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Hypoglycemia, Nondiabetic

Matthew A. Silva, PharmD, RPh, BCPS and Pablo I. Hernandez Itriago, MD, MHCM, FAAFP Reviewed 06/2020
 


BASICS

DESCRIPTION

  • Hypoglycemia defined by the Whipple triad

    • Low plasma glucose level (≤60 mg/dL) with hypoglycemic symptoms that are relieved when glucose is corrected

    • Occurs commonly in patients with d...

DIAGNOSIS

HISTORY

  • CNS (neuroglycopenic) symptoms predominate with gradual glucose reduction:

    • Headache

    • Confusion

    • Light-headedness

    • Fatigue and weakness

    • Visual disturbances

    • Changes in personality

  • Adrenergic symp...

TREATMENT

GENERAL MEASURES

  • Outpatient except for severe cases; may also be inpatient for testing

  • Oral carbohydrate for alert patient without drug overdose (2 to 3 tbsp of sugar in glass of water or frui...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Exercise routine or daily activity may need to be reevaluated and readjusted.

  • Patients with recurrent hypoglycemia should have glucose source at hand for immediate...

REFERENCES

1
Guettier JM, Gorden P. Hypoglycemia. Endocrinol Metab Clin North Am.  2006;35(4):753–766, viii–ix.
2
Cryer PE, Axelrod L, Grossman AB, et al. Evaluation and management of adult hypoglyc...

ADDITIONAL READING

Vaurs C, Brun JF, Bertrand M, et al. Post-prandial hypoglycemia results from a non-glucose-dependent inappropriate insulin secretion in Roux-en-Y gastric bypassed patients. Metaboli...

CODES

ICD10

  • E16.2 Hypoglycemia, unspecified

  • E16.1 Other hypoglycemia

  • P70.4 Other neonatal hypoglycemia

  • E16.0 Drug-induced hypoglycemia without coma

ICD9

  • 251.2 Hypoglycemia, unspecified

  • 579.3 Other and unspec...

CLINICAL PEARLS

  • Symptoms coincide with low blood glucose levels and resolve with PO/IV glucose or glucagon.

  • Avoid known agents/nutrients that trigger hypoglycemia.

  • Treat underlying cause.

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