Hypoglycaemia

E10.0-1/E10.6/E11.0-1/E11.6/E12.0-1/E12.0-1/E12.6/E13.0-1/E13.6/E14.0-1/E14.6

Diagnosis: Clinical

Symptoms:

  • Anxiety
  • Sweating
  • Palpitations
  • Hunger
  • Headaches
  • Behavioural changes

Signs:

  • Sweating
  • Tremor
  • Tachycardia
  • Confusion
  • Bizarre neurological signs
  • Seizures
  • Coma

Biochemical

Act on finger prick blood glucose. Confirm with laboratory measurements if uncertain.

TREATMENT

Start immediately.

  • Dextrose 50%, rapid IV injection, 50 mL.

Assess clinical status and finger prick glucose level over the next 5–10 minutes.

LoEIII [21]

Establish a large bore intravenous line and keep open with:

  • Dextrose 10%, IV.

If no clinical response, give a second injection of:

  • Dextrose 50%, IV, 50 mL.

To prevent recurrent hypoglycaemia, continue infusion with:

  • Dextrose 10%, IV infusion, at a rate of ± 1 L 6 hourly.

Once blood glucose is normal or elevated, and the patient is awake, check blood glucose hourly for several hours, and check serum potassium for hypokalaemia.

If the patient has not regained consciousness after 30 minutes with normal or elevated blood glucose, look for other causes of coma.

Once the patient is awake, give a snack if possible, and admit for observation and education etc., to prevent further hypoglycaemic episodes.

If hypoglycaemia was caused by a sulphonylurea, the patient will require hospitalisation and a prolonged intravenous glucose infusion.

Observe patient for at least 12 hours after glucose infusion has stopped.

Recurrent hypoglycaemia

In cases of recurrent hypoglycaemia consider:

  • inappropriate management, e.g. too much insulin or too high dose of sulphonylurea,
  • poor meal adherence,
  • poor adherence,
  • alcohol abuse,
  • physical exercise,
  • factitious administration of insulin,
  • the “honeymoon” period of type 1 diabetes,
  • the advent of renal failure,
  • hypoglycaemic unawareness, or
  • pancreatic diabetes/malabsorption.

Other causes of hypoglycaemia should also be considered e.g. associated Addison’s disease or hypopituitarism.

Recurrent hypoglycaemia may be the cause of hypoglycaemic unawareness, which may occur in patients with type 1 diabetes. The loss of warning symptoms can lead to severe hypoglycaemia. In some cases, this situation can be restored to normal with avoidance of any hypoglycaemia for at least 2–4 weeks.