Hypoglycemia

1) Disease Description (Causes and Symptoms)

• Definition: Hypoglycemia is a clinical condition that occurs when the blood glucose concentration falls below normal. According to reference materials, hypoglycemia is generally described as a blood glucose level of 50 mg/dL or lower (the blood glucose level at which symptoms occur varies by individual), but clinically, 60–70 mg/dL or lower is often regarded as a level requiring caution along with the presence or absence of symptoms.
• Pathophysiology: It occurs due to an imbalance between glucose supply (food intake, hepatic glycogen breakdown and gluconeogenesis) and utilization (tissue glucose consumption and insulin action). It develops when glucose supply decreases or utilization increases due to excessive insulin or insulin-like activity, liver, adrenal, or pituitary hormone deficiencies, inadequate food intake, alcohol, and other causes.
• Main causes: Excessive administration of diabetes medications (insulin, sulfonylureas, etc.), inadequate food intake (fasting or vomiting), excessive exercise, alcohol consumption, pancreatic tumors that induce insulin secretion (insulinoma), adrenal insufficiency or pituitary insufficiency, certain medications, inherited metabolic diseases, autoimmune hypoglycemia, and others.
• Symptoms: Anxiety, tremors, sweating, palpitations, pallor, and hunger (symptoms caused by sympathetic nervous system activation), as well as dizziness, headache, fatigue, impaired concentration, confusion, abnormal behavior, seizures, and decreased consciousness (neurological symptoms caused by impaired brain function). In severe cases, shock, coma, and brain damage may occur.

2) Treatment Methods

• First aid (when consciousness is clear)
  • Consume 15–20 g of rapidly absorbed carbohydrates (e.g., half a cup of juice or cola, 1 tablespoon of sugar, or 3–4 pieces of candy).
  • Recheck blood glucose after 15 minutes and observe symptoms. If hypoglycemia persists, consume additional carbohydrates.
  • After stabilization, consume a small amount of slowly absorbed carbohydrates (such as bread or crackers) or protein to prevent recurrence.
• First aid (loss of consciousness or loss of the swallowing reflex)
  • Do not give anything orally to an unconscious patient (risk of aspiration into the airway). Immediately transfer the patient to an emergency department.
  • At the hospital, blood glucose is restored through intravenous glucose infusion (e.g., 10–50 mL of 50% glucose, administered according to the circumstances).
  • As on-site emergency treatment, a 1 mg IM/SC injection of glucagon (for adults) may also be used when administered by emergency medical personnel or when a prescribed kit is available.
• Treatment of the underlying cause
  • Drug-induced hypoglycemia: Adjust or discontinue the dosage of insulin or oral hypoglycemic agents.
  • If insulinoma is suspected, consider imaging tests (abdominal CT/MRI), endocrine tests (fasting insulin, C-peptide, etc.), and surgical resection.
  • Hormone deficiency (adrenal or pituitary): Hormone replacement therapy.
  • Patients with diabetes who have recurrent hypoglycemia: Introduction of continuous glucose monitoring (CGMS), education on meals, exercise, and medication, and readjustment of insulin duration of action and administration method.
• Lifestyle management and prevention
  • Have regular meals and snacks, eat an evening snack to prevent nocturnal hypoglycemia, and exercise caution when consuming alcohol.
  • Medication adjustments are needed when the amount of sugar consumed or exercise intensity changes.
  • Carry equipment for preventing hypoglycemia (a glucagon kit and portable glucose preparations).

Precautions

• Do not force food into an unconscious patient.
• Frequent recurrent hypoglycemia requires identification of the cause (to prevent serious complications).
• Consult the treating physician before changing or adjusting medications.

Complications and Prognosis

• Recurrent or severe hypoglycemia carries risks of seizures, brain damage, cognitive decline, and death.
• Timely treatment generally allows complete recovery, but frequent hypoglycemia can adversely affect the long-term prognosis.

3) Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)

• Items to bring
  • A list of medications currently being taken (including prescription drugs, OTC drugs, herbal medicines, and supplements) and the usual medication schedule
  • Recent records from a self-monitoring blood glucose meter (or CGM), including the blood glucose level and time when hypoglycemia occurred
  • Recent history of meals, alcohol consumption, and exercise (during the 24–48 hours before hypoglycemia occurred)
  • Past medical history (liver disease, kidney disease, adrenal or pituitary disease, gastrectomy, etc.) and surgical history
  • Symptom diary (when symptoms began, symptoms, duration, and method of recovery)
  • Recent test results (if available)
• Key items to check during an outpatient visit
  • Frequency and pattern of hypoglycemic symptoms (while fasting, after meals, at night, or during exercise)
  • Method of insulin and oral medication administration (type, dosage, and timing)
  • Alcohol consumption habits and changes in meal patterns
  • Whether there is exposure to the risk of hypoglycemia related to accidents, driving, or work

4) Examples of General Questions to Ask the Doctor

• How high is the risk of hypoglycemia with this medication (the antidiabetic medication I am currently taking)? How should the dosage be adjusted?
• If hypoglycemia recurs, what additional tests (insulin, C-peptide, sulfonylurea testing, cortisol, etc.) should be performed?
• In an emergency (loss of consciousness), what treatment can I or my caregiver provide at home?
• Is it safe for me to drive or work (including work at heights)? What measures should I take to prevent hypoglycemia?

5) Examples of Disease-Specific Questions

• Among my medications (specify the medication names), which one is most likely to cause hypoglycemia? How should the dose and administration time be changed?
• If hypoglycemia occurs unrelated to meals (repeatedly while fasting), is testing for conditions such as insulinoma necessary? If so, what tests should be performed and when?

(Additional information: For instructions on using a glucagon kit in an emergency, whether to begin CGM, and adjustments to medication, meal, and exercise plans, individualized consultation during a medical visit is recommended.)