What treatment option should you consider first for this patient?

If we predict IV cannulation is going to be very difficult, can we consider giving IM glucagon whilst gaining access?

You have an assessment of the patients’ veins whilst your colleague continues with their basic observations. Their veins look difficult, so you consider IM glucagon. You look in your JRCALC and see it is contraindicated in patients with Pheochromocytoma. What is this?

Why is IM glucagon contraindicated in patients with pheochromocytoma?

Luckily, after your first attempt of IV access, you are successful and therefore avoid giving IM glucagon. You start treatment by giving 100 ml IV 10% glucose. Your colleague has also finished his set of observations which are: 90 HR, 14 RR, 110/76 BP, 98% Sp02 and 36.0 Temperature. You start to see a rapid improvement in the patient’s symptoms, and she starts to converse with you after approximately 10 minutes. You test her blood sugars again and they are now 4.5mmol/L. What next line of treatment would you consider?

You start to discuss her current management for her diabetes. She hasn’t seen her diabetic nurse for 6 months and she has not had any recent changes to her medications. She does explain that she gets very little warning of when she is getting a hypo, and recently they have been getting more common. She is getting them every 4-5 days now. She could normally tell when her blood sugars were low in the past due to her sweating and feeling nauseous/lethargy, but she doesn’t get this anymore. This can be common in insulin dependent diabetic patients, what is this called?

What pathophysiology is responsible for the syndrome ‘impaired awareness to hypoglycaemia’?

The patient has eaten complex carbohydrates and is quickly feeling back to her normal self. The only additional treatment you have given is the 100ml of 10% glucose. Observations are all normal including her blood sugars at 6.9mmol/L after 45 minutes from initial treatment. She is now feeling fit and well, back to her usual self. The patient has no further PMH and the only other medication taken is metformin. What management plan do you think is most appropriate for this patient?

What prescribed medications need to be considered when deciding if it is safe to discharge a patient at home due to them being longer acting in effect and may result in a prolonged or recurrent hypoglycaemic event?

Following further review of normalised observations and assessment of the patient, and the patient feeling their normal selves, you put in the necessary safety netting to leave the patient at home. The further primary care assessment has been booked, and the patient will be assessed later in the day.

What neuroglycopenic signs and symptoms are associated with diabetes? TICK ALL THAT APPLY

Considering treatment in non-diabetic patients, you must start hypoglycaemia treatment if they have a blood sugar level of 3.8mmol/L?

What is diabulimia?

Which complications can be associated with diabetes we should be aware for as it will help our assessment of the general health of our diabetic patients?

What percentage of pregnant women will develop gestational diabetes and how likely does this diagnosis transfer into diabetes after pregnancy?

Can hypoglycaemic episodes be reportable to the DVLA if certain conditions are met?