HYPOGLYCEMIA : INVESTIGATIONS , HISTORY TAKING & MANAGEMENT

 HYPOGLYCEMIA : INVESTIGATIONS , HISTORY TAKING & MANAGEMENT

Usual investigations include confirmation of hypoglycemia by finger prick testing or venous blood glucose levels.

Other useful tests include :

Serum Insulin levels

Serum C-peptide levels

HISTORY TAKING IN HYPOGLYCEMIA

Patients in hypoglycemic shock may be unable to give a history.

After treatment and resuscitation , they may provide some history but not complete details.

Hence it is important to take a collateral history from immediate relatives who may give best possible account of what happened.  

Ask about if the patient has diabetes or not and any predisposing factors for hypoglycemia.

Has the patient developed any recent infections ?

Has the patient changed his dose for insulin and treatment of diabetes.

Has the patient been drinking excessive alcohol.

Has the patient taken overdose of Insulin or Antidiabetic medications By Accident or deliberately.

MANAGEMENT OF HYPOGLYCEMIA

Start with the ABC approach ie Airway , Breathing and Circulation.

Exclude Opioid toxicity : pinpoint pupils and low respiratory rate.

Do a prick test to measure blood glucose levels.

If the patient is unconscious and has blood glucose (fingerprick ) / glucometer of less than 2.5 mmol/l , 50 ml of 50 % Dextrose should be given immediately via intra venous route.

In case intravenous access is not possible , intramuscular glucogon 1 mg should be given . But it will not be effective in hypoglycemia due to alcohol.

In case of hypoglycemia due to oral hypoglycemics and medium or long acting Insulins , the patients should not be discharged immediately after becomin conscious. Rather glucose should be monitored for a few hours and aim should be to maintain blood glucose at 5 mmol/l – 10 mmol/l by giving a dextrose infusion.

In case of treating hypoglycemia in malnourished or alcoholic patients , first intravenous thiamine should be given before glucose to avoid development of Wernickes encephalopathy.