Endocrine & metabolic · UKMLA & AKT
Hypoglycaemia in diabetes
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Common triggers: excess insulin or sulfonylurea relative to carbohydrate intake or energy expenditure
- Specific precipitants: missed/delayed meals, unplanned excess exercise, alcohol (inhibits hepatic gluconeogenesis), renal impairment (reduces insulin clearance), lipohypertrophic injection sites
- Counter-regulation: glucagon (alpha cells) → hepatic glycogenolysis/gluconeogenesis; then adrenaline → raises glucose + autonomic warning symptoms
- Repeated hypoglycaemia resets the counter-regulatory threshold lower → adrenaline released only when glucose already dangerously low → hypoglycaemia unawareness (IAH)
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