hypoglycaemia

• symptoms include: anxiety, hunger, behavioural changes, headaches, sweating and palpitations
• signs include: tremor, confusion, seizures, bizarre neurological signs, sweating, tachycardia and coma
• we use finger prick blood glucose to diagnose. their blood glucose is <3 mmol/L
• if the cause of hypoglycaemia is not clear then take blood to check for levels of insulin, c-peptide, and cortisol
• treatment: start immediately. Give dextrose 50%, rapid IV injection, in 50mL of water. Then check glucose levels and clinical response of patient after 5-10 min. responding well-give large bore IV line keep open with dextrose 10%,IV. IF they not responding-give second dextrose 50%,IV,50mL
• To prevent recurrent hypoglycaemia, continue IV infusion with: Dextrose 10%,IV infusion at a rate of 1L 6hourly. once the patient blood glucose is normal/increased and they are awake-then check their blood glucose every hour-keep blood glucose <15 and check their serum potassium for hypokalaemia
• during treatment: if the patient is still not conscious even after 30minutes and their glucose level is now normal/elevated,we will have to check for other causes of their coma,clearly it was not hypoglycaemia
• once the patient is awake after treatment give them a carbohydrated snack
• if the patient hypoglycaemia was due to sulphonylurea, then this patient will require hospitalization and give a prolonged IV glucose infusion. Do not use glucagon in this case-it will stimulate insulin secretion and cause reccurrent hypoglycaemia. check patient after 12hours after glucose infusion stopped
• if the patient is alcoholic or malnourished, give them thiamine 100mg IM or Vitamin B complex
• hypoglycaemic causes include: 1)inappropriate management- too much insulin/ high dose of sulphonylurea. 2)not following a good diet 3)alcohol abuse 4)endocrine 5)tumours 6)liver disease.
• other causes of hypoglycaemia can be associated with addison disease or hypopituitarism