Abnormal blood sugar
An abnormal blood sugar - outside 3.5mmol/L to 5.5 mmol/L in a fasting glucose test.
Very common, especially as you get older.
Obviously, two main types:
- Commonest cause by a long way is diabetics not eating enough, or taking too much insulin/metformin.
- Less common in normal people not eating enough.
- Even less common is an insulin secreting tumour.
- Finally, neonates can have it, from a multitude of reasons.
- Again, the biggest cause by far is diabetes, both Type 1 and Type 2.
- Next most common is drug related. The commonest causes are: steroids, beta blockers and thiazide diuretics.
- Finally, some people who are critically ill can develop a hyperglycaemia. This needs treating, as studies show it can have an effect on survival rates.
Clinical and Associated Features
Hypoglycemia can cause:
One of the later presentations is new onset coma.
Hyperglycemia can cause:
The hyperglycaemia triad:
- Polyuria Frequent urination
- Polydipsia - Excessive thirst
- Polyphagia - Excessive hunger
- Blood glucose
Others depending on likely cause.
Basically give them sugar. Ideally orally (give them an apple), but if unconscious or fitting, iv 200-300ml 10% dextrose (do NOT give 50% as it harms veins).
Generally, it's about treating diabetes. However, there is an emergency called HONK coma (hyperglycaemic hyperosmolar non-ketotic coma) This how to deal with HONK:
- Clinical features: up to 1 week history of dehydration, focal CNS signs
- Blood glucose >35mmol/L, no acidosis (often old patients who don't switch to ketone metabolism)
- Osmolality >340mosmol/kg