Hypoglycaemia

Meet the patient

A 68-year-old man, ICU day 2 after a laparotomy, is on an insulin infusion — hypoglycaemia is a frequent and serious adverse effect of antidiabetic therapy, and inpatients who develop it face longer stays and higher mortality. Overnight the nasogastric feed was held for a planned re-look but the insulin was not. The nurse calls you at 4am: he has just had a generalised tonic-clonic seizure and the finger-prick reads LOW.^[1]

Hypoglycaemia kills neurons actively rather than by starvation: neuronal death comes once the glucose has fallen below about 1 mmol/L (18 mg/dL) and the EEG has gone flat, with significant neuronal necrosis after roughly 30 minutes of electrocerebral silence.^[16] The single question at the bedside is always the same — how low, for how long, and what drove it down — and the first move is always the same: check the glucose, give dextrose, then find the cause.^[1]

References18ShowHide

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