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CDHB

Hypoglycaemia

In Patients with Diabetes

This is commonly seen in patients on insulin or sulphonylureas. Manage as detailed below, but usually no need to draw blood for laboratory tests to investigate the cause of the hypoglycaemia. A mismatch of insulin or sulphonylurea to carbohydrate intake is the likely cause of hypoglycaemia. Consider worsening renal function or (rarely) hypocortisolism as possible contributors.

In Patients without Diabetes

If hypoglycaemia is suspected (bedside glucose low, <3 mmol/L) but the patient is not known to be on treatment for diabetes, i.e., possible insulinoma or inappropriate ingestion of a sulphonylurea: take venous blood sample for glucose, insulin and C-peptide (9 mL blood into EDTA tubes and contact Biochemistry for immediate 4°C centrifugation and freezing of plasma) before giving IV glucose. If venous glucose confirms hypoglycaemia (<3 mmol/L), consult the Endocrine team.

Management of Hypoglycaemia

• If the patient is unconscious, deal with the airway, breathing and circulation, before confirming the diagnosis with a bedside finger prick blood test and also a laboratory blood glucose.
• Take blood for these tests before giving 50 mL 50% IV glucose (dextrose).
• When the patient has regained consciousness, give the patient food (short-acting carbohydrate followed by long-acting carbohydrate).
• If the patient is hypoglycaemic due to a long-acting sulphonylurea, the hypoglycaemia may recur up to 48 hours after initial presentation and regular capillary glucose checks are needed over this period. Management with a 10% glucose drip may be required.
• If the patient is hypoglycaemic but conscious, and can be persuaded to drink, oral glucose is appropriate but this should also be followed up by food. Half a glass of lemonade or fruit juice may be an appropriate first step, depending on clinical circumstances such as degree of hypoglycaemia, amount of insulin taken, etc. The patient's capillary glucose should be checked every 10 minutes, and further lemonade/fruit juice given until glucose >3.5 mmol/L, and then longer acting carbohydrates given (or usual meal if available in less than 15 minutes).
• What precipitated hypoglycaemia?
  • Once the patient has recovered, consider precipitating causes (alcohol, dose of insulin or sulphonylurea too high). If the precipitating cause is found to be related to diabetes self-care, consider referral to the Diabetes Centre for further patient education.

Topic Code: 1377