FN: Hypoglycaemia Flashcards
Hypoglycaemia: whipples triad
- Low plasma glucose
Hypoglycaemia: whipples triad
- Low plasma glucose
Symptoms
Autonomic
Neuroglycopenic
Autonomic onset glucose levels onset of symptoms
2.5-3
Neuroglycopenic onset of symptoms glucose level
.
Autonomic symptoms
Sweating Anxiety Hunger Tremor Palpitations
Neuroglycopenic
Confusion Drowsiness Seqizures Personality change Focal neurology (e.g. CN3) Coma (
Fasting hypoglycameia causes: EXPLAIN
Usually insulin or sulfonylurea Rx in a known diabetic - excercise missed meal, OD 1. Exogenous drugs 2. Pituitary insufficiency 3. Liver failure 4. Addison;s 5. Islet cell tumours (insulinomas) 6. Imune (insulin receptor Abs Hodgkins) Non-pancreatic neplasms e.g. fibrosarcomas
Investigation for hypoglycaemia
72h fast with monitoring
Sympto: lucose, insulin, C-peptide, ketones
Diagnosis of hyperinsulinaemia hypoglycaemia
- Drugs
a. increased with C-pep: sulfonylurea
b. Normal C-pep: insulin - Insulinoma
diagnosis of reduced insulin, no ketones
- Non-pancreatic neoplasms
2. Insulin receptor antibodies
Diagnosis of reduce insulin and raised ketones
- Alcohol binge with no food
- Pituitary insufficiency
- Addisons
Insulinoma path
95% benign beta-cell tumour usually seen with MEN1
Insulinoma presentation
Fasting/excercise induced hypoglycaemia
Insulinoma investigations
hypoglycaemia + raised insulin
Exogenous insulin doesnt suppress C-pep
MRI, EUS pancreas
Insulinoma Rx
Excision
Post-prandial hypoglycameia
Dumping post-gastric bypass
Post-pandrial hypoglycaemia management if the patient is alert and orientate:
Oral Carb
- Rapid acitng: lucozade
- Long actingL toast, sandwich
Post-pandrial hypoglycaemia management if the patient drowsy/confused but swallow intact:
Buccal carb
1 Hypostop/Glucoge
2. Consider IV access
Post-pandrial hypoglycaemia management if the patient is unconcious or concerned re Swallow
IV dextrose
100ml 20% glucose (50ml 50% dextrse: not used)
Post-pandrial hypoglycaemia management if the patient is deteriorating/refractory/insulin/no access
1mg glucagon IM/SC
Wont work in drunks + short duration of effect (20 mins)
Insulin release may => rebound hypoglycaemia
Symptoms
Autonomic
Neuroglycopenic
Autonomic onset glucose levels onset of symptoms
2.5-3
Neuroglycopenic onset of symptoms glucose level
.
