Hypoglycemia - Don't Get Fooled!!

Dr. Fox

HYPOGLYCEMIA
Presentation:

• Classic Hypoglycemia Symptoms = Both autonomic and neuroglycopenic symptoms
• Autonomic = catecholamine release -> tremor, tachycardia, and diaphoresis.
• Neuroglycopenic -> confusion, Seizures, and coma
• Many pts do not present in the “classic” fashion.
• Interestingly - Can actually present with FOCAL Neurologic deficit… SO CHECK GLUCOSE BEFORE CALLING CODE STROKE!!

Not all patients recognize their own hypoglycemia well.

• Often we get used to diabetics stating that they think their sugar is low.
• Unfortunately, they may not perceive their own level well.
• Additionally, they may have symptoms at “normal-low” levels.
• Poorly controlled diabetics first developed symptoms at a mean glucose of 78 mg/dL in one study.
• Patients on beta-blockers may not have significant autonomic symptoms.
  

Some patients that are at high risk for hypoglycemia:

• Children (See Morsel) - high metabolic demands
• Alcoholics - ETOH inhibits gluconeogenesis and depletes glycogen stores. Plus they don’t eat much.
• Elderly - cuz they often don’t eat many calories.

Treatment - we often do it wrong!

• “Give ‘em an amp”
• Treatment should be 0.5 - 1 g/kg IV of 50% Dextrose (D50W).
• Use 2 g/kg of D25 in kids and 5 g/kg of D10 in infants.
• Standard “amp” of D50 has 25 grams.
• Most adults should get more than one amp.
• Each “amp” is only 100 cal.
• Each treatment should be followed by a meal (if patient able to eat).
• Glucose drip - Need to use D10 (D5 x 1 litre contains only 50 grams (200 cal)).
• D20 is even better… but requires central line.
• Glucagon?? -- Useful if you can’t get an IV. Requires adequate glycogen stores to be present to work… may not be effective in kids and alcoholics.

Main Point - Change in Mental Status? Check Glucose early!!

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