Plasma glucose <70 mg/dL (3.9 mmol/L) with autonomic / neuroglycopenic symptoms (Whipple's triad).
Etiology
- • Insulin / sulfonylurea overdose
- • Missed meal, exercise, alcohol
- • Adrenal insufficiency, sepsis, liver failure
- • Insulinoma (rare)
History taking
- • Drug timing, meals, exercise
- • Awareness of hypoglycaemia
- • Recurrent episodes
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Loss of consciousness, seizure
- • Persistent neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • CBC, basic metabolic panel as indicated
- • Targeted disease-specific tests
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Conscious: 15 g fast carbs (glucose tabs / juice), recheck in 15 min
- • Unconscious: IV dextrose 25 g or IM glucagon 1 mg
Drug therapy
- • Identify and stop offending drug
- • Adjust insulin / OHA
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Carry glucose source
- • Educate family on glucagon
- • Inform DVLA / equivalent if recurrent
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • Sulfonylurea hypoglycaemia can recur for 24–72 h — admit
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
