Overview
The blood sugar should be tested in every acutely unwell person, mainly because hypoglycaemia is an underdiagnosed cause of reduced consciousness, and can mimic stroke symptoms.
Hypoglycaemia
A blood sugar level of <3.9 is generally considered to indicate hypoglycaemia. This is a clinical emergency and should be rapidly treated.
Causes of Hypoglycaemia
Diabetics
- Insulin - excessive insulin dosing, regular insulin dosing despite reduced carbohydrate intake / missing a meal, use of an insulin infusion perioperatively without dextrose infusion
- Oral hypoglycaemics - sulfonylureas
Non-Diabetics
- Insulinoma
Symptoms
- Autonomic (mild / moderate hypoglycaemia) - hunger, anxiety, diaphoresis, tremor, palpitations, paraesthesiae
- Neuroglycopaenic (severe hypoglycaemia) - fatigue, confusion, visual changes, seizures, unconsciousness
Hyperglycaemia
Symptoms
- Fatigue
- Polyuria
- Polydipsia
- Thirst
- Weight loss
Acute Complications
- Diabetic ketoacidosis (DKA)
- Hyperglycaemic hyperosmolar state (HHS)
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