Hypoglycaemia Flashcards
(38 cards)
What are the symptoms of hypoglycaemia?
- Hunger
- Anxiety
- Sweating
- Tingling lips
- Tremor
- Palpations
- (headache) occasionally
As levels fall lower:
- Confusion
- Weakness
- Incoordination
- Impaired vision
- Double vision
- Difficulty concentration
Severe
- Convulsions & slurred speech
- Inability to swallow
- Unconscious
- Coma
What drug is most likely to cause hypoglycaemia?
- Sulphonylurea
- Insulin
Explain the management for hypoglycaemia?
Blood glucose is over 4mmol/l with hypo symptoms - have a small carb snack like bread/normal meal
If blood glucose is less than 4mmol/l with/without symptoms; and conscious and can swallow - give oral glucose e.g. glucogel
After 30-45 minutes or 3 cycles:
If blood glucose is less than 4mmol/l and still conscious - give IM glucagon or IV glucose 10% infusion (and thiamine if alcoholic patient)
If no better, it’s an emergency
if glucose levels is still less than 4mmol/l and unconscious - give IM glucagon or IV glucose 10% / 20% infusion
(if glucagon is not effective after 10 minutes (or is unsuitable) then give IV glucose 10% / IV 20%)
What’s an alterantive to glucogel, that you can give to patients with 4mmol/l or less, with or without symptoms?
- Glucose liquid
- Glucose tablets
- Dextrogel
- Pure fruit
- Dissolved sugar (sucrose)
Which patients cannot take sucrose?
Patients taking acarbose
Which patients should not take orange juice?
Patients following a low potassium diet due to chronic kidney disease
Why are chocolates and biscuits not given for hypoglycaemia?
Because they have a low sugar content, and high fat content and can delay gastric emptying
Explain the three cycles you can do for hypoglycaemia?
Eat, wait 15 mins.
Repeat for a max of 3 times in total.
What should be done after glucose concentration is over 4mmol/l?
A snack containing a long acting carb should be given.
Or a normal carb containing meal, if due
What is an example of a long acting carb?
- Two biscuits
- One slice of bread
- 200-300ml of milk (not soya or alternatives)
When should glucagon be avoided?
- Prolonged fasting
- Adrenal insufficiency
- Chronic hypoglycaemia
- Alcohol-induced hypoglycaemia
- In patient taking Sulfonylurea, give IV glucose instead
What can be given to patients that have CV risk?
ACE inhibitor, low dose aspirin & lipid regulating drug
What should be done to diabetic patients to prevent nephropathy?
BP should be reduced to lowest level, to prevent decline of glomerular filtration rate and reduce proteinuria
What test must be done for nephropathy?
Test for urinary protein and serum creatinine.
If test is negative, test urine for microalbuminuria (early sign of nephropathy)
What must all patients with nephropathy be given?
Must be given ACEi or ARB, if not contra-indicated; even if BP is normal
Which diabetic patients should be given ACEi?
Given to patients with CKD and proteinuria, to reduce progression of CKD
What painkillers can be used with neuropathy complications with diabetic patients?
- Duloxetine, venlafaxine can be used for pain.
- Amitriptyline and imipramine can be used as alternatives
- Pregabalin and gabapentin can tried, if all above are ineffective
- Opioid analgesics (such as tramadol, morphine, oxycodone) can be used in combination with pregabalin
For autonomic neuropathy - codeine, tetracycline & erythromycin
What are the signs and symptoms of Diabetic Ketoacidosis (DKA)?
- Dehydration due to polydipsia & polyuria
- Weight loss
- Excessive tiredness
- Nausea & vomiting
- Abdominal pain
- Rapid n deep respiration (hyperventilation)
- Sweet smell to breath (acetone breath)
- Reduced consciousness
- Sweet or metallic taste
- Different odour to urine or sweat
What is Hyperosmolar hyperglycaemic state (HHS)?
Very high blood sugar levels in people with type 2 diabetes that has or hasn’t been diagnosed and can be caused by illness and dehydration
What are the signs and symptoms of Hyperosmolar hyperglycaemic state (HHS)?
- Dehydration due to polydipsia & polyuria
- Weight loss
- Weakness
- Tachycardia
- Hypotension
- Poor skin turgor
- Acute cognitive impairment
- Shock (in severe cases)
What are the treatments for HHS?
IV fluid replacement, followed by IV insulin
K+ omitted or replaced if required
- Same as the treatment for DKA but no glucose at the start
What does the management of DKA involve?
It involves fluid + electrolytes + insulin
- Sodium/potassium chloride 0.9% IV infusion, if systolic BP is less than 90mmHg, for 10-15 mins. Repeat if BP is still low and seek medical advice
- Mix sodium chloride 0.9% with a soluble insulin, in an infusion to a concentration of 1unit/ml, infuse at a fixed rate of 0.1units/kg/hr.
What must be monitored for DKA management?
Monitor blood glucose and blood ketone hourly
What should be continued during DKA managment?
Continue long acting analogues (detemir & glargine), during DKA treatment.
