II. Definitions
- Hypoglycemia
- Plasma Glucose <54 mg/dl (3.0 mmol/L)
- Severe Hypoglycemia
- Hypoglycemia event in which patient requires another person's assistance for management
III. Causes: Adults
- Subtypes
- Endocrine disorders
- Substance Abuse or Overdose
- Nutritional
- Nutritional Deficiency
- Eating Disorder
- Liver disease (e.g. Cirrhosis)
- Medications
- Miscellaneous
IV. Causes: Children
- Sepsis
- Inborn Errors of Metabolism
- Poor oral intake or decreased absorption (e.g. Diarrhea)
- Hypothyroidism
- Hypopituitarism
- Large malignancy (e.g. Wilms Tumor)
- Toxin Ingestion
V. Findings
VI. Diagnosis: Whipple's Triad
VII. Management
- See Hypoglycemia Management
- Manage underlying cause
VIII. Prevention
- See Diabetes Mellitus Glucose Management
- See Diabetes Sick Day Management
-
General Dietary Measures
- Avoid Fasting
- Small, frequent meals
- Prepare Emergency Kit that is always available
- Medical alert bracelet
- Glucagon
- Emergency Glucose Replacement
- Glucometer
- Prepare for a hypoglycemic event (and teach family and friends)
- Recognize signs of Hypoglycemia (e.g. Altered Level of Consciousness or confusion, sweating, Dizziness)
- Test Blood Glucose for Hypoglycemia symptoms (but do not delay replacement)
- Treat Hypoglycemia if Blood Glucose <70 mg/dl (or <80-90mg/dl in elderly)
- See Hypoglycemia Management
- Deliver Glucagon in an unconscious or altered patient
- Temporize briefly until Glucose can be absorbed
- Deliver Emergency Glucose Replacement (15-20 grams Carbohydrate)
- Glucose monitoring
- Monitor Blood Glucose every 15 minutes until >100 mg/dl
- Redose Glucose replacement per above every 15 min as needed
- Eat a small meal once Blood Glucose has returned to a normal level
- Adjust diabetes Blood Sugar goals
- Indicated in those with multiple comorbid conditions, elderly or other risks of severe Hypoglycemia
- Allow Hemoglobin A1C to rise to around 8%
- Adjust diabetes medications to lower risk of Hypoglycemia
- Avoid Glyburide (use other Sulfonylureas such as Glipizide or Glimepiride instead)
- Exercise particular care in the Nursing Home elderly who frequently have unrecognized Hypoglycemia (weekly)
- Consider replacing Sulfonylurea with alternative
- Avoid Sulfonylurea with Insulin (especially with short-acting or Bolus Insulin such as Lispro/Humalog, Novolog)
- Sulfonylureas may be used with long-acting or Basal insulin (e.g. Lantus, Levemir) in patients at lower risk of Hypoglycemia
- Convert older Insulin preparations to newer agents with better predictable onset and duration
- Convert NPH Insulin to newer long-acting or Basal insulin (e.g. Lantus, Levemir)
- Convert Regular Insulin to newer short-acting or Bolus Insulin (e.g. Lispro/Humalog, Novolog)