163 - Hypoglycemia

Patients who use insulin or oral hypoglycemic medications are at the greatest risk for hypoglycemia. These patients experience mild, self-treated hypoglycemic episodes about twice per week. Severe hypoglycemia, which requires the assistance of another person to regain euglycemia, is experienced at least once per year by 27% of patients treated with intensive insulin regimens. Hypoglycemia is the cause of death in approximately 3% of people with insulin-dependent diabetes. Patients taking oral hypoglycemic agents also commonly experience hypoglycemia. Although these episodes are generally associated with milder symptoms, they occur in more than 30% of patients each year. Sulfonylureas are the most widely used oral hypoglycemic agents. In 2004, 4148 sulfonylurea overdoses were reported to American poison control centers; of these, 36% occurred in children younger than 6 years, 21% required treatment of hypoglycemia, 2.5% were lifethreatening, and 0.22% were fatal. The incidence of hypoglycemia is expected to rise as tight glycemic control continues to be emphasized for the 17 million Americans with diabetes. Hypoglycemia in nondiabetic patients is quite rare and should raise concern about the possibility of a severe underlying illness, alcohol ingestion, or inappropriate exposure to insulin or an oral hypoglycemic agent.