Hypoglycemia

Question 1

Definition of hypglycemia

Answer 1

blood glucose level < 50-60 mg/dL.

Question 2

What conditions are associated with hypoglycemia?

Answer 2

Adrenal insufficiency
Alcohol abuse (chronic)
Diabetics (predisposing factors – use of long acting insulin, oral hypoglycemic agents)
Insulinoma
Liver disease
Sepsis

Question 3

What can hypoglycemia mimic?

Answer 3

Coma
Stroke
Seizures
Syncope

Question 4

What are some CNS symptoms of hypoglycemia?

Answer 4

Altered level of consciousness
Agitation/combativeness
Confusion/lethargy
Seizures or focal neurologic deficits

Question 5

As glucose levels fall, a counter regulatory hormones rise resulting in a “hyperepinephrinemic” state. What symptoms would you see?

Answer 5

anxiety/irritability
diaphoresis
nausea/vomiting
nervousness
palpitations/tachycardia
tremor

Question 6

Who should be treated?

Answer 6

Patients with altered mental status and a blood glucose level < 60 mg/dL should be treatment for hypoglycemia.

Question 7

What are different ways to give glucose?

Answer 7

(1) Oral glucose is the best when it can be given safely in awake and alert patients. soda, juice, sandwich, snacks
(2) IV Glucose: In adults start with 50 ml of 50% Dextrose in Water (D50). In pediatric patients use 1 ml/kg of 25% Dextrose in water or 2-4 ml/kg of 10% Dextrose in water
(3) In adults administer 1 mg IM and 0.5 mg in pediatric patients < 20 kg (useful if no IV access)
(4) Ocreotide. May be useful in the setting of sulfonylurea-induced hypoglycemia not responsive to other therapies. Initial dose of 50-125 ug subcutaneously.

Question 8

Who should be admitted?

Answer 8

Strongly consider admitting patients who are on long-acting insulin or oral hypoglycemic agents.