Metabolic condition characterised by an abnormally low blood glucose level, typically defined as less than 4.0 mmol/L; most common side effect of insulin therapy

Aetiology

• Occurs when more insulin is injected than is needed
• Irregular eating habits, unusual exertion and alcohol excess may precipitate a hypoglycaemic episode
• Insulin errors and variation in insulin absorption e.g. as a result of lipohypertrophy are also important
• The times of greatest risk are before meals, during the night and during or after exercise

Clinical features

• Pallor
• Sweating
• Tremor
• Palpitations
• Confusion
• Nausea
• Hunger
• Cognitive impairment
• Coma

Management

Mild hypoglycaemia - patient is conscious

• ABCDE approach
• Consumption of 15-20g of fast-acting carbohydrate such as glucose tablets, a small can of non-diet soda, sweets, or fruit juice