Hypoglycemia

Question 1

What is and what causes hypoglycemia?

Answer 1

• Defined as a decreased serum glucose < 70 mg/dL; however symptoms may not occur until plasma glucose concentrations drop below 55mg/dL; there is no lab value, but rather a serum glucose of at least 70 mg/dL or less and a patient presentation of symptoms that defines hypoglycemia.
• In patients who do not have diabetes, hypoglycemia is uncommon; but when it occurs there are a few major causes of hypoglycemia: pharmacologic, alcohol, critical illness, counter-regulatory hormone deficiencies (cortisol deficiency), and non-islet cell tumors (insulinomas)
• Most cases of hypoglycemia occur in diabetic patients undergoing therapeutic intervention with meglithinides, sulfonylureas, or insulin.
• Severe hypoglycemia: hypoglycemia severe enough that the patient needs assistance dealing with it.

Question 2

What are the physical/subjective exam findings associated with hypoglycemia?

Answer 2

• Dizziness
• Weakness
• Neuro changes- mental status changes, seizures, coma
• Tremors
• Sweating
• Tachycardia
• Palpitations
• Paresthesias

Question 3

How do you manage patients with hypoglycemia?

Answer 3

If symptomatic, in hospital give:

• D50W 25-50mL, or
• Glucagon 1mg, or
• Glucose tablets 16gms

If in community setting, teach patient to take:

• Glucose tabs 16gms or equivalent in food source
• Monitor glucose levels as necessary. If taking oral anti-glycemic agents, follow closely for 24-48 hours.*