Pathology:                    Mismatchin glucose supply, glucose utilisation, and circulating insulin. Blood glucose<4mmol/L


Aetiology:                     Poororal intake, Missed/delayed meal, drugs (insulin, sulfonylureas), ethanolingestion (delayed effect), diabetic gastroparesis, Addison’s disease, postexercise in insulin or SU treated subjects, sepsis, Insulinoma


Symptoms:                   Autonomic: Anxiety, sweating, hunger, palpitations

                                          Neuroglycopaenic: clumsiness, amnesia


Signs:                              Autonomic: tachycardia, tremor, pallor

Neuroglycopaenic:incoordination, aggression, drowsiness, slurred speech,

confusion, coma,personality change


Investigations:          Bloods: Glucose

                                          Other:Assess for underlying cause, should be ordered if indicated; Short

synacthen test, serum insulin & c-peptide(in non-diabetes patients),

pituitary profile, 72 hour fast (hypoglycaemiasurvey)


Treatment:                  Conscious patient: 20-30 g of quickacting carbohydrate (e.g. 4-6 dextrose tabs,

100 ml Lucozade, 150ml fruit juice)

Unconscious: Glucagon1mg IM or SC, 50 ml 20% dextrose IV.


Follow up: Slow release carbohydrate, repeat glucose levels, andeducation to recognise and avoid further episodes


Complications:          Injury, neurological (cognitivedeficit, stroke), coma, death


Prognosis:                    Usuallygood unless prolonged severe or recurrent hypoglycaemia


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