-- History: *** diabetes, meds and adherence, nutrition and PO intake, weight loss, emesis, CKD
-- Clinical/Exam: *** diaphoresis, visual changes, headaches, AMS, seizure, coma
-- Data: *** insulin level, c-peptide level, beta-hydroxybutyrate, pro-insulin, sulfonylurea and meglitinide screen
-- Etiology/DDx: *** Insulin Mediated: insulin or sulfonylurea overdose or exogenous administration, insulinoma (endogenous), autoimmune insulin antibodies; Non-Insulin Mediated: malnutrition, chronic EtOH use, ESRD, cirrhosis, sepsis, adrenal insufficiency
-- (drawn while hypoglycemic) - insulin level, c-peptide level, beta-hydroxy butyrate, pro-insulin, sulfonylurea and meglitinide screen
-- If c/f insulinoma - will do PET scan to localize the tumor
-- PRN 15g PO dextrose gel > IV 12.5-25g D50
-- IV D5LR drip if needed
PDF coming soon!
Severe hypoglycemia can be life threatening, always check a level if a patient is altered. Differentiate between insulin mediated and non-insulin mediated etiologies. Make sure your workup is sent when the patient is actually hypogylcemic (if insulin is normal-high despite being hypoglycemic, indicates an inappropriate release). Avoid iatrogenic hypogylcemia int he hospital by reducing the home dose of insulin, especiall ythe long-acting dose when patients are NPO.