Summary
Definition
History and exam
Key diagnostic factors
- known diabetes
- presence of risk factors
Other diagnostic factors
- irritability
- shakiness
- sweating
- tremor
- palpitations
- tachycardia
- feeling warm
- anxiety
- nausea
- hunger
- pallor
- higher blood glucose than usual on waking up
- seizure
- loss of consciousness
- coma
- confusion
- problems with short-term memory
- changes in vision
- changes in speech
- difficulty hearing
- lethargy
- drowsiness
- quietness
- tantrums
- erratic behavior
- nightmares
- headache
- difficulty concentrating
- dizziness
- fall or motor vehicle accident
- bedwetting
Risk factors
- type 1 diabetes
- antidiabetic drugs
- age >60 years
- age <6 years
- poor glycemic control
- intensive glycemic control efforts
- previous severe (level 3) hypoglycemia
- previous clinically significant (level 2) hypoglycemia
- increased duration of diabetes
- treatment with insulin >5 years
- impaired cognitive function
- impaired awareness of hypoglycemia
- first trimester of pregnancy
- failure to thrive in children
- poor oral intake
- weight loss
- malnutrition
- sleep
- hypoglycemia-causing drugs (nondiabetic)
- exercise
- renal failure
- liver failure
- endocrine disorders
- critical illness
- alcohol ingestion
Diagnostic tests
1st tests to order
- blood glucose
Treatment algorithm
level 3 (severe) hypoglycemia or unconscious or unable to take glucose orally
level 1 (alert value) or 2 (clinically significant) hypoglycemia and conscious and able to take glucose orally
Contributors
Authors
Guillermo Umpierrez, MD
Professor of Medicine
Emory University School of Medicine
Atlanta
GA
Disclosures
GU has received research grant support to Emory University from Dexcom, Abbott, and Bayer. Previous support was received from AstraZeneca.
Andrew Muir, MD
Marcus Professor of Pediatrics
Chief of Pediatric Endocrinology
Emory University School of Medicine
Atlanta
GA
Disclosures
AM has received research grant support to Emory University from the National Institute of Diabetes and Digestive and Kidney Diseases and Boehringer Ingelheim.
Khemaporn Lertdetkajorn, MD
Fellow
Emory University School of Medicine
Atlanta
GA
Disclosures
KL declares that she has no competing interests.
Peer reviewers
Kasia J. Lipska, MD, MHS
Associate Professor of Medicine
Yale School of Medicine
New Haven
CT
Disclosures
KJL receives grant support from the National Institutes of Health and other support from Centers for Medicare & Medicaid Services (CMS) to develop and evaluate publicly reported quality measures. KJL also receives royalties from UpToDate for writing and editing content.
Edward Jude, MD, MRCP
Consultant Physician and Diabetologist and Professor of Medicine
Tameside and Glossop Integrated Care NHS Foundation Trust
Ashton-under-Lyne
UK
Disclosures
EJ declares that he has no competing interests.
May Ng, OBE, PhD, MBA, LLM, MSc, MBBS, FRCPCH, FHEA, SFFMLM
Honorary Professor and Consultant Paediatric Endocrinologist
Southport and Ormskirk Hospital NHS Trust
Southport
UK
Disclosures
MN declares that she has no competing interests.
Differentials
- hypoglycemia due to nondiabetic drugs
- acute or chronic liver failure
- chronic kidney disease
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