Common Presentation

There is considerable variation in symptoms associated with hypoglycaemia, although individuals may recognise their own pattern from repeated episodes.

Symptoms are classically divided into two groups; adrenergic or autonomic, and neuroglycopenic, some add a third group of non specific symptoms. In type 1 DM adrenergic and non specific symptoms start at blood glucose levels of approximately 3.8 mmol/L [6]. These are the symptoms most frequently identified as warning symptoms, and give time for action to be taken before the neuroglycopenic symptoms develop.

Significant pathologies may present in association with severe hypoglycaemia presenting to the ED. It is not clear whether these conditions are cause or effect of hypoglycaemia. In a US study of diabetic patients aged over 65 treated with insulin or oral hypoglycaemics, 5% of episodes of severe hypoglycaemia were associated with ‘catastrophic complications’ e.g. stroke, TIA, MI, injury or death [8,10].

Table 1: Symptoms associated with hypoglycaemia
Adrenergic or Autonomic Neuroglycopenic Non Specific
Sweating Confusion Hunger
Hunger Coma Headache
Tremor or shaking Convulsions Nausea
Hunger Focal neurological deficits
Nausea Speech difficulties
Pallor Incoordination
Tachycardia Unusual behaviour including aggression