eMedicine Specialties > Emergency Medicine > Endocrine & Metabolic
Hypoglycemia: Follow-up
Updated: Nov 26, 2008
Follow-up
Further Inpatient Care
- Patients with no known cause or no previous episodes of hypoglycemia must be admitted for further evaluation.
- For overdose, accidental ingestion, or therapeutic misadventures with oral hypoglycemics, little correlation exists between the amount of oral hypoglycemic agent ingested and the length or depth of coma. These patients require admission.
- Inadequate data are available to predict the extent or the time course of hypoglycemia in children.
- Chlorpropamide has demonstrated refractory hypoglycemia for up to 6 days after ingestion. Asymptomatic patients who have ingested hypoglycemic agents should be observed for the development of hypoglycemia, because the onset of action and the half-life are extremely variable. The length of observation is based on the ingested agent.
- Admission criteria
- No obvious cause
- Oral hypoglycemic agent
- Long-acting insulin
- Persistent neurologic deficits
- Discharge may be considered after a high carbohydrate meal in the following situations:
- Obvious cause is found and treated.
- Episode is reversed rapidly.
Further Outpatient Care
- For patients on either short-acting insulin or hypoglycemic agents who have not eaten and have had their hypoglycemia reversed rapidly, a high carbohydrate meal prior to discharge is recommended.
- A competent adult who has been directed to monitor fingerstick glucose measurements closely during the remainder of the day should accompany the patient after discharge.
Deterrence/Prevention
- Patients must be counseled as to the causes and the early signs and symptoms of hypoglycemia. This counseling is particularly important for those patients who have a history of prior episodes of hypoglycemia or who are newly diagnosed diabetics.
- General outpatient diabetic education or inpatient diabetic teaching is indicated.
Complications
- Prolonged hypoglycemia may cause permanent neurologic deficit or death.
- Unrecognized infection causing hypoglycemia in diabetic patients may result in recurrent hypoglycemic spells or progression of the infection.
Prognosis
- The prognosis for this condition is excellent if detected and treated early.
Patient Education
- Diabetic patients with episodes of hypoglycemia need education in nutrition, checking glucose levels at home, and early signs and symptoms of hypoglycemia.
- Recognition of early symptoms is paramount for self-treatment.
- For excellent patient education resources, see eMedicine's Diabetes Center. Also, visit eMedicine's patient education article, Low Blood Sugar.
Miscellaneous
Medicolegal Pitfalls
- Discharging a patient following a hypoglycemic episode that is likely the result of a long-acting oral hypoglycemic medication is a potential pitfall. Any patient for whom the cause is not identified readily may have a recurrence of hypoglycemia with resultant sequelae.
More on Hypoglycemia |
| Overview: Hypoglycemia |
| Differential Diagnoses & Workup: Hypoglycemia |
| Treatment & Medication: Hypoglycemia |
 Follow-up: Hypoglycemia |
| References |
| « Previous Page |
References
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Leiken JB, Palouchek FP. Poisoning and Toxicology Handbook. 1996-1997.
Martin FI, Hansen N, Warne GL. Attempted suicide by insulin overdose in insulin-requiring diabetics. Med J Aust. Jan 15 1977;1(3):58-60. [Medline].
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Paterson KR, Paice BJ, Lawson DH. Undesired effects of biguanide therapy. Adverse Drug React Acute Poisoning Rev. 1984;3(3):173-82. [Medline].
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Further Reading
Keywords
hypoglycemia, low blood sugar, low glucose, glucopenia, decrease in the blood glucose level, insulinoma, coma, cardiac dysrhythmia, confusion, convulsions, diabetes, non–insulin-dependent diabetes, oral hypoglycemics, islet cell tumor, extrapancreatic tumor,insulin, palpitations, nausea, sweating, anxiety, diabetes mellitus type 1, diabetes mellitus type 2
