Hypoglycemia in Adults

Clinical Description

Low blood sugar level below 70mg/dl (3.9mmol/L). Severe hypoglycemia (blood sugar < 2.2mmol/l).

Causes/risk factors:

• Overdose of anti-diabetic medications (oral or insulin)
• Anti-diabetic drugs in renal impairment
• Elderly
• Omitted meals or inadequate meals
• Excessive unaccustomed physical activity
• Excessive alcohol intake
• Liver failure

Signs and Symptoms

• Sweating
• Excessive hunger
• Trembling
• Tachycardia
• Drowsiness
• Confusion
• Loss of consciousness, seizures, and irreversible brain damage if severe hypoglycaemia

Investigations

• Random blood sugar (urgently done using glucometer)
• urea and creatinine (exclude renal impairment)
• Liver function test

Treatment

Treatment objectives

• Treat hypoglycemia urgently if suspected even without knowing blood sugar level (if glucometer not available)
• Establish causes and treat appropriately
• Re-educate patient on meals and medications dose

Non-pharmacological

• Appropriate advice on medications dosing and meals

Pharmacological

Adults

• IV dextrose 50% solution 25-50 ml over 1-3 minutes through a large vein Then 5- 10% solution 500ml 4 hourly until the patient is able to eat normally.
• Glucose in form of refined sugars in a conscious patient for adults e.g., SOBO, soft drink, sweets.