Makindo Medical Notes

🚨 Hypoglycaemia Urgent Management Capillary or Plasma Glucose < 3–4 mmol/L (≈72 mg/dL)

⚡ Symptoms: Trembling, sweating, confusion, hunger, anxiety, coma, seizures. 🧠 Neuroglycopenia: Drowsiness, speech difficulty, odd behaviour, collapse. ❗ Severe: Coma when CBG <1.5 mmol/L. If GCS <9 or difficult to manage → call for senior help/Crash team. 😊 Conscious & able to swallow: 4 Glucotabs OR Dextrogel OR 15–20 g rapid sugar (avoid diet drinks). 💉 Unconscious/unable to swallow: IV: 150 mL of 10% glucose (over 10–15 min). IM/SC: Glucagon 1 mg (intranasal where available). ⚠️ Less effective in malnutrition or liver failure. 🔁 Persisting hypoglycaemia: Infuse 10% glucose 1L over 4–6 h with CBG monitoring. 🕵️ Review cause: Missed meal? Sulfonylurea? Insulin error? Alcohol? Intercurrent illness?

📖 Introduction

• Hypoglycaemia is potentially fatal — delayed treatment risks irreversible brain injury.
• Most common cause: 💉 Insulin or sulfonylureas (missed meals, OD, deliberate self-harm).

⚠️ Think broadly: Addison’s disease, liver failure, alcohol binge without food, insulinoma, pituitary disease, quinine, severe sepsis, malaria.

🧪 Clinical Features

• 🤯 Autonomic: Sweating, tremor, palpitations, hunger, anxiety.
• 🧠 Neuroglycopenic: Confusion, odd behaviour, slurred speech, seizures, coma.
• 💥 May mimic stroke, seizure, delirium → always check CBG!

🧾 Whipple’s Triad

• Compatible symptoms/signs of hypoglycaemia.
• Documented low plasma glucose.
• Resolution after glucose correction.

🔍 Investigations

• Confirm lab glucose + CBG.
• Insulin & C-peptide (to distinguish endogenous vs exogenous insulin use).
• Consider: LFTs, renal profile, cortisol/ACTH, ±72-hour fast if unexplained.

💊 Management (Stepwise)

• 📏 Measure CBG: <3–4 mmol/L → act immediately.
• 🥤 If cooperative: 15–20 g rapid sugar (e.g., 150 mL pure juice). Recheck in 10–15 min. Repeat ×3 if still <4.
• 🍯 If uncooperative but safe swallow: 2 tubes of 40% glucose gel (e.g., Glucogel) buccally.
• 💉 If unable to swallow/unconscious:
  • IV 150 mL 10% glucose (or 20/50% equivalents) → recheck after 10 min.
  • IM/SC glucagon 1 mg (intranasal 3 mg if available).
• ⏳ Prolonged hypoglycaemia: IV infusion 10% glucose; monitor closely.
• 🍺 Alcohol/malnutrition: Give IV thiamine (Pabrinex) with glucose.
• 🔄 Aftercare: Prevent recurrence → adjust insulin/meds, review diet, diabetes specialist input.

📊 Causes (Mnemonics)

• Exogenous: Insulin, sulfonylureas, quinine, alcohol binge.
• Endogenous: Insulinoma, Addison’s, pituitary failure, severe sepsis.
• Misc: Critical illness, malnutrition, bodybuilders misusing insulin.

📑 References

• JBDS Hypoglycaemia Guideline (2020)