Hypoglycaemia Flashcards
(32 cards)
What does management of hypoglycaemia depend on?
On the patient’s level of alertness
How do you treat hypoglycaemia if patient is alert and orientated?
Oral carbohydrates
- rapid acting: juice/sweets
- longer acting: sandwich
How do you treat hypoglycaemia if patient is drowsy but swallowing intact?
Buccal glucose (sublingual - hypostop/glucogel
AND start thinking about IV access
How do you treat hypoglycaemia if unconscious or concerned about swallowing?
IV access
20% glucose IV
What should you consider if patient is deteriorating / refractory hypoglycaemic /difficult IV access?
IM/SC 1mg glucagon
What must you consider when administering glucagon?
If the patient has sufficient hepatic glycogen stores
What is generally low glucose on a ward?
<4mmol/L
What is generally low glucose in ITU/neonates?
<2.5mmol/L
What are symptoms of hypoglycaemia
Adrenergic:
- tremor
- palpitations
- sweating
- hunger
Neuroglycopoenic
- somnolence
- confusion
- incoordination
- seizures
- coma
What occurs to symptoms if a patient has recurrent hypoglycaemic episodes?
HYPOGLYCAEMIA UNAWARENESS
so the lack of adrenergic symptoms due to hypoglycaemia
What is the triad for diagnosis of hypoglycaemia?
Low glucose
Symptoms
Relief of symptoms with glucose administration
What is the order of hormone changes following hypoglycaemia?
- Suppression of insulin
- Release of glucagon
- Release of adrenaline
- Release of cortisol
Explain counter regulation of hypoglycaemia
- Low glucose means insulin suppression
- Immediately after low glucose means increased glucagon
- Low insulin and high glucagon mean:
- reduce peripheral uptake of glucose
- increase glycogenolysis
- increase gluconeogenesis
- increase lipolysis
- This means increased glucose, increased FFA
What do FFAs do once produced by lipolysis?
The enter the beta oxidation cycle to generate ATP
Others will form ketone bodies
What are the two key ways of measuring glucose?
- VENOUS GLUCOSE
2. CAPILLARUY GLUCOSE
What is negative about measuring blood glucose via capillary?
POOR PRECISION at low glucose levels
What are common causes of hypoglycaemia in people without diabetes?
Critically unwell Organ failure Hyperinsulinism Post-gastric bypass, extreme weight loss Drugs
What are causes of hypoglycaemia in diabetics?
Medications Inadequate carbohydrate intake / missed meals Excessive alcohol Strenuous exercise Co-existing AI conditions
What are DIABETES medications that can cause hypoglycaemia
Sulphonylureas
GLP1 agents
Insulin (both short and long acting)
Which OTHER medications can cause hypoglycaemia?
Beta blockers
Saliclylate
Alcohol
What must you do to drug doses for diabetes in someone who also has liver /renal failure?
REDUCE THE DOSE
As they have impaired drug clearancer
What comorobidities are dangerous if someone is on drugs for diabetes=?
liver / renal failure
Addisons
autonomic neuropathy
What is C peptide a product of?
A product of PRO-insulin
What is the ratio between C peptide and insulin?
1:1 EQUIMOLAR
