Hypoglycemia Differential Diagnoses

  • Author: Osama Hamdy, MD, PhD, FACE; Chief Editor: George T Griffing, MD   more...
 
Updated: Feb 3, 2012
 
 

Diagnostic Considerations

Because the consequences of hypoglycemia can be devastating and an antidote is readily available, diagnosis and treatment must be rapid in any patient with suspected hypoglycemia, regardless of the cause. Patients with no previous history of hypoglycemia require a complete workup to find a potentially treatable disease.

Careful consideration should be given to all diabetic patients presenting with hypoglycemia. New medications, activity changes, and infection should be considered. Early in the course of non–insulin-dependent diabetes, patients may experience episodes of hypoglycemia several hours after meals. The symptoms generally are brief and respond spontaneously.

Conditions such as Jamaican vomiting sickness, ingestion of ethanol-containing mouthwash or cologne (children), gastric surgery, potassium administration during periodic attacks of paralysis, excessive muscular activity, diarrhea (childhood) can also cause hypoglycemia.

The following should also be considered when evaluating a patient with hypoglycemia:

  • Hepatic disease: (eg, hepatic failure, cirrhosis, galactose intolerance, fructose intolerance, glycogen storage diseases)
  • Transient ischemic attacks
  • Cardiac dysrhythmia
  • Endocrine disorders (eg, pheochromocytoma, Addison disease, glucagon deficiency, carcinomas, extrahepatic tumors)
  • Substance abuse (eg, cocaine, ethanol, salicylates, beta-blockers, pentamidine)
  • Hypoglycemic agents (eg, insulin, oral hypoglycemic agents)
  • Nutritional disorders (eg, prolonged starvation before anesthesia, protein calorie malnutrition, L-leucine-sensitive hypoglycemic defect in children, low-calorie ketogenic diet, renal disease)
  • Autoimmune disorders (eg, Graves disease)
  • Central nervous system (CNS) disorders
  • Psychogenic

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Osama Hamdy, MD, PhD, FACE  Medical Director, Obesity Clinical Program, Director of Inpatient Diabetes Management, Joslin Diabetes Center; Assistant Professor of Medicine, Harvard Medical School

Osama Hamdy, MD, PhD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists and American Diabetes Association

Disclosure: Merck Inc Honoraria Speaking and teaching

Coauthor(s)

Vellore A R Srinivasan, MSc, PhD  Professor, Department of Biochemistry, Mahatma Gandhi Memorial Medical College and Research Institute, Sri Balaji Vidyapeeth University, India

Disclosure: Sri Balaji Vidyapeeth University, Mahatma Gandhi Medical College and Research Institute campus , Pondicherry ( Puducherry ) , India . P.C. 607 402 Salary Employment

Kenneth J Snow, MD  Associate Chief, Adult Diabetes, Joslin Clinic

Kenneth J Snow, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Vasudevan A Raghavan, MBBS, MD, MRCP(UK) Director, Cardiometabolic and Lipid (CAMEL) Clinic Services, Division of Endocrinology, Scott and White Hospital, Texas A&M Health Science Center College of Medicine

Vasudevan A Raghavan, MBBS, MD, MRCP(UK) is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Heart Association, Endocrine Society, National Lipid Association, and Royal College of Physicians

Disclosure: Nothing to disclose.

David S Schade, MD Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center

David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Hill NR, Thompson B, Bruce J, et al. Glycaemic risk assessment in children and young people with Type 1 diabetes mellitus. Diabet Med. Jul 2009;26(7):740-3. [Medline].

  2. Turnbull FM, Abraira C, Anderson RJ, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. Aug 5 2009;[Medline].

  3. Prolonged Nocturnal Hypoglycemia Is Common During 12 Months Of Continuous Glucose Monitoring In Children And Adults With Type 1 Diabetes. Diabetes Care. Mar 3 2010;[Medline].

  4. Swinnen SG, Dain MP, Aronson R, et al. A 24-week, randomized, treat-to-target trial comparing initiation of insulin glargine once-daily with insulin detemir twice-daily in patients with type 2 diabetes inadequately controlled on oral glucose-lowering drugs. Diabetes Care. Mar 3 2010;[Medline].

  5. Ito T, Otsuki M, Igarashi H, et al. Epidemiological Study of Pancreatic Diabetes in Japan in 2005: A Nationwide Study. Pancreas. Feb 22 2010;[Medline].

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  10. Pugh SK, Doherty DA, Magann EF, et al. Does hypoglycemia following a glucose challenge test identify a high risk pregnancy?. Reprod Health. Jul 14 2009;6:10. [Medline].

  11. Lin YY, Hsu CW, Sheu WH, Chu SJ, Wu CP, Tsai SH. Use of therapeutic responses to glucose replacement to predict glucose patterns in diabetic patients presenting with severe hypoglycaemia. Int J Clin Pract. Aug 2009;63(8):1161-6. [Medline].

  12. Egi M, Bellomo R, Stachowski E, et al. Hypoglycemia and outcome in critically ill patients. Mayo Clin Proc. Mar 2010;85(3):217-24. [Medline].

  13. Goh HK, Chew DE, Miranda IG, Tan L, Lim GH. 24-Hour observational ward management of diabetic patients presenting with hypoglycaemia: a prospective observational study. Emerg Med J. Oct 2009;26(10):719-23. [Medline].

  14. Sinert R, Su M, Secko M, Zehtabchi S. The utility of routine laboratory testing in hypoglycaemic emergency department patients. Emerg Med J. Jan 2009;26(1):28-31. [Medline].

 
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Diagnostic algorithm. A systematic approach is often required to establish the true cause of hypoglycemia, using an algorithmic approach.
 
 
 
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