Endocrinology
Hypoglycemia
저혈당
Glucose <70 mg/dL causing autonomic and neuroglycopenic symptoms
- How common
- Common in diabetics on therapy
- Typical age
- All ages
What is it?
Falling glucose triggers glucagon/epinephrine; further drop causes neuroglycopenia.
Commonly affected: Brain (glucose-dependent organ)
How it develops
- Glucose dropExcess insulin, missed meal, exercise, alcohol
- Counter-regulationSympathetic symptoms (tremor, sweating)
- Neuroglycopenia<54 mg/dL: confusion, dizziness
- LOC/seizure<40: LOC, possible death
Symptoms
- LOC/seizureSevere hypoglycemia
- Confusion/dizzinessBrain glucose deficit
- Hypoglycemia unawarenessRecurrent episodes blunt symptoms
- Diaphoresis/tremorSympathetic activation
- Palpitations/anxietyEpinephrine effect
How it is examined
- Whipple triadSymptoms + glucose <70 + relief with glucose
- Insulin/C-peptideDistinguish factitious vs insulinoma
- Medication reviewInsulin, sulfonylureas, other agents
Imaging
No diagnostic imaging.
- Clinical
Pancreatic MRI/EUS for insulinoma.
- Pancreatic tumor
Non-surgical care
- Oral glucose 15gIf conscious (15-15 rule)
- IV D50W 25gIf unconscious with IV access
- Glucagon 1mg IM/SCOutpatient, no IV access
- Correct causeAdjust insulin, meal timing education
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Insulinoma
Procedures that may be discussed
- Pancreatic tumor resection
Outlook
No sequelae with prompt treatment; recurrence raises CV/cognitive risk.