eMedicine Specialties > Endocrinology > Diabetes Mellitus

Hypoglycemia: Follow-up

Author: 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
Coauthor(s): Vellore A R Srinivasan, MSc, PhD, Associate Professor, Department of Biochemistry, Sri Balaji Vidyapeeth University, Mahatma Gandhi Medical College and Research Institute Campus, India; Kenneth J Snow, MD, Associate Chief, Adult Diabetes, Joslin Clinic
Contributor Information and Disclosures

Updated: Mar 9, 2010

Follow-up

Further Outpatient Care

  • If the patient has fasting hypoglycemia and the cause is treatable, long-term follow-up usually is not needed. If the cause cannot be treated definitively (eg, inoperable pancreatic insulinoma), diazoxide can be used to elevate blood glucose levels and chemotherapy that specifically targets the beta cell (ie, using cytotoxic agents such as streptozotocin) should be considered.
  • If the patient has reactive hypoglycemia, periodic outpatient monitoring is warranted to assess the continued presence of symptoms.

Complications

  • Untreated fasting hypoglycemia can lead to severe neuroglycopenia and, possibly, death.
  • Untreated reactive hypoglycemia may cause significant discomfort to the patient, but long-term sequelae are not likely.

Prognosis

  • Prognosis depends on the cause of the hypoglycemia. If the cause of fasting hypoglycemia is identified and curable, prognosis is excellent. If the problem is not curable, such as an inoperable malignant tumor, long-term prognosis is poor. However, note that these tumors may progress rather slowly.
  • If the patient has reactive hypoglycemia, symptoms often spontaneously improve over time, and long-term prognosis is very good.

Patient Education

For excellent patient education resources, visit eMedicine's Diabetes Center. Also, see eMedicine's patient education article, Hypoglycemia (Low Blood Sugar).

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify the presence of fasting hypoglycemia rather than postprandial hypoglycemia
  • Failure to evaluate fasting hypoglycemia with a prolonged fast (ie, as long as 72 h)
  • Failure to document true hypoglycemia as a cause of symptoms
 


More on Hypoglycemia

Overview: Hypoglycemia
Differential Diagnoses & Workup: Hypoglycemia
Treatment & Medication: Hypoglycemia
Follow-up: Hypoglycemia
Multimedia: Hypoglycemia
References
Further Reading
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References

  1. 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].

  2. 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].

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

  4. 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].

  5. 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].

  6. 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].

  7. Chen L. A literature review of intensive insulin therapy and mortality in critically ill patients. Clin Nurse Spec. Mar-Apr 2010;24(2):80-6. [Medline].

  8. Garza H. Minimizing the risk of hypoglycemia in older adults: a focus on long-term care. Consult Pharm. Jun 2009;24 Suppl B:18-24. [Medline].

  9. 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].

  10. 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].

  11. Cryer PE, Polonsky KS. Glucose homeostasis and hypoglycemia. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, eds. Williams Textbook of Endocrinology. 9th ed. Philadelphia, Pa: WB Saunders; 1998:939-71.

  12. Field JB. Hypoglycemia. Definition, clinical presentations, classification, and laboratory tests. Endocrinol Metab Clin North Am. Mar 1989;18(1):27-43. [Medline].

  13. Ibarra JD Jr. Hypoglycemia. Postgrad Med. Feb 1972;51(2):88-93. [Medline].

  14. Koch B. Selected topics of hypoglycemia care. Can Fam Physician. Apr 2006;52:466-71. [Medline].

  15. Service FJ. Classification of hypoglycemic disorders. Endocrinol Metab Clin North Am. Sep 1999;28(3):501-17, vi. [Medline].

  16. Service FJ. Diagnostic approach to adults with hypoglycemic disorders. Endocrinol Metab Clin North Am. Sep 1999;28(3):519-32, vi. [Medline].

  17. Service FJ. Hypoglycemia. Endocrinol Metab Clin North Am. Dec 1997;26(4):937-55. [Medline].

  18. Service FJ. Hypoglycemic disorders. N Engl J Med. Apr 27 1995;332(17):1144-52. [Medline].

  19. Shamoon H. Hypoglycemia. In: Endocrinology and Metabolism. 3rd ed. New York, NY: McGraw-Hill; 1995:1251-69.

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Further Reading

Related eMedicine topics:
 Diabetes Mellitus, Type 1 [Endocrinology]
Diabetes Mellitus, Type 1 [Pediatrics: General Medicine]
Diabetes Mellitus, Type 1 - A Review
Diabetes Mellitus, Type 2 [Endocrinology]
Diabetes Mellitus, Type 2 [Pediatrics: General Medicine]
Diabetes Mellitus, Type 2 - A Review
Disorders of Carbohydrate Metabolism
Hypoglycemia [Emergency Medicine]
Hypoglycemia [Pediatrics: General Medicine]
Insulinoma
Pediatrics, Hypoglycemia
Pseudohypoglycemia

Clinical guidelines:
 Neonatal hypoglycemia: initial and follow up management.
Barbara Bush Children's Hospital at Maine Medical Center - Private Nonprofit Organization. 2004 Apr. 4 pages. NGC:004293

Guidelines for glucose monitoring and treatment of hypoglycemia in breastfed neonates.
Academy of Breastfeeding Medicine - Professional Association. 1999 (revised 2006). 7 pages. NGC:005865

Standards of medical care in diabetes. V. Diabetes care.
American Diabetes Association - Professional Association. 1998 (revised 2008 Jan). 8 pages. NGC:006281

Clinical trials:
 Insulin Analogues and Severe Hypoglycaemia

Mechanisms Responsible for Hypoglycemia Associated Autonomic Failure (HAAF)

Naltrexone and Hypoglycemia in Type 1 Diabetes

Sulfonylurea Effects on Glucagon Regulation During Hypoglycemia in Type 1 DM

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Keywords

hypoglycemia, blood sugar, blood glucose, low blood sugar, high blood sugar, type 2 diabetes, diabetes mellitus, plasma glucose disorder, glucose disorder, low blood sugar, Whipple triad, decreased glucose, insulin-producing tumor, neuroglycopenic symptoms, reactive hypoglycemia, fasting hypoglycemia, hypoglycemic disorder, hypoglycemic

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

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

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Yoram Shenker, MD, Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison
Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
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.

 
 
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