if cloudy!

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17
Q

For how many hours after exercise should BG be monitored to prevent hypo?

A

Up to 24 hours.
Ideal time to exercise is after a meal.
Is pre exercise testing is

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18
Q

Is dizziness a neurogenic or neuroglycopenic symptom?

A

Neuroglycopenic

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19
Q

Is weakness a neurogenic or neuroglycopenic symptom?

A

Neuroglycopenic

20
Q

Is anxiety a neurogenic or neuroglycopenic symptom?

A

Neurogenic

21
Q

Is nausea a neurogenic or neuroglycopenic symptom?

A

Neurogenic

22
Q

Why should you put an unconscious person on their side when giving glucagon?

A

In case they vomit

23
Q

Is a D has been drinking alcohol and has low blood

Sugar can they use glucagon in an emergency?

A

Glucagon kit DOES NOT WORK when the liver is busy metabolizing alcohol!

24
Q

Are type one or two diabetics more likely to experience hypoglycemia

A

Hypoglycemia occurs 2-3 x more often in t1

25
Q

How long can cognitive impairment last in them after bg levels return to normal!?

A

Significant differences in cognitive function up to 75mins after event
Implications for those working with machinery and driving

26
Q

What can SSRIs cause

A

Hypoglycemia unawareness

27
Q

How does caffeine (small doses of 200mg bid) affect BG?

A

Can increase hypoglycemia unawareness in t1dm

28
Q

repeated hypoglycemia in T1Dm can lead to what?

A

repeated hypoglycemia causes a failure of the sympatho-adrenal response and results in counterregulatory defciency that impairs hypoglycemia awareness

29
Q

what proportion of lows are known to occur at night and are often asymptomatic?

A

About 50% of lows are known to occur at night and are often asymptomatic; reported frequencies vary from 36 to 67%. The symptoms may present as nightmares or morning headaches

30
Q

Does the BG response to glucagon differ in T1DM vs T2DM?

A

type 1 diabetes may not have as great a BG response to glucagon as the person with type 2 diabetes.

31
Q

What’s the consequence of a pancreatectomy for hypoglycemia response?

A

NO glucagon!! Only epinephrine response

32
Q

What 3 things make up the definition of hypoglycemia?

A

1- Presence of autonomic or neuroglycopenic symptoms.

2-low BG IE: less than 4

3-symptoms respond to CHO

33
Q

Is trembling neurogenic/autonomic or neuroglycopenic?

A

Neurogenic/autonomoc

34
Q

Is palpitaions neurogenic/autonomic or neuroglycopenic?

A

Neurogenic/autonomic

35
Q

If difficulty concentrating neurogenic/autonomic or neuroglycopenic?

A

Neuroglycopenic

36
Q

Is sweating neurogenic/autonomic or neuroglycopenic?

A

Neurogenic/autonomic

37
Q

Is confusion neurogenic/autonomic or neuroglycopenic?

A

Neuroglycopenic

38
Q

Is tingling neurogenic/autonomic or neuroglycopenic?

A

Neurogenic/autonomic

39
Q

Is drowsiness neurogenic/autonomic or neuroglycopenic?

A

neuroglycopenic

40
Q

Is headache neurogenic/autonomic or neuroglycopenic?

A

neuroglycopenic

41
Q

Definition of mild. Moderate. Severe hypo.

A

Mild. Autonomic only. Can self treat.

Moderate. Autonomic anf neuroglycopenic. Can self treat.

Severe. Requires assitance. Unconscious may occur. Typically <2.8

42
Q

In type twos with CVD or t high risk of CVD, what is the implications of severe hypo?

A

Clear association between severe hypo and INCREASED MORTALITY

43
Q

Are milk and OJ faster or slower than oral glucose to tx hypo?

44
Q

In which 3 circumstances ia glucagon effectiveness REDUCED?

A

More than 2 alcoholic drinks in the previous few hours
After prolonged fasting
Advanced heotic disease

45
Q

Glucagon. IM OR SC

CDE Exam (32 decks)

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