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Causes

• Excess insulin or oral hypoglycemic medications
• Skipping or delaying meals
• Prolonged fasting
• Increased physical activity without adequate food intake
• Alcohol consumption (especially on an empty stomach)
• Critical illnesses (liver, kidney, or heart disease)
• Hormonal deficiencies (e.g., adrenal insufficiency)

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Types

• Mild Hypoglycemia: Patient is alert and able to self-treat
• Moderate Hypoglycemia: More pronounced symptoms but still conscious
• Severe Hypoglycemia: Requires assistance; may involve confusion, seizures, or unconsciousness

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Clinical Features

Autonomic (early symptoms):

• Sweating
• Tremors
• Palpitations
• Hunger
• Anxiety

Neuroglycopenic (late symptoms):

• Confusion or difficulty concentrating
• Dizziness
• Blurred vision
• Slurred speech
• Seizures or loss of consciousness

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Laboratory Findings

• Low plasma glucose (<70 mg/dL)
• In some cases: insulin, C-peptide, and cortisol levels may be evaluated
• HbA1c to assess overall glycemic control

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Investigations

• Capillary blood glucose (glucometer): Immediate assessment
• Laboratory plasma glucose: Confirmation
• Continuous Glucose Monitoring (CGM): Detects recurrent episodes
• Further hormonal or metabolic workup in non-diabetic or unexplained cases

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Management

• Immediate treatment (Rule of 15):
  • This is only applicable for fully conscious patient
  • Take 15 grams of fast-acting carbohydrates (e.g., glucose tablets, juice)
  • Recheck glucose after 15 minutes and repeat if needed
• Prevention:
  • Regular meals and snacks
  • Medication adjustment as needed
  • Monitoring blood glucose regularly
  • Patient education on early symptom recognition

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Summary

Hypoglycemia is a common and potentially serious condition, especially in people with diabetes. Early recognition and prompt treatment are essential to prevent complications. Proper education, regular monitoring, and individualized treatment plans are key to prevention.

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