HYPOGLYCAEMIA

Definition:

 Plasma glucose< 4mmol/L.

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.