Hypoglycemia

About Hypoglycemia

Hypoglycemia, low blood glucose usually defined as below 70 mg dL 3.9 mmol L, most commonly occurs as a complication of diabetes treatment, particularly with insulin or sulfonylureas. It is common in type 1 diabetes and is a major limiting factor in diabetes management. Whipple triad defines true hypoglycemia: symptoms consistent with low glucose, documented low glucose during symptoms, and symptom resolution with glucose correction. Symptoms fall into two categories. Adrenergic symptoms from sympathetic activation include tremor, sweating, palpitations, hunger, anxiety, and tingling. Neuroglycopenic symptoms from brain glucose deprivation include confusion, difficulty speaking slurred speech, blurred vision, dizziness, weakness, drowsiness, seizures, and loss of consciousness. Severe hypoglycemia requiring assistance is a medical emergency. Repeated episodes cause hypoglycemia unawareness, where the patient loses adrenergic warning symptoms, creating a dangerous cycle. Non diabetic causes include insulinoma pancreatic insulin producing tumor, adrenal insufficiency, severe liver disease, alcohol binge drinking without eating, medications quinine, pentamidine, and factitious or surreptitious insulin use. Diagnosis of non diabetic hypoglycemia requires documenting low glucose during symptoms with simultaneous insulin and C peptide levels. For a conscious person, management typically involves fast acting carbohydrate such as glucose tablets or a sugary drink, followed by rechecking glucose, as set out in an individual diabetes care plan. Severe hypoglycemia with unconsciousness or seizures is a medical emergency; call your local emergency number. Treatment includes glucagon given by a trained person or intravenous glucose in hospital. Strategies to reduce hypoglycemia include reviewing insulin regimens with a clinician, continuous glucose monitoring CGM with alarms, and structured diabetes education.