Hypoglycaemia Flashcards
Define hypoglycaemia
Blood glucose <3.3 mmol/L.
Inpatient diabets <4
What triad helps confirm hypoglycaemia?
Whipple triad
Low blood glucose levels
S/S consistent with hypoglycemia
Relief of Sx when blood glucose increases after Tx
Which diabetic drugs may result in hypoglycaemia?
Insulin
Sulfonylureas: increase insulin secretion
What can cause increased sensitivity to insulin?
Weight loss
Increase in activity/ exercise
List 4 acute illnesses that can cause hypoglycaemia
Sepsis
Trauma
Burns
Organ failure
List 3 glucose elated causes of hypoglycaemia
Fasting/ missing a meal: decreased exogenous glucose
Chronic alcohol use: decreased endogenous glucose
Exercise: increased glucose utilisation
List 6 non-diabetic iatrogenic causes of hypoglycaemia
Indomethacin
Pentamidine
Quinine
Sulfonamide
IGF-1
Lithium
What is the most common non-iatrogenic cause of hypoglycaemia?
Alcohol consumption
Inhibitory effect on gluconeogenesis + glycogenolysis.
List 3 rare causes of hypoglycaemia
Addisons disease (reduced physiological response)
Hypopituitarism (reduced physiological response)
Insulinoma
List 5 initial symptoms of hypoglycaemia. What causes these?
Sweating (66%)
Shaking (55%)
Hunger (44%)
Anxiety (27%)
Nausea (13%)
Autonomic Sx due to release of glucagon + adrenaline
List 4 symptoms of hypoglycaemia when glucose is <2.8mmol/l. What causes these?
Weakness (50%)
Vision changes (42%)
Confusion (33%)
Dizziness (26%)
Neuroglycopenic Sx due to inadequate glucose to brain
Name 2 severe features of hypoglycaemia
Convulsion
Coma
Describe management of hypoglycaemia in alert and oriented patients
Oral Glucose 10-20g (may need to be repeated up to 3x)
Then fast acting carbohydrate
If doesn’t respond to 3 repeats, use IM/ IV
Describe management of hypoglycaemia in patients with altered mental status
IM Glucagon
If not effective after 10 mins IV Glucose 10%
When may glucagon be less effective? What should be used instead?
In those taking a sulfonylurea
IV Glucose 10%
