Acute metabolic derangements - hypoglycaemia
Description
Whipple's triad - required before investigating anyone without diabetes
1. Symptoms consistent with hypoglycaemia (ideally neuroglycopenic)
2. Low plasma glucose documented at the time of those symptoms
3. Resolution of symptoms when the glucose is corrected
- A low capillary glucose in an asymptomatic person is not a hypoglycaemic disorder. Do not start a workup without the triad
Levels (diabetes)
| Level | Glucose | Meaning |
|---|---|---|
| 1 - alert | 3.0-3.9 mmol/L | Treat, review regimen |
| 2 - clinically significant | <3.0 mmol/L | Neuroglycopenia likely |
| 3 - severe | Any level | Cognitive impairment requiring another person's help - defined by the help, not the number |
Symptoms
- Autonomic (adrenergic/cholinergic, ~3.6-3.9) - tremor, palpitations, sweating, hunger, anxiety, paraesthesiae
- Warning symptoms. Masked by beta blockade, and lost in hypoglycaemia unawareness
- Neuroglycopenic (~<3.0) - confusion, behaviour change, slurred speech, incoordination, visual change, focal deficit, seizure, coma
- May be mistaken for stroke, intoxication or psychiatric illness
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