Pitfalls

The main pitfall in the treatment of hypoglycaemia is not considering it as a diagnosis. Check a glucose early in;

• Unconscious or drowsy patients
• Unusual or bizarre behaviour
• Agitated or aggressive patients
• Patients after alcohol consumption
• Patients at risk of malnourishment or prolonged vomiting (e.g. hyperemesis)
• Elderly patients with vague or non-specific neurological signs or symptoms.

Capillary blood glucose testing may give inaccurate results if taken from poorly perfused sites or in patients with profound hypoxia or shock. If in doubt check a venous blood gas and send a serum sample to the lab for analysis.

Be careful in patients treated for hypoglycaemia -some will develop rebound hypoglycaemia. Those who have hypoglycaemia secondary to oral hyperglycaemic agents will likely require a prolonged observation period.

Patients with diabetes are usually well able to self-treat hypoglycaemia – remember to explore what was different on this occasion. Address this (where possible) prior to discharge.