INFORMATION FOR CANDIDATE:

Your next patient in general practice is a 57 year

old Bruce Jones presenting because she had an
episode of nausea, sweating, dizziness and light
headedness this morning which scared her.

YOUR TASK IS TO:

 Take a history
 Examine the patient
 Arrange for appropriate investigations
 Discuss the most likely diagnosis and
management with the patient
HOPC: Your next patient in general practice is a 57 year old Bruce Jones presenting
because she had an episode of nausea, sweating, dizziness and light headedness this
morning which scared her because his heart was pounding as well.
Bruce has been an insulin dependent diabetic for 6 years, usually well controlled. He
measures is blood sugar level with a glucometer at home once per day and tries to keep a
Last night he did not have much for dinner and this morning he took his usual insulin,
took the dog for a walk forgetting to have his breakfast. When he returned home he
suddenly felt nauseated, became very sweaty, suffered from dizziness and light
headedness. He first just lied down to relax but got so scared that he thought he better see
a doctor.

PHx.: T2DM diagnosed 10 y ago, requiring additional insulin 6 y ago, cholecystectomy 4

y ago no other problems

FHx.: NAD

SHx: widowed electrician, 2 adult children, lives on his own with a dog and a cat, non
smoker, little alcohol, no recreational drugs, NKA, takes protophane 20 units bd (long
acting insulin)

EXAMINATION: somewhat pale looking man with normal vital signs.

INVESTIGATIONS:
 BSL fingerprick 3.5!
 Urine dipstick: glucose +, otherwise normal

DIAGNOSIS: HYPOGLYCAEMIA
The normal blood sugar level in adults is 3.6 – 5.8 mmol/L and should be at that level
even in diabetics. Hypoglycaemia (very low blood sugar) means BSL >3 mmol/L and
usually occurs in insulin dependent diabetics although it can happen in T2DM on oral
hpoglycaemic medications, especially with sulphonylureas.
Common symptoms are:
 Nausea
 Sweating
 Tremor
 Palpitations
 Perioral paraesthesia
 Feeling of hunger
 Loss of consciousness

The causes include:

 Inadequate food intake
 Increased exercise
 Drugs (salicylates, iron, alcohol, pentamidind, chlopropamide)
 Hepatic disease (cirrhosis, Reye syndrome – hypolgycaemia in infants only)
 Addision’s
 Lung cancer
 Malaria
  Sepsis
 Status epilepticus
 Insulinoma

MANAGEMENT:
 Fruit juice or lemonade
 Jelly beans or honey
 Glucagon (1 mg i.m, s.c. or i.v)
 Repeat BSL fingerprick,
 Referral to diabetic educator
 Explain long term problems with diabetes (kidneys, eyes, etc.)
 If a patient is unconscious s/he needs iv 10 -25 – up to 50 ml of 50% dextrose (can
be given pr)