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General Medicine

Hypoglycemia, Diabetic

Joseph A. Florence, MD and Emily K. Flores, PharmD, BCPS Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Abnormally low concentration of glucose in circulating blood of a patient with diabetes mellitus (DM); often referred to as an insulin reaction

  • Classification of hypoglycemia (1),(2)[...

DIAGNOSIS

HISTORY

  • Discuss timing of episodes, awareness, frequency, and causes (1).

  • Symptoms vary considerably between individuals.

  • Adrenergic symptoms

    • Hunger, trembling, pallor, sweating, shaking, poundi...

TREATMENT

GENERAL MEASURES

  • Glucose: pure glucose preferred; any form of CHO that contains glucose should be effective (see “Medication” section below) (1)[A].

  • Glucagon should be prescribed proactively t...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Rest until glucose is normal. Individuals with poor cognitive function or severe hypoglycemia should have their glycemic therapy tailored to avoid significant hyp...

REFERENCES

1
American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2018. Diabetes Care.  2018;41(Suppl 1):S55–S64. [View Abstract on OvidMedline]
2
Seaquist ER, A...

ADDITIONAL READING

Thompson AE. JAMA patient page. Hypoglycemia. JAMA.  2015;313(12):1284. [View Abstract on OvidMedline] 

SEE ALSO

  • Diabetes Mellitus, Type 1

  • Algorithm: Hypoglycemia

CODES

ICD10

  • E11.649 Type 2 diabetes mellitus with hypoglycemia without coma

  • E10.649 Type 1 diabetes mellitus with hypoglycemia without coma

  • E13.649 Oth diabetes mellitus with hypoglycemia without coma

ICD9

CLINICAL PEARLS

  • Address hypoglycemia in every visit with patients at risk.

  • Best treatment includes:

    • Patient education and empowerment

    • Frequent SMBG or CGM

    • Flexible insulin (or other drug) regimens

    • Regular ...

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