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.

General examination

In a patient with frequent recurrent hypoglycaemia a thorough general and systems examination is essential. Specifically, the injection sites should be inspected for signs of lipohypertrophy, the palmar creases and buccal mucosa should be inspected for hyper-pigmentation suggestive of Addison’s disease.

The patient's general condition, including their nutritional status, should also be assessed.

In the acutely presenting hypoglycaemic patient little examination is necessary and the priority should be restoration of blood glucose levels.

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