Type I diabetes mellitus

Question 1

Clinical presentations of hypoglycaemia due to increased autonomic activation

Answer 1

• palpitations/tachycardia
• tremor
• sweating
• pallor/cold extremities
• anxiety

Question 2

Hypoglycaemia

Answer 2

Plasma glucose <3.6 mmol/L

-inevitable result of treating diabetes (major cause of anxiety in patients and relatives)

Question 3

Clinical presentation of hypoglycaemia due to impaired CNS function

Answer 3

Glucose required for brain function

• drowsiness
• confusion
• altered behaviour
• focal neurology (CNS impairment affecting a certain part of the body)
• coma

Question 4

Hypo occurrence

Answer 4

• often clear pattern
• pre lunch hypos are common
• nocturnal hypos are very common and not recognised

Question 5

Risk factors for hypoglycaemia development

Answer 5

• quality of glycaemic control (more frequent in patients with low HbA1c)
• unaccustomed exercise
• missed meals
• inadequate snacks
• alcohol
• inappropriate insulin regime

Question 6

Oral hypoglycaemia management and prevention

Answer 6

• glucose (solution or tablets for rapid absorption)

- complex carbohydrates (maintain blood glucose after initial treatment)

Question 7

Parenteral hypoglycaemia management and prevention

Answer 7

used if consciousness impaired
-IV dextrose (eg: 10% glucose infusion)=dextrose form of glucose from corn so increases blood glucose
-1mg Glucagon IM (glucose released from glucagon stored in liver and skeletal muscle but if fasting, stores are low. Emergency injection glucagon kits at home)=glucagon promotes gluconeogenesis and glucogenolysis hence increasing hepatic glucose output
AVOID TOO CONCENTRATED SOLUTIONS IF POSSIBLE (EG: 50% GLUCOSE)

Question 8

Severe hypoglycaemia

Answer 8

Hypo event needing another person’s help to treat

-may contribute to arrhythmia and sudden death

Question 9

Low plasma glucose effects

Answer 9

• mental process impairment <3 mmol/L
• consciousness impaired <2 mmol/L
• long term effects on the brain
• recurrent hypos result in loss of warnings and hence hypoglycaemia unawareness (blunting of symptoms=SEVERE COMPLICATION OF DIABETES)
• hypoglycaemia unawareness associated with poor diabetes control=islet cell transplantation could be useful here