hypoglycaemia

Question 1

definition of hypoglycaemia

Answer 1

plasma glucose <3mmol/L

threshold for sx varies

Question 2

complications of hypoglycaemia

Answer 2

prompt dx essential - brain damage and death

Question 3

sx of hypoglycaemia

Answer 3

autonomic

• sweating
• anxiety
• hunger
• tremor
• palpitations
• dizziness

neuroglycopenic

• confusion
• drowsiness
• visual trouble
• seizures
• coma
• focal sx - transient hemiplegia
• mutism
• personality change
• restlessness
• incoherence

Question 4

causes of fasting hypoglycaemia

Answer 4

insulin or sulfonylurea treatment - increased activity, missed meal, OD

exogenous drugs - insulin, alcohol, aspirin poisenoing, ACEi, B blocker, pentamidine, quinine sulfate , aminoglutethamide, insulin like growth factor

pit insufficiency

liver failyure

addison’s

islet cell tumours - insulinoma, and immune hypoglycaemia eg anti-insulin receptor Ab in Hodgkin’s

non-pancreatic neoplasms eg fibrosarcomas and haemangiopericytomas

Question 5

when to Ix hypoglucaemia

Answer 5

sx or signs + low plasma glucoe _ resolution of sx and signs post glucose rise

document BM during attack and lab glucose

drug history and exclude liver failure

72hr fasting may be needed

bloods - glucose, insulin, c-peptide, plasma ketones

if endogenous hyperinsulinism suspected do insulin, c peptide, proinsulin and B-hydroxybutyrate

Question 6

interpreting Ix of hypoglycaemia

Answer 6

hypoglycaemia hyoerinsulinaemia - insulinoma, sulfonylurea, insulin injection, non-insulinoma pancreatogenous hypoglycaemia syndrome, mutation in the insulin receptor gene, congenital

insulin low or undetectable, no excess ketones - non-pancreatic neoplasm, anti-insulin receptor Ab

low insulin, high ketones - alcohol, pit insufficiency, addison’s

Question 7

post-prandial hypoglycaemia

Answer 7

after gastric/bariatric surgery nad in t2dm

ix - prolonged OGTT

Question 8

mx of hypoglycaemia

Answer 8

small high starch meals

if post-prandial low glucose - give slowly absorved carb

in dm - rationalise insulin therapy

acute:

• if conscious and can swallow - quick acting carb snack and recheck glucose
• if conscious but not responding - glucose gel between teeth
• unconscious - IV glucose or glucagon IM

then long acting carb