Non-diabetes hypoglycaemia Flashcards
1
Q
What is the definition of hypoglycaemia in people without diabetes?
A
- Documented plasma glucose <2.5mmol/l
* With symptoms
2
Q
What are the autonomic symptoms of hypoglycaemia?
A
- Sweating
- Palpitaitons
- Pallor
- Tremor
- Nausea
- irritability
- Hunger
3
Q
What are the neuroglycopenic symptoms of hypoglycaemia?
A
- Inability to concentrate
- Confusion
- Drowsiness
- Personality change
- Slurred speech
- Incoordination
- Weakness
- Dizziness
- Vision impairment
- Headache
- Seizure
- coma
4
Q
In patients with diabetes, which symptoms of hypoglycaemia tend to happen first?
A
Autonomic
5
Q
What is Whipple’s triad?
A
- Symptoms consistent with hypoglycaemia
- Low plasma glucose concentration
- Relief of those symptoms after the plasma glucose level is raised
6
Q
What must be ascertained in the event of suspected hypoglycaemia (non-diabetic)
A
- Does Whipple’s triad exist
- Definite evidence of a low glucose level
- Do symptoms occur in the fasting or the postprandial state?
- Take a full past medical history, family history and drug history
7
Q
What are the investigations for hypoglycaemia after a meal?
A
- Post Prandial
- Patient to fast then comes into clinic for a mixed meal
- Observed for 5 hours, bloods are taken checking insulin, c peptide and proinsulin
8
Q
What are the investigations for hypoglycaemia in a fasted state (in between meals)
A
- Provoke the homeostatic response that keeps blood glucose concentrations from falling to concentrations that cause symptoms in the absence of food
- Glucagon, adrenaline > growth hormone/cortisol
- Complete at plasma glucose 2.5mmol/l with symptoms, after 72 hours have elapsed or when plasma glucose is <3 if Whipple’s triad has been previously documented
9
Q
Which group may have a low plasma glucose with no symptoms after fasting?
A
- Young, lean, healthy women
- May have plasma glucose ranges of 2.2-3.0 or lower with no symptoms
- Alternative circulating fuels to the brain
10
Q
What are the investigations for hypoglycaemia?
A
- Glucose
- insulin
- C peptide
- sulfonylurea screen
- Beta hydroxybutyrate (low in insulinoma)
- (pro insulin low with exogenous insulin)
- Insulin antibodies (can be taken at any time)
11
Q
Endogenous insulin excess
A
- Hypoglycaemia
- Increased insulin
- increased c peptide
12
Q
Exogenous insulin excess
A
- Hypoglycaemia
- Raised insulin
- Decreased C peptide
13
Q
Hypoglycaemia not due to insulin excess
A
- Hypoglycaemia
- Insulin decreased
- C peptide decreased
