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
