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Hypoglycaemia

Background knowledge ๐Ÿง 

Definition

  • Blood glucose level < 4.0 mmol/L
  • Symptoms due to low blood glucose
  • Can be classified as mild, moderate, or severe

Epidemiology

  • Common in diabetic patients on insulin or sulfonylureas
  • Can occur in non-diabetic individuals due to various causes
  • More frequent in type 1 diabetes
  • Incidence increases with tighter glycaemic control

Aetiology and Pathophysiology

  • Excess insulin or insulin secretagogues
  • Predisposing factors
    • Decreased food intake
    • Increased physical activity
    • Alcohol consumption
  • Other conditions
    • Adrenal insufficiency
    • Hypopituitarism
    • Insulinoma
    • Malnutrition
    • Glycogen storage disorders
  • Critical illnesses (e.g., sepsis)

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Sweating
  • Tremors
  • Hunger
  • Anxiety
  • Dizziness
  • Palpitations

Signs

  • Confusion
  • Drowsiness
  • Seizures
  • Coma
  • Pallor
  • Altered behaviour

Investigations ๐Ÿงช

Tests

  • Blood glucose measurement (finger prick)
  • Plasma glucose levels
  • Insulin and C-peptide levels
  • Ketones (blood and urine)
  • Critical sample: glucose, insulin, C-peptide, beta-hydroxybutyrate, cortisol, GH

Management ๐Ÿฅผ

Management

  • Immediate oral glucose (e.g., sugary drink)
  • If unconscious, IV dextrose or IM glucagon
  • Adjust insulin or oral hypoglycaemic therapy
  • Education on hypoglycaemia prevention
  • Consider continuous glucose monitoring (CGM)
  • Refer to diabetes specialist nurse or endocrinologist if recurrent

Complications

  • Neurological damage (prolonged or severe episodes)
  • Cardiovascular events
  • Recurrent hypoglycaemia unawareness
  • Increased risk of accidents and injuries
  • Impact on quality of life

Prognosis

  • Good if promptly and properly managed
  • Poorer outcomes if recurrent or severe
  • Dependent on underlying cause
  • Improved with patient education and regular follow-up

Key Points

  • Early recognition and treatment are crucial
  • Education on prevention strategies is vital
  • Regular monitoring and follow-up can prevent complications
  • Consideration of patient-specific factors is important in management

References

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