Hypoglycaemia

Question 1

What is the definition of hypoglycaemia?

Answer 1

• For people with T1DM = <4.0 mmol/L

* Clinical hypoglycaemia is defined as a BSL < 3.4 mmol/L.

Question 2

What can precipitate a hypoglycaemic episode?

Answer 2

• Hyperinsulinism (most common <2yo)
• Vigorous exercise without extra carbohydrate
• Accelerated starvation is the most common cause of hypoglycaemia beyond infancy
• Acute complication of T1DM either due to excess insulin or illnesses causing N/V and diarrhoea and decreased oral intake

Question 3

What are some symptoms of hypoglycaemia?

Answer 3

• paleness
• heart pounding
• shakiness
• irritability, change in mood
• headache
• lack of concentration
• sweating
• confusion, vagueness
• feeling hungry
• crying
• dizziness
• weakness

Question 4

What are some investigations you might order for a hypoglycaemic episode?

Answer 4

• Bloods
• Glucose
• Ketones
• Cortisol
• Insulin and C-peptide
• Lactate
• GH
• Amino acids
• Electrolytes
• LFTs
• Urine (first voided urine after hypoglycaemic episode)

Question 5

How might you manage a hypo? (non-insulin pump)

Answer 5

1. 5-10g high GI carbohydrate
2. Wait 15 mins
3. Repeat blood glucose
4. If still <4mmol, repeat.
5. If >4mmol, 10-15g slow GI carbohdyrate
6. D/C with education for assisting with hypos
   
   • Ask family and friends to recognise
   • Keep high GI foods close by
   • Plan for schools
   • Supervise injections
   • Eat on time

Question 6

What is accelerated starvation?

Answer 6

• = previously “ketotic hypoglycaemia”
• usually 18mo-5yo
• occurs after prolonged fast and is usually precipitated by a relatively mild illness

Question 7

What does Dx of accelerated starvation require?

Answer 7

• documenting a low BSL + ketonuria and/or ketonaemia

- but definitive diagnosis requires exclusion of other metabolic and endocrine causes.