• Definition
  • 🍒Hypoglycaemia is defined as a blood glucose concentration <4mmol/L
  • 🍒What is the definition of a severe hypoglycaemic event as defined by AUDSROADs?
  • 🍒The minimum period of time before returning to drive after a severe hypoglycaemic event is 6 weeks
• Symptoms
  • Symptoms can broadly be classified as:
    • Adrenergic: pale skin, sweating, shaking, palpitations
    • Neuroglycopenic: hunger, difficulty concentration, confusion, unconsciousness, seizures
  • Hypoglycaemia unawareness
    • Typically adrenergic symptoms present at a higher threshold than neuroglycopenic (i.e. adrenergic symptoms present first to indicate the onset of decreasing glucose concentration)
      • Otherwise ⇒ hypoglycaemia unawareness
    • 🍒Hypoglycaemia unawareness is more common in type 1 diabetes
    • 🍒Hypoglcaemia unawareness may be screened for using the Clarke questionaire in insulin treated diabetes of >10 years duration
    • Hypoglycaemia unawareness is potentially reversible with strict avoidance of hypoglycaemia
  • Common acute precipitants of hypoglycaemia:
    • Variation in carbohydrate content of food intake (e.g. fasting)
    • Stopping hyperglycaemia-inducing drugs (e.g. Corticosteroids)
    • Suppression of glucose producing in the liver by alcohol
    • Vigorous and/or prolonged exercise
    • Incorrect dose or administration of insulin or long-acting sulfonylurea
    • 🍒Other than fasting and incorrect dosage of insulin, what are some acute precipitants of hypoglycaemia in diabetic patients?
• Management
  • Ideally, confirm hypoglycaemia by measuring the patient’s blood glucose concentration. However, if measurement is likely to be delayed, start treatment immediately.
  • Patients in the community ⇒ arrange immediate transfer to hospital by ambulance
  • 🍒What is the management of severe hypoglycaemia in the outpatient setting?
  • 🍒What is the management of severe hypoglycaemia in the inpatient setting?
  • 🍒What is the management of nonsevere hypoglycaemia?
  • 🍒What is the management of nonsevere hypoglycaemia in children/adolescents where oral intake is impractical?

https://aci.health.nsw.gov.au/ecat/adult/presyncope-or-syncope