Hypogylcaemia

Question 1

When does hypoglycaemia occur

Answer 1

When glucose levels fall below 3.5 mM

Question 2

What causes hypoglycaemia

Answer 2

• Poor diabetic control
• Insulinoma
• Drugs
• Alcohol
• Hypopituitarism/ Addison’s

Question 3

What drugs may cause hypogylcaemia

Answer 3

Sulfonylureas e.g. gliclazide - increases insulin secretion from B cells

Question 4

When do diabetics get hypos

Answer 4

• Administering too much insulin
• Intercurrent illness
• Alcohol abuse
• Between changes in medications
• Vigorous exercise

Question 5

What is Whipple’s triad

Answer 5

Helps us narrow down our differentials to hypoglycaemia:
1. Symptoms of hypoglycaemia
2. Low blood sugar levels
3. Resolution of symptoms when giving glucose

Question 6

What are the mild symptoms of hypoglycaemia

Answer 6

Autonomic symptoms (adrenergic stimulation as glucose is low therefore our body increases adrenalin secretion to stimulate glucagon):

• Sweating
• Pallor
• Palpitations
• Tremor

Question 7

What are the moderate features of hypoglycaemia

Answer 7

Neurogylcopenic symptoms:

• Slurred speech
• Confusion
• Weakness
• Dizziness
• Double vision

Question 8

What are the severe symptoms of hypoglycaemia

Answer 8

• Seizure
• Coma

These are rare findings

Question 9

How do we treat hypoglycaemia

Answer 9

Treat before investigation - medical emergency and can be fatal

If patient can tolerate food/drink - give sweet drink or glucose tablets

If patient can’t tolerate drinks (unconscious) - give dextrose gel rubbed into mouth (community), or can give SC/IM glucagon or IV 20% glucose infusion (hospital)