Hypoglycemia
Basics
Description
Description
- Deficiency in counterregulatory hormones (glucagon, epinephrine, cortisol, growth hormone) or excessive insulin response
- Serum glucose <70 mg/dL
Risk Factors
Risk Factors
- Strict glycemic control with insulin
- Prior hypoglycemia episodes
- Hypoglycemia unawareness
- Decreased counterregulation
- <5 yr of age or elderly
- Comorbid conditions:
- Renal disease
- Malnutrition
- Coronary artery disease
- Liver disease
Genetics
- Congenital metabolic and endocrine disorders that decrease gluconeogenic ability (e.g., hereditary fructose intolerance)
- Congenital hyperinsulinism
- Neonatal diabetes mellitus (often a mutation effecting an ATP-dependent potassium channel)
Etiology
Etiology
- Increased insulin levels:
- Overdose of oral hypoglycemic agent or insulin
- Oral antihyperglycemics (i.e., α-glucosidase inhibitors, biguanides, and thiazolidinediones) do not cause hypoglycemia alone, but may enhance the risk when used with insulin or sulfonylureas
- Sepsis
- Insulinoma
- Autoimmune hypoglycemia
- Alimentary hyperinsulinism
- Renal failure (partially responsible for insulin metabolism)
- Liver cirrhosis (responsible for significant insulin metabolism)
- Underproduction of glucose:
- Alcohol (inhibitory effect on glycogen storage and gluconeogenesis)
- Drugs
- Salicylates
- β-blockers (including eye drops)
- SSRIs
- Some antibiotics (e.g., sulfonylureas, pentamidine)
- Adrenal insufficiency
- Malnutrition
- Dehydration
- Cerebral edema
- Extremes of age
- Congestive heart failure
- Counterregulatory hormone deficiency
- Hypothyroidism or hyperthyroidism
Pregnancy Considerations
- Third-trimester pregnant patients risk relative substrate deficiency–induced hypoglycemia
- The fetus is less likely to become hypoglycemic during mother's hypoglycemic episode secondary to active glucose transport across placenta:
- Oral hypoglycemic use in pregnancy may lead to profound and prolonged neonatal hypoglycemia
Pediatric Considerations
Most common cause of hypoglycemia in the first 3 mo of life is persistent hyperinsulinemic hypoglycemia of infancy (PHHI) in mothers with diabetes
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Citation
Schaider, Jeffrey J., et al., editors. "Hypoglycemia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307435/all/Hypoglycemia.
Hypoglycemia. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307435/all/Hypoglycemia. Accessed August 31, 2024.
Hypoglycemia. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307435/all/Hypoglycemia
Hypoglycemia [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2024 August 31]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307435/all/Hypoglycemia.
* Article titles in AMA citation format should be in sentence-case
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