Hypoglycaemia Flashcards

(27 cards)

1
Q

Define the term “hypoglycaemia”

A

Defined as low plasma glucose concentration (< 4 mmol/L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the plasma glucose concentration that defines hypogylcaemia

A

< 4 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypoglycaemia is very common among diabetic patients treated with which medication

A

Insulin or sulphonylureas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When blood glucose concentration falls, there is activation of four counterregulatory mechanisms.

Name these

A
  • Body decreases insulin secretion – immediate response
  • Increase in glucagon secretion
  • Increase in adrenaline secretion
  • Secretion of cortisol and growth hormone – late response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the two main counterregulatory mechanism to hypoglycaemia

A

Decrease in insulin secretion

Increase in glucagon secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What level of hypoglycaemia stimulates the autonomic system causing the autonomic symptoms

A

< 3.1 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common cause of hypoglycaemia

A

Most commonly occurs in association with treatment for diabetes mellitus e.g. insulin, Sulphonylureas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common cause of hypoglycaemia in non-diabetics

A

Insulinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is an insulinoma

A

Benign pancreatic tumour of the beta cells causing excess insulin secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Naem some of the causes of hypoglycaemia

A
  • Treatment for diabetes mellitus e.g. insulin, Sulphonylureas - most common in diabetics
  • Insulinoma – benign pancreatic tumour of the beta cells causing excess insulin secretion - most common in non-diabetics
  • Alcohol
  • Sepsis
  • Malnourishment
  • Adrenal insufficiency
  • Paraneoplastic syndrome – secretion of insulin-like growth factor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the blood glucose concentrations that cause autonomic symptoms (hypoglycaemia)

A

< 3.1 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the blood glucose concentrations that cause neuroglycopenic symptoms (hypoglycaemia)

A

< 2.8 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes autonomic symptoms associated with hypoglycaemia

A

The release of glucagon and adrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes neuroglycopenic symptoms associated with hypoglycaemia

A

Inadequate glucose supply to the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name some of the autonomic symptoms of hypoglycaemia

A

Tremor

Palpitations

Anxiety

Sweating

Hunger

Paraesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name some of the neuroglycopenic symptoms of hypoglycaemia

A

Dizziness

Weakness

Drowsiness

Confusion

Seizures

Coma

17
Q

Why do patients with diabetes have reduced symptoms and presentation with severe hypoglycaemia

A

This is because patients with diabetes may lose their hypoglyaemic awareness

Occur in patients with type 1 and long-standing type 2 diabetes

18
Q

The diagnosis of hypoglycaemia is based on

A

Capillary blood glucose or serum blood glucose measurements

19
Q

What is the name given to the collection of three signs that is used as a formal diagnosis of hypoglycaemia

A

Whipple’s triad

20
Q

Whipple’s triad refers to a collection of three signs that is used as a formal diagnosis of hypoglycaemia .

Name the 3 signs

A

Low blood glucose concentration

Symptoms of hypoglycaemia

Reversal of symptoms when blood glucose concentration is restored

21
Q

In what patient group is the Whipple’s triad not clinically relevant for

A

Those with diabetes as they have reduced hypoglycaemic awareness

22
Q

Name the key investigation for hypoglycaemia

A

Capillary blood glucose

OR
Serum blood glucose measurements

23
Q

Name the other investigations that may be useful to aid in the investigation of hypoglycaemia

A

Serum insulin, C-peptide and proinsulin – to distinguish the presence of exogenous and endogenous insulin

Abdominal CT/MRI – to localise an insulioma

8am cortisol and/or synacthen (synACTHen) testing – for adrenal insufficiency

24
Q

Serum insulin, C-peptide and proinsulin can be used to distinguish the presence of exogenous and endogenous insulin.

What would you expect the levels to be for an endogenous production of insulin

[High, Low, Normal]

A

High insulin

AND
High C-peptide and proinsulin

25
Serum insulin, C-peptide and proinsulin can be used to distinguish the presence of exogenous and endogenous insulin. What would you expect the levels to be for an **exogenous** production of insulin [High, Low, Normal]
High insulin AND Low C-peptide and proinsulin
26
How woud you manage mild/moderate hypoglycaemia
Oral glucose (10-20g) given in liquid, gel or tablet form Quick acting carbohydrate e.g. GlucoGel, Dextrogel, sweets. Followed by slow acting carbohydrates e.g. toast
27
How woud you manage severe hypoglycaemia
ABCDE appraoch IV load of glucose e.g. 200ml IV 10% dextrose If not access, subcut or intramuscular injection of 1mg glucagon