Hypoglycaemia

Question 1

What is hypoglycaemia?

Answer 1

Hypoglycaemia occurs when blood glucose concentration falls below the normal fasting glucose level (<3.3mmol/L).

Question 2

What is the normal fasting glucose range?

Answer 2

4.0-5.8mmol/L

Question 3

What are the common causes of hypoglycaemia in diabetes?

Answer 3

• Excess insulin
• Sulfonylureas (e.g. gliclazide)
• Viral illness
• Alcohol
• Too much exercise

Question 4

What are non-diabetic causes of hypoglycaemia?

Answer 4

• Drugs (e.g. indomethacin, quinine, sulfonamide, IGF-1, lithium)
• Alcohol consumption

Question 5

What are the autonomic symptoms of hypoglycaemia?

Answer 5

• Sweating
• Palpitations
• Tremor
• Hunger

Question 6

What are the neurological symptoms of hypoglycaemia?

Answer 6

• Confusion
• Drowsiness
• Dizziness
• Weakness
• Incoordination
• Behavioural changes
• Speech abnormalities
• Seizures

Question 7

What are the non-specific symptoms of hypoglycaemia?

Answer 7

• Fatigue
• Nausea
• Headache

Question 8

What is Whipple’s triad for diagnosing hypoglycaemia?

Answer 8

• Symptoms/signs of hypoglycaemia
• Low blood glucose
• Resolution of symptoms with correction of glucose

Question 9

What is the first step in managing a conscious patient with hypoglycaemia?

Answer 9

Glucose gel by mouth (e.g. GlucoGel)

Question 10

What should be done if a conscious patient with hypoglycaemia shows no change after the first glucose gel?

Answer 10

Repeat BM after 10-15 mins, if no change, repeat glucose gel further 2-3 times.

Question 11

What should be provided to a fully alert patient after hypoglycaemia treatment?

Answer 11

Longer-acting carbohydrate (e.g. toast)

Question 12

What is the initial treatment for an unconscious patient with hypoglycaemia?

Answer 12

• Glucagon 1mg
• IV glucose (150ml 10% glucose)

Question 13

What is neonatal hypoglycaemia?

Answer 13

Neonatal hypoglycaemia is defined as <2.6mmol/L glucose in newborns.

It can be normal in term babies as transient hypoglycaemia.

Question 14

What is transient hypoglycaemia?

Answer 14

Transient hypoglycaemia occurs in the first 24 hours with no consequence, as newborns can utilize alternative fuels like ketones and lactate.

Question 15

List the risk factors for neonatal hypoglycaemia.

Answer 15

• Preterm birth (<37 weeks)
• Maternal/gestational diabetes
• Intrauterine growth restriction
• Hypothermia
• Neonatal sepsis

Question 16

What are the possible clinical features of neonatal hypoglycaemia?

Answer 16

• Asymptomatic
• Autonomic symptoms:
  
  • ‘jitteriness’
  • Irritable
  • Tachypnoea
  • Pallor
• Neurological symptoms:
  
  • Poor feeding/sucking
  • Weak cry
  • Drowsy
  • Hypotonia
  • Seizures
• Other:
  
  • Apnoea
  • Hypothermia

Question 17

What should be done for asymptomatic neonatal hypoglycaemia?

Answer 17

• Encourage normal feeding
• Monitor blood glucose

Question 18

What is the management for symptomatic neonatal hypoglycaemia?

Answer 18

• Admit to neonatal unit
• IV infusion of 10% dextrose