Hypoglycemia in the Non-Diabetic Patient

Glucose is the brain’s immediate fuel supply. When circulating glucose falls, the body first releases counterregulatory hormones such as epinephrine. This produces warning symptoms—tremor, sweating, hunger, palpitations, and anxiety. If glucose delivery to the brain falls further, neuroglycopenia develops: confusion, unusual behavior, blurred vision, weakness, seizure, or loss of consciousness. Symptoms alone do not establish a hypoglycemic disorder. Anxiety, intoxication, sepsis, dysrhythmia, stroke, and medication effects can resemble hypoglycemia. In adults without diabetes, diagnosis requires Whipple’s triad: 1. Symptoms or signs consistent with hypoglycemia 2. A measured plasma glucose of 55 mg/dL (54 mg/dL) or lower 3. Resolution of symptoms after glucose is corrected A bedside glucose value is useful for rapid decisions, but plasma glucose is the diagnostic measurement. If the patient is clinically unstable, obtain a sample only when doing so does not delay treatment.