Hypoglycaemia

Hypoglycaemia is defined by Glucose < 4 mmol/L. It can present with:

• Shaking

• Sweating

• Headache

• Difficulty concentrating

• Slurred speech

• Confusion

• Loss of consciousness

Whipple's Triad

Signs suggesting hypoglycaemia:

• Symptomatic - Sweating, Shaking, Light-headedness, LOC

• Low glucose level

• Symptoms relieved by giving glucose

Causes

• Hyperinsulinaemia

  • Endogenous - Insulinoma

  • Exogenous - Iatrogenic (Insulin, Sulphonylureas, Sitagliptin), Deliberate

• No Hyperinsulinaemia

  • Endocrine deficiency affecting gluconeogenesis

  • Starvation

  • IGF2-secreting tumours (rare)

• Reactive

  • Alcohol, Methanol

  • Galactosaemia, Hereditary fructose intolerance

Investigations

• Insulin, C-peptide - distinguishes between exogenous and endogenous insulin production

• Cheking med hx for iatrogenic causes

• Abdominal CT/MRI/PET to localise an insulinoma

N.B. C-peptide is released as insulin is being made in the body.

Management

If the patient is conscious:

• A-E

• Give 15-20g of oral supplements such as glucose tablets, can of Coca-Cola, sweets or fruit juice

If the patient is unconscious/seizing:

• A-E

• 100ml 10% Dextrose IV over < 15 mins or 1mg Glucagon IM (if no IV access)