Hypoglycemia

Hypoglycaemia is an abnormally low concentration of blood glucose. Severe hypoglycaemia can be fatal or lead to irreversible neurological damage, Blood glucose levels should be measured whenever possible patients presenting symptoms of hypoglycaemia.

If hypoglycemia suspected but blood glucose measurement is not available, glucose to another available sugar) should be given empirically. Always consider hypoglycaemia in patients presenting impaired consciousness (lethargy, coma) or seizures.

Clinical features

Rapid onset of non - specific signs, mild to severe depending on the degree of the hypoglycemia: sensation of hunger and fatigue, tremors, tachycardia, pallor, sweats, anxiety, blurred vision, difficulty speaking, confusion, convulsions, lethargy, coma.

Hypoglycaemia

Capillary blood glucose concentration (reagent strip test);

Severe hypoglycaemia

3.3 mmol / liter (< 60 mg / dl )

Diabetic patients on home treatment

2.2 mmol / liter ( < 40 mg / dl )

Management Of Hypoglycemia Conscious patients: Children

3.9 mmol / liter ( < 70 mg / dl ) If blood glucose measurement is not available , diagnosis is confirmed when symptoms resolve after the administration of sugar or glucose.

Patients with impaired consciousness or prolonged convulsions

A teaspoon of powdered sugar in a few ml of water or 50 ml of fruit juice, maternal or therapeutic milk or 10 ml / kg of 10 % glucose by oral route or nasogastric tube

Children

15 to 20 g of sugar ( 3 or 4 cubes ) or sugar water , fruit juice , s etc. Symptoms improve approximately 15 minutes after taking sugar by oral route.

Adults

5 ml / kg of 10 % glucose by IV route ( 2 to 3 minutes ) or infusion

Causes other than diabetes

1 ml / kg of 50 % glucose by slow IV ( 3 to 5 minutes ) . Neurologic symptoms improve a few minutes after the injection.

• Check blood glucose after 15 minutes. If it is still low, re administer glucose by IV route or sugar by oral route according to the patient's clinical condition.
• If there is no clinical improvement, differential diagnoses should be considered: e.g. serious infection (severe malaria, meningitis, etc.), epilepsy.
• In all cases, after stabilization, give a meal or snack rich in complex carbohydrates and monitor the patients for a few hours.
• If patient does not return to full alertness after an episode of severe hypoglycaemia , monitor blood glucose levels regularly
• For the treatment of hypoglycemia in a person with impaired consciousness and no established IV access, immediate administration of glucagon is suggested, rather than waiting to establish IV access. Administration of glucagon (subcutaneous, intramuscular or nasal) will usually lead to recovery of consciousness within 15 minutes, although it may be followed by marked nausea or even vomiting. Dose of glucagon is 1mg IM / IV / SC and 3mg (nasal); May repeat in 15 minutes as needed.
• Last but not the least, underlying cause of hypoglycemia should be treated.

Diagnosis

• Endocrinology Treat severe malnutrition, neonatal sepsis, severe malaria, acute alcohol intoxication, etc.
• End prolonged fast
• Replace drugs inducing hypoglycemia (e.g. quinine IV, pentamidine, ciprofloxacin, enalapril, beta - blockers, high - dose or anticipate hypoglycaemia (e.g. aspirin, tramadol), administer quinine IV in a glucose infusion).

Non diabetic patients

• Avoid missing meals, increase intake of carbohydrates if necessary.
• Adjust dosage of insulin according to blood glucose levels and physical activity.
• Adjust dosage of oral anti - diabetics, taking into account possible drug interactions.