Hypoglycaemia

• What is hypoglycaemia?

  Blood glucose < 4 mmol/L
• What are the possible causes of hypoglycaemia?


  Drugs (insulin, sulphonylureas, GLP-1 analogues, DPP-4 inhibitors, beta blockers)

  Alcohol

  Acute liver failure

  Sepsis

  Adrenal insufficiency

  Insulinoma

  Glycogen storage disease
• What are the signs & symptoms of hypoglycaemia?


  Glucose < 3.3 mmol/L = adrenergic symptoms

  • trembling
  • sweating
  • palpitations
  • hunger
  • headache

  Glucose < 2.8 mmol/L = neuroglycopenic symptoms

  • double vision
  • difficulty concentrating
  • slurred speech
  • confusion
  • coma
• What are the conditions to consider in hypoglycaemia?


  DKA -> due to insulin treatment

  Adrenal insufficiency

  Insulinoma (insulin-secreting tumour)

  Alcohol intoxication
• What Inx can be done when a pt presents with hypoglycaemia?

  Review medication Hx - for potential drug-induced causes

  Measure serum insulin, C-peptide & proinsulin levels

  • high insulin + high C-peptide and proinsulin -> endogenous production (insulinoma)
  • high insulin + low C-peptide & proinsulin levels -> exogenous administration of insulin

  8am cortisol testing - to exclude adrenal insufficiency

  Consider abdo imaging (CT/MRI/PET)
• What is the management of hypoglycaemia (pt is conscious)?


  A-E approach

  15-20g of fast-acting carbohydrate (e.g., glucose tablets, non-diet soda, sweets, fruit juice)

  Avoid chocolate (slower absorption)

  Follow up with slower-acting carbohydrate (e.g. toast, biscuit)
• What is the management of severe hypoglycaemia (seizures, unconsciousness)?


  A-E approach

  200ml 20% dextrose IV (alternatively dextrose 20% can be administered via a large vein)

  Glucagon 1 mg IM (if no IV access) -> NOTE: this will not work if alcohol ingestion is cause of hypoglycaemia)

  Manage prolonged or repeated seizures
• What is the aftercare of hypoglycaemia?


  Consider medication changes

  Investigate possible non-drug causes (if needed)
• DVLA has regulations for pts with hypoglycaemia

  This is dependent on severity, frequency of episodes, type of license & specific medication regimen.
• What is neonatal hypoglycaemia?

  Low blood sugar (usually < 2.6 mmol/L) in newborns.

  Normal term babies often have hypoglycaemia in first 24 hrs of life
• What may persistent/severe neonatal hypoglycaemia may be caused by?

  Preterm birth (< 37 wks)

  Maternal diabetes mellitus

  IUGR (intra-uterine growth restriction)

  Hypothermia

  Neonatal sepsis

  Inborn errors of metabolism

  Nesidioblastosis

  Beckwith-Wiedemann syndrome
• What are the signs & symptoms of neonatal hypoglycaemia?

  May be asymptomatic

  Jitteriness

  Tachypnoea

  Irritable

  Pallor

  Poor feeding/sucking

  Weak cry

  Drowsy

  Hypotonia

  Seizures

  Apnoea

  Hypothermia
• What is the management of neonatal hypoglycaemia?

  Asymptomatic

  • encourage normal feeding
  • monitor blood glucose

  Symptomatic OR very low blood glucose

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