Hyper- and Hypoglycaemia

Question 1

What happens to insulin, adrenaline, cortisol and glucagon in hypoglycaemia, in order?

Answer 1

1) Low insulin
2) Release of glucagon
3) Release of adrenaline
4) Release of cortisol

Question 2

What defines hypoglycaemia?

Answer 2

The exact blood level ranges, depending on the clinical context. It is a combination of blood level, symptoms and whether it is relieved with glucose therapy

Question 3

How do you treat hypoglycaemia?

Answer 3

Alert: oral carbohydrates

• Fast: juice/syrup
• Slow: sandwiches

Drowsy: buccal carbohydrate
- Sub-lingual glucose gel

Unconscious: IV glucose

• Fast: 50ml of 50% glucose
• Slow: 100ml of 20% glucose

Consider IM 1mg glucagon if needed

Question 4

What bloods are helpful in investigating hypoglycaemia? When should these be done?

Answer 4

• Insulin
• C-peptide
• Drug screens
• Auto antibodies
• Cortisol
• Free fatty acids
• Ketones
• Lactate

These should be done DURING the hypoglycaemia

Question 5

Describe the causes of hypoinsulinaemic hypoglycaemia in adults

Answer 5

• Fasting
• Exercise
• Endocrine deficiencies
• Liver failure
• Anorexia

Question 6

Describe the causes of hypoinsulinaemic hypoglycaemia in neonates

Answer 6

You expect the ketones to be present

If present:

• Prematurity
• IUGR
• GDM

If absent:

• Metabolic disorders
• Fatty acid oxidation deficiency
• Glycogen storage disorder 1
• Medium chain acetyl CoA dehydrogenase deficiency

Question 7

Describe the causes of hyperinsulinaemic hypoglycaemia in adults

Answer 7

Check C-peptide

If low: exogenous insulin (too high a dose)

If high: endogenous insulin

• Insulinoma
• Sulphonylurea overdose
• Other diabetic drugs

Question 8

What is a non-islet tumour hypoglycaemia?

Answer 8

Non-islet tumours secrete an insulin-like chemical that acts like insulin: big IGF-2

This will mean glucose, insulin, c-peptide, FFA and ketones will all be low