CMT05210: INTERNAL
MEDICINE
Session 7: Hypoglycaemia
Learning objectives
At the end of this session each participant should
be able to;
• Define hypoglycaemia
• Describe pathogenesis of hypoglycaemia
• Explain clinical features of hypoglycaemia
• Explain complications of hypoglycaemia
• Describe management hypoglycaemia
• Provide measures to prevent and control of
hypoglycaemia
Hypoglycaemia
• Hypoglycemia also known as low blood sugar, is a fall
in blood sugar to levels below 2.5mmol/L (45mg/dl) in
normal nourished person OR
• Below 3mmol/L (54mg/dl) in malnourished.
• Common causes are;
• starvation
• Drug-induced—taking too much insulin
• Insulinoma (a pancreatic tumour that make insulin)
• Alcoholism as Ethanol lowers nicotinamide adenine
dinucleotide levels thus decreases gluconeogenesis
• Postoperative complications after gastric surgery (due to
rapid gastric emptying)
• Adrenal insufficiency
• Liver failure (Hepatitis, liver cirrhosis and Cancer)
• Critical illness (Infections and Immune reactions
Pathophysiology
• When glucose levels becomes low, insulin levels
decrease. This decrease is normally enough to
prevent hypoglycemia.
• As glucose levels decrease further, glucagon
levels increase (glucagon is the first line of
defense against more severe hypoglycemia).
Epinephrine is the next hormone to combat
hypoglycemia. Cortisol and other
catecholamines also play a role.
• As glucose levels get very low symptoms
begin;
• Confusion, abnormal behavior or both, such
as the inability to complete routine tasks,
Clinical features
• Confusion,
• abnormal behavior or both, such as the inability to complete
routine tasks,
• anxiety
• Visual disturbances,
• headache,
• blurred vision,
• Seizures,
• sweating,
• tremors,
• weakness,
• drowsiness,
• increased BP and pulse,
• Loss of consciousness.
Investigations
These should be done
• Random blood glucose
• Urine dipstick,
• Arterial Blood gases,
• Serum electrolyte panel (sodium & potassium)
Also do the following investigations as they deem
necessary
• Blood culture and sensitivity
• MRDT / BS for Malaria
• BUN – Blood urea nitrogen
• Urinalysis
Management
Management Principles;
• admission in high dependency area of Medical
ward or ICU.
• Correction of hypoglycemia with glucose
• Treatment of causative factors, if present
Correction of hypoglycemia.
• Give Dextrose 10% IV 5ml/Kg as a BOLUS
• Re check the blood glucose level after 30minutes
• if still low repeat 5ml/kg 10% Dextrose IV
• Feed the patient as soon as he/she is conscious
• If the child is able to feed without danger of
aspiration give sugar solution OR
• fluids containing 5 – 10 % dextrose
• When hypoglycemia resolves, continue with normal
feeding.
• NB; it is mandatory to investigate and Treat the
causative factors, if present
Evaluation
• Define Diabetic hypoglycaemia
• Explain the clinical features
hypoglycaemia.
• Describe the treatment of
hypoglycaemia
.
References
• Davidson, S, (2014) - Principles and Practice of
Medicine, 22nd Edition, Churchill Livingstone.
• Longmore, M, et al, (1999), Oxford Handbook of
Clinical Medicine, 6th Edition, Oxford
• Swash, M., & Glynn, M. (2007). Hutchinson’s Clinical
Methods: An Integrated Approach to Clinical Practice:
22nd Edition. Philadelphia, PA: Saunders Elsevier
• Trouse, (2000) Short textbook of Medicine University
Press
• MoHCDGEC Standard treatment guidelines & national
essential medicines list tanzania mainland 2017
• MoHCDGEC/ NACTE (2016). Curriculum for
Technician Certificate (NTA Level 5) Curriculum,
Dodoma.
