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.
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