Hypoglycaemia

Hypoglycaemia is any episode of blood glucose level less than 4 mmol/L, symptomatic or not. It is a common and potentially serious side effect of the treatment of diabetes with a range of oral hypoglycaemic agents and of course with insulin. The commonest therapeutic agents implicated in hypoglycaemia are sulphonylureas and insulin.

Capillary blood glucose level

Acutely, this is the only investigation that matters. 

Us+Es

Patients with recurrent hypoglycaemia should have their renal function assessed. Sulphonylureas and insulin undergo a prolongation of half life in renal impairment.

HbA1c

Although not directly relevant to the management of hypoglycaemia, it is a useful opportunity to assess the overall level of glycaemic control.

LFTs

Patients with unexplained frequent or recurrent hypoglycaemia should have their hepatic function assessed.

Cortisol

Patients with unexplained frequent or recurrent hypoglycaemia should have their adreno-cortical function assessed. Either by random cortisol measurement or by short synacthen test.

Diabetesbible is for health professionals