HYPOGLYCAEMIA

Definition:

 Plasma glucose< 4mmol/L.
Diabetes Control Chart
Symptoms:
Adrenergic manifestations
vShakiness, anxiety, nervousness
vPalpitations, tachycardia
vSweating, feeling of warmth (although sweat glands have muscarinic receptors, thus "adrenergic manifestations" is not entirely accurate)
vPallor, coldness, clamminess
vDilated pupils(mydriasis)
vFeeling of numbness "pins and needles" (paresthesia)
Glucagon manifestations
  • Hunger, borborygmus
  • Nausea, vomiting, abdominaldiscomfort
  • Headache
Neuroglycopenic manifestations
vAbnormal mentation, impaired judgment
vNonspecific dysphoria, moodiness, depression, crying, exaggerated concerns
vNegativism, irritability, belligerence, combativeness, rage
vPersonality change, emotional lability
vFatigue, weakness, apathy, lethargy, daydreaming, sleep
vConfusion, amnesia, dizziness, delirium
vStaring, "glassy" look, blurred vision, double vision
vFlashes of light in the field of vision
vAutomatic behavior, also known as automatism
vDifficulty speaking, slurred speech
vAtaxia, incoordination, sometimes mistaken for "drunkenness"
vFocal or general motor deficit, paralysis, hemiparesis
vParesthesia, headache
vStupor, coma, abnormal breathing
vGeneralized or focal seizures
vDysmenorrhea

Types:
1.Fasting Hypoglycaemia
vCauses for diabetic patient :
Ø  Insulin or sulfonylurea treatment.    Activity, miss meal ,overdose insulin
v Causes for non-diabetic patient : EXPLAIN
ØExogenous drugs (eg insulin)
ØPituitary insuficiency
ØLiver failure
ØAddison’s disease
ØIslet cell tumour (eg. Insulinoma)
ØNon-pancreatic neoplasm

Diagnosis and Investigations
ØFinger-pricks
ØTake drug history and exclude liver failure
Ø72 hours fasting. Take blood sample for glucose insulin, c-peptide and plasma ketones if symptomatic. ( in normal insulin    , c-peptide     )

2. Post-prandial hypoglycaemia
Causes:
ØAfter gastric/bariatric surgery
ØType 2 diabetes

Investigation:
Prolong (OGTT) Oral Glucose Tolerance test. 5h.

Oral sugar
If cannot swallow, 20-50ml 50% glucose IV (via large vein with 0.9% saline flush to prevent phlebitis)
Glucagon 1mg if no IV access (repeat after 20 minutes & follow with oral carbohydrate).
Diabetics ,insulin therapy.

Comments

Popular Posts