Case 1 - Hypoglycaemia

Question 1

Presentation of hypoglycaemia

Answer 1

• Autonomic - pallor, sweating, tremor, tachycardia, tingly lips, convulsions
• Neuro - decreased conc, behavioural change
• Sometimes none if hypoglycaemia unawareness

Question 2

Managing hypoglycaemia

Answer 2

• A-E
• IV access

If mild - ie conscious and able to swallow:
* Glucojuice
* Lift juice shot
* 5-7 dextrose tablets

If able to swallow but bit disorientated:
* 2 tubes glucose gel

If no response in 40mins or after 3 treatment cycles:
* IM glucagon or 50ml of 20% glucose

If unconcious/aggressive/NBM or BG less than 2.6, start with severe management - 100ml 20% glucose over 10-15 minutes

Question 3

After immediate treatment what further steps should be taken?

Answer 3

• Test CBG every 10 mins
• If remains less than 4mmol follow treatment plan
• Once above 4mmol/L and conscious and able to swallow give long acting carbohydrate eg cereal, biscuits, yoghurt
• Restart insulin once above 4mmol/L

Question 4

Algorithm for treatment of hypoglycaemia

Answer 4

Question 5

Reasons for recurrent hypoglycaemia

Answer 5

• Reduced oral intake
• Not eating enough
• Postponing or meal skipping
• Too much insulin given
• Drinking alcohol
• Increasing exercise without adjusting medication

Question 6

What is meant by multiple daily injection basal bolus insulin regime with 1:10 QA to carb ratio?

Answer 6

• Multiple daily injections
• Basal - long acting insulin
• Bolus - fast acting insulin
• 1:10 - how much bolus insulin to give per gram of carb, eg 60g carbs give 6 units bolus insulin

Question 7

Example of long acting insulin

Answer 7

• Lantus
• Tresiba
• Insulatard
• Humulin I
• Levemir

Question 8

Examples of short acting insulin

Answer 8

• Novorapid
• Humalog
• Apidra
• Actrapid
• Humulin S