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Flashcards in FN: Hypoglycaemia Deck (43):
1

Hypoglycaemia: whipples triad

1. Low plasma glucose

2

Hypoglycaemia: whipples triad

1. Low plasma glucose

3

Symptoms

Autonomic
Neuroglycopenic

4

Autonomic onset glucose levels onset of symptoms

2.5-3

5

Neuroglycopenic onset of symptoms glucose level

.

6

Autonomic symptoms

Sweating
Anxiety
Hunger
Tremor
Palpitations

7

Neuroglycopenic

Confusion
Drowsiness
Seqizures
Personality change
Focal neurology (e.g. CN3)
Coma (

8

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

9

Investigation for hypoglycaemia

72h fast with monitoring
Sympto: lucose, insulin, C-peptide, ketones

10

Diagnosis of hyperinsulinaemia hypoglycaemia

1. Drugs
a. increased with C-pep: sulfonylurea
b. Normal C-pep: insulin

2. Insulinoma

11

diagnosis of reduced insulin, no ketones

1. Non-pancreatic neoplasms
2. Insulin receptor antibodies

12

Diagnosis of reduce insulin and raised ketones

1. Alcohol binge with no food
2. Pituitary insufficiency
3. Addisons

13

Insulinoma path

95% benign beta-cell tumour usually seen with MEN1

14

Insulinoma presentation

Fasting/excercise induced hypoglycaemia

15

Insulinoma investigations

hypoglycaemia + raised insulin
Exogenous insulin doesnt suppress C-pep
MRI, EUS pancreas

16

Insulinoma Rx

Excision

17

Post-prandial hypoglycameia

Dumping post-gastric bypass

18

Post-pandrial hypoglycaemia management if the patient is alert and orientate:

Oral Carb
1. Rapid acitng: lucozade
2. Long actingL toast, sandwich

19

Post-pandrial hypoglycaemia management if the patient drowsy/confused but swallow intact:

Buccal carb
1 Hypostop/Glucoge
2. Consider IV access

20

Post-pandrial hypoglycaemia management if the patient is unconcious or concerned re Swallow

IV dextrose
100ml 20% glucose (50ml 50% dextrse: not used)

21

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

22

Symptoms

Autonomic
Neuroglycopenic

23

Autonomic onset glucose levels onset of symptoms

2.5-3

24

Neuroglycopenic onset of symptoms glucose level

.

25

Autonomic symptoms

Sweating
Anxiety
Hunger
Tremor
Palpitations

26

Neuroglycopenic

Confusion
Drowsiness
Seqizures
Personality change
Focal neurology (e.g. CN3)
Coma (

27

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

28

Investigation for hypoglycaemia

72h fast with monitoring
Sympto: lucose, insulin, C-peptide, ketones

29

Diagnosis of hyperinsulinaemia hypoglycaemia

1. Drugs
a. increased with C-pep: sulfonylurea
b. Normal C-pep: insulin

2. Insulinoma

30

diagnosis of reduced insulin, no ketones

1. Non-pancreatic neoplasms
2. Insulin receptor antibodies

31

Diagnosis of reduce insulin and raised ketones

1. Alcohol binge with no food
2. Pituitary insufficiency
3. Addisons

32

Insulinoma path

95% benign beta-cell tumour usually seen with MEN1

33

Insulinoma presentation

Fasting/excercise induced hypoglycaemia

34

Insulinoma investigations

hypoglycaemia + raised insulin
Exogenous insulin doesnt suppress C-pep
MRI, EUS pancreas

35

Insulinoma Rx

Excision

36

Post-prandial hypoglycameia

Dumping post-gastric bypass

37

Post-pandrial hypoglycaemia management if the patient is alert and orientate:

Oral Carb
1. Rapid acitng: lucozade
2. Long actingL toast, sandwich

38

Post-pandrial hypoglycaemia management if the patient drowsy/confused but swallow intact:

Buccal carb
1 Hypostop/Glucoge
2. Consider IV access

39

Post-pandrial hypoglycaemia management if the patient is unconcious or concerned re Swallow

IV dextrose
100ml 20% glucose (50ml 50% dextrse: not used)

40

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

41

Fasting causes of hypoglycaemia insulin excess

- Excess exogenous insulin e.g in diabetes mellitus/insulin given surreptitiously
- Beta-cell tumours/disorders – persistent hypoglycarmia hypersinsulinism in infancy (PHHI, previously called nesidioblastosis), insulinoma
- Drug induced (sulphonylurea)
- Autoimmune 9insulin receptor antibodies)
- Beckwith syndrome

42

Fasting causes of hypoglycaemia Without hyperinsulinanaemia

- Liver disease
- Ketotic ypoglycaemia of childhood
- Inborn errors of metabolism e.g. glycogen storage disorders
Hormonal deficiency: reduced GH, reduced ACTH, ADdisons, congenital adrenal hyperplasia

43

Reactive/non-fasting causes of hypoglycaemia

1. Galactosaemia
2. Leucine sensitivity
3. Fructose intolerance
4. Maternal diabetes
5. Hormonal deficiency
6. Aspirin/alcohol poisoning

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