Hypoglycaemia

Question 1

What is hypoglycaemia

Answer 1

A low blood sugar level (<4mmol/l)

Question 2

What are the 4 problems associated with insulin?

Answer 2

• Immune response
• Local at injection site
• Weight gain (dose related)
• Hypoglycaemia (biggest problem & risk with insulin)

Question 3

Why is immune response a problem with insulin?

Answer 3

Insulin resistance due to insulin signalling inhibition results in a series of immune response that worsen the inflammatory state (which causes diabetes) which then leads to hyperglycemia.

Question 4

What are the 3 local/reactions at injection site?

Answer 4

• Lipohypertrophy (a lump of fatty tissue under your skin caused by repeated injections in the same place)
• Bruising/redness/scarring
• Rare allergic reactions

Question 5

What are the signs and symptoms of MILD hypoglycaemia?

Answer 5

• Palpitations
• Tremor
• Hunger & sweating (adrenergic & lost if on beta-blockers)
• Perioral numbness & tingling
• Blurred vision
• Fatigue
• Headache

Question 6

What are the signs and symptoms of MODERATE hypoglycaemia?

Answer 6

Behaviour change:
- Restlessness
- Agitation
- Irritability
- Drowsiness (but rousable)
- Confusion
- Slurred speech

Question 7

What are the signs and symptoms of SEVERE hypoglycaemia?

Answer 7

• Very agitated/aggressive
• Unconscious
• Unresponsive
• Seizures
• Coma

Question 8

What are the causes of Hypoglycaemia?

Answer 8

• Incorrect dosing of insulin at night time
• Delayed/missed meals
• Alcohol
• More exercise than usual
• Heat
• Stress

Question 9

What is the recommended treatment for MILD hypoglycaemia?

Answer 9

15-20g rapidly absorbed sugar
- If necessary repeat after 10-15mins
- Taken after a snack/next meal of sustained carbohydrate

Question 10

What is the recommended treatment for MODERATE hypoglycaemia?

Answer 10

• 1.5-2 tubes of GlucoGel or IM glucagon (1mg)

Question 11

What is the recommended treatment for SEVERE hypoglycaemia?

Answer 11

• IM glucagon (1mg) or IV glucose (150ml of 10% over 10-15mins)

Question 12

What should be the target blood glucose for hypoglycaemia patients?

Answer 12

Always to be >4mmol/l