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Hypoglycemia - Symptoms
Discharge of the
sympathetic
nervous system
Central nervous
system glucose
deprivation
Sweating
Tachycardia
Anxiety
Hunger
Paresthesias
Palpitations
Altered LOC
Dizziness
Seizures
Coma
Blurred vision
Hypothermia
Whipples Triad
• Documented
hypoglycemia
• Symptoms
• Symptoms resolve w/
Glucose
Hypoglycemia
• Fasting (Post
absorptive)
– If reproducible, implies
disease, requires w/u
– Occurs after a fast or
exercise
– Do an overnight fast
– Etiology
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Drugs
Critical illness
Hormonal deficiencies
Hyperinslinism
• Reactive (Post
prandial)
– Reactive
– Usually not serious, self
limiting
– Etiology
• Idiopathic, s/p gastric
surgery, rarely
enzyme defect
Etiology –Fasting hypoglycemia
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•
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Alimentary hyperinsulinism
Hereditry fructose intolerance
Galactosemia
Leucine Sensitivity
Idiopathic
•Artifact
–Leukocytosis
–Polycythemia
Etiology –Fasting hypoglycemia
Impaired production
• Endocrinopathy
– Adrenal insufficiency
– Hypopituitary
– Glucogon deficiency
– Catacholamine
deficiency
• Starvation
• Organic
– Acute liver failure
– Chronic renal failure
– Acute CHF
• Drugs
– Alcohol Propanolol, Salicilates
• Hypothermia
Overutilization of Glucose
• Drugs
– Insulin,, Sulfonylureas,
Quinine, Disopyramine,
Pentamidine, Sulfonamides
• Tumor
– Insulinoma
• Infection
– Septicemia, Malaria
Hypoglycemia
• Emergency Department Presentation
– 2/3 Hx Diabetes
– 2/3 Recent ETOH use
– 1/4 Septic
– Comment: Think of hypoglycemia in septic,
drunk diabetics
• Hospitalized
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–
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–
60% Drugs (Insulin, sulfonylureas, ETOH)
15% Renal disease
15% Liver disease
Others malnutrition and sepsis
Work Up
• Identification
• Hx & PE
• Collect blood during
hypoglycemic
episode
– Check Glucose,
– Draw and hold blood
for Insulin (C-peptide
and Proinsulin) and
specific drug screen
• Treatment
– Glucose
• Repeat serum
glucose
– Treat primary
problem
Admission/Discharge
• Resolved hypoglycemia
• Resolution of symptoms
• Identification of primary
problem
– Severity
– Likelihood or
reoccurrence
– Use caution w/ patients
on long acting oral
hypoglycemics
• Food
• Social issues
– Food
– Live alone
– Was this an OD?
• Are there
hypoglycemic
drugs in the
home?
• Healthcare worker
Clinical Pearls
• In diabetics, hypoglycemia is almost always
related to medication
• In a nondiabetic with confusion, LOC, Sz, a
workup is required
• Hypoglycemia in a nondiabetic w/o sepsis.
Liver dz, renal dz, or Hx of ETOH should
raise the suspicion of an insulinoma, tumor,
hormonal, etc
More Pearls
• Poorly controlled
IDDM will suffer
hypoglycemia at a
higher glucose level
• Pt w/ controlled
IDDM and
insulinomas can
tolerate lower
glucose levels
• Neurohypoglycemia
~ 54
• Arterial gluc levels
are higher (30%)
• Use caution in pts
on beta blockers