Hypoglycemia Revisited in the Acute Care Setting

Abstract

Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic complications and even death, and further preclude maintenance of euglycemia over a lifetime of diabetes. Recent studies have shown that hypoglycemia is associated with adverse outcomes in many acute illnesses. In addition, hypoglycemia is associated with increased mortality among elderly and non-diabetic hospitalized patients. Clinicians should have high clinical suspicion of subtle symptoms of hypoglycemia and provide prompt treatment. Clinicians should know that hypoglycemia is associated with considerable adverse outcomes in many acute critical illnesses. In order to reduce hypoglycemia-associated morbidity and mortality, timely health education programs and close monitoring should be applied to those diabetic patients presenting to the Emergency Department with SH. ED disposition strategies should be further validated and justified to achieve balance between the benefits of euglycemia and the risks of SH. We discuss relevant issues regarding hypoglycemia in emergency and critical care settings.

Hazardous factors besides infection in hypoglycemia

“…Recurrent hypoglycemia commonly occurs in patients suffering from lack of recent food intake, coronary artery disease, concurrent infection or renal insufficiency. Hence it is proposed that they are admitted for observation and treatment (6). Although patients with hypoglycemia and a concurrent infection demonstrated a higher prevalence of cancer than non-infected patients (16.5 vs. 6.0%) in the current study, the difference was not statistically significant.…”

“…However, hypoglycemia is not associated with the adverse outcome of acute myocardial infarction (6). Hypoglycemia with concurrent infection did not affect biochemistry levels (GOT, creatinine, sodium and potassium) when compared with hypoglycemic patients without concurrent infection.…”

“…Clinically, hypoglycemia itself results in variable symptoms of cranial dysfunction and altered mental conditions; in addition, infection and sepsis demonstrate these symptoms. The etiologies of hypoglycemia result from missed meals, infectious diseases, tumor, stroke, glyburide use, polypharmacy, renal insufficiency, loss of diabetic care or iatrogenic reasons (6).…”

“…In such a situation, intravenous dextrose fluid could not alleviate the neurologic deficit due to the initial hypoglycemia. In addition, elderly patients and those with preexisting co-morbidity conditions (chronic liver disease, end stage renal disease or adrenal insufficiency) are at risk for mortality (6,15). Recurrent hypoglycemia commonly occurs in patients suffering from lack of recent food intake, coronary artery disease, concurrent infection or renal insufficiency.…”

The impact of hypoglycaemia on patients admitted to hospital with medical emergencies

“…Sepsis, renal failure, malignancy and overdose are recognized cause of hypoglycaemia [18]. In our cohort of patients without diabetes with the above diagnosis, the mean glucose level was 3.2 mmol/l.…”