Hypoglycemia, Diabetic
Hypoglycemia, Diabetic
Signs and Symptoms
History
Symptoms are idiosyncratic and vary considerably between individuals (6)[A].
Gather detailed history.
Adrenergic hypoglycemia symptoms:
Hunger, trembling, pallor
Sweating, shaking, pounding heart, anxiety
Neuroglycopenic hypoglycemia symptoms:
Dizziness, poor concentration, drowsiness, weakness, confusion, lightheadedness, slurred speech, blurred vision, double vision, unsteadiness, poor coordination
Behavioral hypoglycemia symptoms:
Tearfulness, confusion, fatigue, irritability, aggressiveness
Physical Exam
General: Confusion, lethargy
HEENT diplopia
Cardiologic: Tachycardia
Neurologic: Tremulousness, weakness, paresthesias, stupor, seizure, or coma
Mental status: Irritability, inability to concentrate, or short-term memory loss
Skin: Pale, diaphoresis
End organ damage: Microvascular, macrovascular, ophthalmologic, neurologic, renal
Tests
Lab
Plasma or whole-blood glucose <70 mg/dL
Suspect hypoglycemic unawareness in type 1 asymptomatic diabetes with low/normal HgbA1c.
Chronic hypoglycemia is indicated by low glycohemoglobin level.
Disorders that may alter lab results: Hemoglobinopathies may alter HgbA1c results.
Differential Diagnosis
Aspirin induces hypoglycemia in some children.
Hypoglycemia is well-documented in chronic alcoholics and binge drinkers.
Gastrointestinal dysfunction causing postprandial hypoglycemia or alimentary reactive hypoglycemia
Hormonal deficiency states (hormonal reactive hypoglycemia)
Idiopathic reactive hypoglycemia (reactive hypoglycemia, a popular diagnosis 20 years ago, is actually quite rare)
Hypoglycemia of sepsis
Islet cell tumors
Factitious hypoglycemia from surreptitious injection of insulin
Hypoglycemia may be found in nondiabetics under certain conditions such as early pregnancy, prolonged fasting, long periods of strenuous exercise, heart failure, malignancy, and renal or liver disease.
