Hypoglycemia is defined as glucose levels less than 4.0mmol/L. Hypoglycemic events can be dangerous, due to their cardiovascular and neurological effects:
Hospital patients are at high risk for hypoglycemic events due to a range of factors:
Clinical presentation of hypoglycaemia
Hypoglycemia is associated with some typical, recognisable symptoms. Sick inpatients may not present in a typical way, particularly if your patient is elderly, if diabetes is long standing or if your patient is treated with ß-blockers.
How to adjust the insulin dose to reduce recurrent episodes of hypoglycaemia
Even if there is a single hypoglycaemic event, reduce the dose of the culprit insulin for tomorrow to prevent further events.
Sulfonylureas cause hypoglycemia by stimulating ß-cells to secrete insulin in the presence of glucose. Thus, intravenous dextrose can prolong the hypoglycaemia.
Suspect this diagnosis if hypoglycemia is prolonged or not responding to dextrose treatment.
Treatment is Octreotide, 50 mg given subcutaneously or intravenously STAT
Sulfonylurea-induced hypoglycemia is more likely in patients with:
Do not restart sulfonylurea medications, and avoid their use in high risk patients.