30/03/2025
✅ Hypoglycemia: Blood glucose < 70 mg/dL.
Severe hypoglycemia: Cognitive impairment requiring assistance.
❇️ Etiology
🔷Endogenous insulin overproduction
* Insulinoma, Non-insulinoma pancreatogenous hypoglycemia (NIPHS)
* Insulin secretagogues (Sulfonylureas, Meglitinides)
🔷Exogenous insulin administration
* Insulin overdose in diabetes mellitus patients
🔷Reactive hypoglycemia
* Postprandial (often after gastric surgery)
🔷Alcohol-induced hypoglycemia
* Inhibition of gluconeogenesis
🔷Critical illness
* Sepsis, hepatic/renal failure, adrenal insufficiency
❇️ Clinical Features
🔷Neurogenic Symptoms (Autonomic)
Sweating, tremor, palpitations, anxiety
🔷Neuroglycopenic Symptoms (CNS)
Confusion, irritability, blurred vision, seizures, loss of consciousness
❇️ Diagnosis
🔷Whipple’s Triad (classic criteria):
* Symptoms of hypoglycemia
* Blood glucose < 70 mg/dL
* Symptom resolution after glucose administration
🔷Labs:
* Blood glucose, insulin, C-peptide, sulfonylurea levels
* Insulinoma: ↑ Insulin, ↑ C-peptide, normal/high proinsulin
* Exogenous insulin use: ↑ Insulin, ↓ C-peptide
❇️ Management
🔷Acute Hypoglycemia
* Oral glucose (if conscious)
* IV dextrose (if unconscious)
* Glucagon IM if IV access unavailable
🔷Long-term Management
* Treat underlying cause (e.g., remove insulinoma, adjust insulin dosing)
