Hypoglycemia

Rationale

Maintenance of blood sugar within normal limits is essential for health. Unrecognized and/or untreated hypoglycemia can have temporary or permanent neurologic consequences, especially on the developing brain. While hypoglycemia occurs most frequently in people with diabetes, it is a manifestation of several other conditions.

Causal Conditions

(list not exhaustive)

1. endocrinologic (e.g., endogenous insulin excess, counter-regulatory hormone deficiency)
2. metabolic (e.g., glycogen storage disease, ketotic hypoglycemia)
3. drugs (e.g., insulin, sulfonylureas)
4. critical illness (e.g., sepsis, hepatic failure, adrenal insufficiency)

Key Objectives

Given a patient with low blood glucose, the candidate will initiate an appropriate management plan while diagnosing the cause, severity, and complications. To minimize complications, management should be prioritized and initiated even before a cause is identified. Attention should be paid to preventive strategies.

Enabling Objectives

Given a patient with low blood glucose, the candidate will

1. list and interpret critical clinical findings, including those based on
   1. an appropriate history and physical examination aimed at determining the cause and complications, and
   2. identification of potential contributing medications or medication interactions;
2. construct and prioritize an effective management plan, including
   1. providing emergent and resuscitative treatment,
   2. determining appropriate pharmacotherapy in addition to provision of glucose (e.g., glucagon),
   3. determining whether the patient requires specialized care,
   4. referring the patient to appropriate support services, including lifestyle and psychosocial supports, and
   5. counselling and educating the patient on preventive and nonpharmacologic measures.