Hypoglycemia describes an abnormally low blood glucose level (<4 mmol/L). It is a common clinical problem in diabetics overtreated with glucose lowering agents.
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Clinical presentation
Signs of hypoglycemia include:
dizziness
tremors, palpitations and anxiety
hunger
sweating
fatigue
seizures
coma
Symptoms should resolve when the blood glucose levels are corrected. In severe cases of hypoglycemia, death can result.
Pathology
Etiology
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.
Radiological features
Whilst hypoglycemia is predominantly a clinical diagnosis, severe cases can result in hypoglycemic encephalopathy. Radiology can also aid identification of tumors causing hypoglycemia.
Treatment and prognosis
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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