Last revised by Sonam Vadera on 18 Mar 2023

Hypoglycemia describes an abnormally low blood glucose level (<4 mmol/L). It is a common clinical problem in diabetics overtreated with glucose lowering agents.

Signs of hypoglycemia include:

  • dizziness

  • tremors, palpitations and anxiety

  • hunger

  • sweating

  • confusion

  • fatigue

  • seizures

  • coma

Symptoms should resolve when the blood glucose levels are corrected. In severe cases of hypoglycemia, death can result.

Hypoglycemia is most commonly seen in patients with diabetes mellitus who are receiving glucose-lowering agents, e.g. insulin or sulfonylureas.

Other causes of hypoglycemia include alcohol, tumors such as insulinomas and critical illness states 1.

Whilst hypoglycemia is predominantly a clinical diagnosis, severe cases can result in hypoglycemic encephalopathy. Radiology can also aid identification of tumors causing hypoglycemia. 

Early identification of hypoglycemia is critical to prevent severe complications. In patients able to tolerate oral intake, rapidly absorbed carbohydrates should be consumed. For those unable to tolerate oral intake, intravenous dextrose administration or administration of subcutaneous or intramuscular glucagon is indicated. In cases of insulinomas, surgical resection is usually preferred 1.

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