Hypoglycaemia

Question 1

Causes

Answer 1

Insulinoma

Self-administered insulin/ sulphonylureas

Liver failure

Addison’s disease

Alcohol (causes exaggerated insulin secretion)

Nesidoblastosis- beta cell hyperplasia

Question 2

Hormonal response to hypoglycaemia

Answer 2

First response is decreased insulin secretion

Followed by increased glucagon secretion

Growth hormone and cortisol are also released

Question 3

Sympathoadrenal response

Answer 3

Increased catecholamine-mediated (adrenergic) and acetylcholine-mediated (cholinergic) neurotransmission in the peripheral autonomic nervous system and central nervous system

Question 4

Features if <3.3

Answer 4

Cause autonomic symptoms due to release of glucagon and adrenaline

Sweating

Shaking

Hunger

Anxiety

Nausea

Question 5

Features <2.8

Answer 5

Neuroglycopenic symptoms due to inadequate glucose supply to brain

Weakness

Vision changes

Confusion

Dizziness

Question 6

Management of hypoglycaemia in community

Answer 6

Oral glucose 10-20g in liquid, gel or tablet form

Alternatively quick-acting carb e.g. GlucoGel or Dextrogel

Hypokit contains syringe and vial of glucagon for IM or SC injection and home

Question 7

Management in hospital

Answer 7

If alert, quick-acting carb

If unconscious or unable to swallow, SC or IM glucagon

Alternatively IV 20% glucose through large vein