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.0.0 RSP Endocrine > [14] Hypoglycaemia > Flashcards

[14] Hypoglycaemia Flashcards

1
Q

What are the categories of symptoms of hypoglycaemia?

A

Autonomic

Neuroglycopenic

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2
Q

At what glucose levels do the autonomic symptoms of hypoglycaemia occur?

A

2.5-3

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3
Q

What are the autonomic symptoms of hypoglycaemia?

A 
Sweating 
Anxiety
Hunger
Tremor
Palpitations
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4
Q

At what glucose levels do the neuroglycopenic symptoms of hypoglycaemia occur?

A

<2.5

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5
Q

What are the neuroglycopenic symptoms of hypoglycaemia?

A 
Confusion 
Drowsiness
Seizures 
Personality change
Focal neurology
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6
Q

At what glucose level does a hypoglycaemic coma occur?

A

<2.2

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7
Q

What diabetes medications cause fasting hypoglycaemia?

A

Usually insulin or sulphonylureas

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8
Q

Give 3 examples of when diabetes medications can cause hypoglycaemia

A

Exercise
Missed meal
Overdose

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9
Q

What are the causes of fasting hypoglycaemia in non-diabetics

A 
Exogenous drugs
Pituitary insufficiency
Liver failure
Addison's 
Islet cell tumours (insulinomas)
Immune 
Other neoplasms
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10
Q

Give an example of an immune cause of fasting hypoglycaemia

A

Insulin receptor antibody production in Hodgkins lymphoma

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11
Q

Give an example of a non-pancreas neoplasm that can cause fasting hypoglycaemia

A

Fibrosarcomas

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12
Q

How is fasting hypoglycaemia investigated?

A

72 hour fast with monitoring

Blood tests

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13
Q

What is looked for in blood tests in fasting hypoglycaemia?

A

Glucose
Insulin
C-peptide
Ketones

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14
Q

What can cause hyperinsulinaemic hypoglycaemia?

A

Drugs

Insulinoma

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15
Q

What drug causes hyperinsulinaemic hypoglycaemia with raised C-peptide?

A

Sulphonylureas

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16
Q

What drug causes hyperinsulinaemic hypoglycaemia with normal C-peptide?

A

Insulin

17
Q

What causes fasting hypoglycaemia with low insulin and no ketones?

A

Non-pancreatic neoplasm

Insulin recetor antibodies

18
Q

What causes fasting hypoglycaemia with decreased insulin and increased ketones?

A

Alcohol binge with no food
Pituitary insufficiency
Addison’s

19
Q

What % of insulinomas are benign?

A

95%

20
Q

What are insulinomas?

A

ß-cell tumours

21
Q

Where are insulinomas usually seen?

A

In MEN1

22
Q

How do insulinomas present?

A

Fasting or exercise induced hypoglycaemia

23
Q

What is found on investigation in insulinomas?

A

Hypoglycaemia with increased insulin

24
Q

What effect does exogenous insulin have on C-peptide in insulinomas?

A

None - it doesn’t suppress it

25
Q

What imaging may be used in investigation of insulinomas?

A

MRI

EUS pancreas

26
Q

How are insulinomas managed?

A

Excision

27
Q

What causes post-prandial hypoglycaemia?

A

Dumping post-gastric bypass

28
Q

How is hypoglycaemia managed when the patient is alert and orientated?

A

Oral carbohydrate

29
Q

Give an example of a rapid acting oral carbohydrate

A

Lucozade

30
Q

Give an example of a long acting oral carbohydrate

A

Toast

31
Q

How is hypoglycaemia managed when the patient is drowsy/confused, but still has intact swallow?

A

Buccal carbohydrate

32
Q

Give two examples of buccal carbohydrates

A

Hypostop

Glucogel

33
Q

What should be considered in a patient with hypoglycaemia that is drowsy/confused, but with an intact swallow?

A

IV access

34
Q

How should hypoglycaemia be managed in a patient who is unconscious, or there are concerns regarding their swallow?

A

IV dextrose

35
Q

What dose of IV dextrose is given in hypoglycaemia?

A

100ml 20% glucose

36
Q

How is deteriorating, refractory, insulin-induced, or no-access hypoglycaemia managed?

A

1mg glucagon IM or SC

37
Q

What are the problems with giving IM or SC glucagon in hypoglycaemia?

A

Won’t work in alcoholics
Short duration of effect (20 mins)
Insulin release may lead to rebound hypoglycaemia

.0.0 RSP Endocrine (18 decks)

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