Hypoglycaemia

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Hypoglycaemia

• a potential problem for all patients on insulin
• symptomatic when blood glucose <3 mmol/l

Symptoms

• Early
  • sweating
  • tremor
  • pounding heart beat
• Severe
  • personality change
  • coma

Examination

• Early
  • pallor
  • cold sweat
• Severe
  • pale
  • drowsy
  • detached
  • behaviour
    • clumsy
    • inappropriate
    • irritable / aggressive
  • coma
  • convulsions

Exacerbating factors

• Tight control of DM
  • lowers the glucose concentration needed to trigger hypoglycaemic symptoms
  • increase in frequency of hypoglycaemic episodes decreases the warning symptoms experienced by the patient
  • important to adjust appropriately the individual’s insulin type, dose and frequency and the time and quantity of meals and snacks.
• beta-blockers 
  • blunt hypoglycaemic awareness 
  • delay recovery.

• human insulin 

  • claimed to decrease hypoglycaemic warnings (no scientific evidence)

  • patient may revert to porcine insulin.

Treatment

• Mild
  • readily absorbed oral carbohydrate
• severe
  • 25-50ml IV glucose 50% + saline flush
  • IM glucagon (in community)

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