Adult Medical Emergency Handbook - Scottish Intensive Care Society

HYPOGLYCAEMIA
INTRODUCTION
• Complication of diabetes most feared by patients.
• Mild hypoglycaemia common in diabetic patients on insulin and is
usually managed by themselves.
• Severe hypoglycaemia is that requiring help from another person
to treat it.
• Unconsciousness caused by hypoglycaemia in hospital setting
requires parenteral treatment.
• Hypoglycaemia is implicated in 4% of deaths in diabetics under
the age of 50 years.
RECOGNITION AND DIAGNOSIS
• Defined arbitrarily as laboratory blood glucose < 3.5 mmol/l.
• Always confirm hypoglycaemia with a laboratory measurement,
but treat on basis of BM while awaiting lab result.
• Symptoms of hypoglycaemia are age specific, with behavioural
change being common in children and neurological symptoms
prominent in the elderly - always check blood glucose in patients
with suspected stroke or altered conscious level (including
confusion).
• Most patients presenting with hypoglycaemia will be on insulin or
sulphonylurea drugs, e.g. gliclazide.
AETIOLOGY
In patients with diabetes mellitus on insulin or sulphonylureas (not
biguanides i.e. metformin or thiazolidindione) common causes
include:
• Lack of food.
• Unaccustomed exercise.
• Alcohol
• Excess insulin.
• May be more than one of these factors. About 25% of Type 1
diabetic patients have reduced/lost awareness which increases
the risk of severe hypoglycaemia.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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