Hypoglycaemia

• Hypoglycaemia is defined as a blood glucose level < 4.0 mmol/L.
• Symptoms due to low blood glucose.
• Can be classified as mild, moderate, or severe.

• Common in diabetic patients on insulin or sulfonylureas.
• Can occur in non-diabetic individuals due to various causes.
• More frequent in type 1 diabetes.
• Incidence increases with tighter glycaemic control.

• Excess insulin or insulin secretagogues.
• Early symptoms related to increased adrenaline secretion (to increase blood sugar).
• Predisposing factors:
  • Decreased food intake.
  • Increased physical activity.
  • Alcohol consumption.
• Other conditions:
  • Adrenal insufficiency.
  • Hypopituitarism.
  • Insulinoma.
  • Malnutrition.
  • Glycogen storage disorders.
• Critical illnesses (e.g., sepsis).

• Sweating.
• Tremors.
• Hunger.
• Anxiety.
• Dizziness.
• Palpitations.

• Confusion.
• Drowsiness.
• Seizures.
• Coma.
• Pallor.
• Altered behaviour.

• Blood glucose measurement (finger prick).
• Plasma glucose levels.
• Insulin and C-peptide levels.
• Ketones (blood and urine).
• Critical sample (rule out underlying disorders): glucose, insulin, C-peptide, beta-hydroxybutyrate, cortisol, GH.

• Immediate oral glucose (e.g., sugary drink).
• If unconscious, IV dextrose or IM glucagon.
• Adjust insulin or oral hypoglycaemic therapy.
• Education on hypoglycaemia prevention.
• Consider continuous glucose monitoring (CGM).
• Refer to diabetes specialist nurse or endocrinologist if recurrent.

• Neurological damage (prolonged or severe episodes).
• Cardiovascular events.
• Recurrent hypoglycaemia unawareness.
• Increased risk of accidents and injuries.
• Impact on quality of life.

• Good if promptly and properly managed.
• Poorer outcomes if recurrent or severe.
• Dependent on underlying cause.
• Improved with patient education and regular follow-up.

• Early recognition and treatment are crucial.
• Education on prevention strategies is vital.
• Regular monitoring and follow-up can prevent complications.
• Consideration of patient-specific factors is important in management.

NICE guidelines: Diabetes in adults: diagnosis and management.