Insulin treatment

Question 1

Hypoglycaemia during insulin treatment

Answer 1

This is the most common complication of insulin therapy.
It limits what can be achieved with insulin.
People with diabetes have an impaired ability to counter regulate glucose levels after hypoglycaemia.

Question 2

How does hypoglycaemia occur with insulin treatment?

Answer 2

Results from an imbalance between injected insulin and a patient’s normal diet, activity and basal insulin treatment.

Question 3

Symptoms of hypoglycaemia

Answer 3

Symptoms develop when blood glucose levels fall below 3 mmol/L and typically develop over a few minutes.
Adrenergic features:
Sweating
Tremor
Palpitations
Virtually all T1DM patients experience this and 1 in 3 will go into a coma at some point in their lives.

Question 4

Signs of hypoglycaemia

Answer 4

Pallor
Cold
Nervous dysfunction (neuroglycopenia) resulting in altered behaviour or conscious level.
Such patients appear pale, drowsy or detached.
Behaviour is clumsy or inappropriate.
Some individuals become irritable or even aggressive
Others slip rapidly into a hypoglycaemic coma.

Question 5

Classification of hypoglycaemia

Answer 5

Nocturnal Hypoglycaemia
Mild Hypoglycaemia
Severe Hypoglycaemia

Question 6

What is nocturnal hypoglycaemia?

Answer 6

Basal insulin requirements fall during the night but increase again from about 4 am onwards when levels of injected insulin are falling.
As a result, people wake up with high blood glucose but injecting more insulin at night increases the risk of hypoglycaemia in the early hours of the morning.

Question 7

What is mild hypoglycaemia?

Answer 7

Symptoms of sweating, tremors and palpitations.

Glucose or sweets should be carried to relieve symptoms.

Question 8

What is severe hypoglycaemia?

Answer 8

Convulsions, coma and death likely.
Unconscious patients should be given either IM glucagon 1mg or IV glucose (25-50 ml of 50% glucose solution) followed by a flush of 0.9% saline to preserve the vein.
If the patients can cooperate- Lucozade 30 ml
Unable to cooperate but conscious- buccal glucose gel
-Rule of 15 is used to treat severe hypoglycaemia

Question 9

When is severe hypoglycaemia more likely?

Answer 9

Alcohol excess 
Very young or old 
Long duration DM 
Recent severe hypoglycaemia 
Pregnancy 
Autonomic neuropathy 
Renal or hepatic impairment