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Hypoglycemia
Aka: Hypoglycemia
- See Also
- Postprandial Hypoglycemia (Reactive Hypoglycemia)
- Fasting Hypoglycemia
- Hypoglycemia Management
- 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
- Causes
- Subtypes
- Postprandial Hypoglycemia (Reactive Hypoglycemia)
- Fasting Hypoglycemia
- Endocrine disorders
- Diabetes Mellitus on Insulin or Insulin Secretagogue
- Adrenal Insufficiency
- Pheochromocytoma
- Hyperthyroidism
- Substance Abuse or Overdose
- Alcoholism with Alcohol Intoxication
- Cocaine
- Salicylate Toxicity
- Nutritional
- Nutritional Deficiency
- Eating Disorder
- Liver disease (e.g. Cirrhosis)
- Medications
- See Sulfonylurea Drug Interactions Causing Hypoglycemia
- Insulin, Insulin Secretagogue
- Quinolones (esp. Gatifloxacin and esp. with Sulfonylureas)
- Methadone
- Tramadol
- Pentamidine
- Quinine
- Symptoms
- Sensitivity to hypoglycemic episodes decreases with recurrent hypoglycemic episodes
- Higher risk for severe Hypoglycemia
- Sympathetic response
- Sweating
- Tremor
- Tachycardia
- Anxiety
- Hunger
- Neurologic symptoms
- Dizziness
- Visual disturbance
- Confusion
- Loss of consciousness
- Convulsions
- Syncope
- Diagnosis: Whipple's Triad
- Low Plasma Glucose
- Men < 2.8 mmol/L (50 mg/dl)
- Women < 2.2 mmol/L (40 mg/dl)
- Hypoglycemic Symptoms
- May be masked by certain conditions or medications
- Autonomic Neuropathy
- Beta Blockers
- Symptoms improve with plasma Glucose correction
- Management
- See Hypoglycemia Management
- 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)
- Consider replacing Sulfonylurea with alternative
- Gliptin (e.g. Januvia)
- GLP-1-agonist (e.g. Byetta)
- Pioglitazone (Actos)
- 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)
- References
- Inzucchi (2012) Diabetes Care 35(6):1364-79 [PubMed]