Clinical Profile of Hypoglycemia in Diabetic Patients: A Prospective Study in a Tertiary Care Hospital

Abstract

Background: Hypoglycemia refers to a clinical condition resulting from an abnormally low plasma glucose level <40 mg/dl without symptoms and <50 mg/dl with symptoms. Clinically, it is characterized by varying degree of neurological dysfunction and is responsive to the administration of glucose. Hypoglycemia is commonly caused by drugs used to treat diabetes mellitus. Objective: To study the clinical profile, precipitating factors and outcome in the patients of hypoglycemia. Materials and Methods: This hospital based 2 years prospective study was conducted in the Department of Medicine, Kasturba Medical College and hospital, Manipal, Karnataka. Clinical profile of 100 diabetic patients on OHA’s or Insulin treatment with the diagnosis of hypoglycemia were analyzed. The criteria for hypoglycemia was blood glucose level of <40mg/dl without symptoms and <50 mg/dl with symptoms.  Results: Out of 100 patients, 30 (30%) patients were of type 1 diabetes mellitus and 70 (70%) patients of type 2 diabetes mellitus. The male:female ratio was 1:1.7. The most common precipitating factor was found to be delaying or skipping meals (80%), followed by decreased carbohydrate intake (70%), increase in insulin or OHAs dosage (54%), decrease in insulin requirement (10%). The most common autonomic symptom was sweating (90%) followed by palpitation (80%). Neuroglycopenic symptoms were observed at much lower blood glucose level. Majority of hypoglycemic patients (68%) had blood glucose in the range 31-40 mg/dl. 64 patients (64%) were on only insulin therapy and 16 (16%) patients were on OHAs. 20 (20%) patients were on combination (insulin+OHAs) therapy. Maximum incidence of hypoglycemia was reported among patients who were on combination of short acting plus intermediate-acting (i.e Premix – 30/70) Insulin. However, within the set of patients developing hypoglycaemia due to OHA’s, the frequency was much higher (62.5%) with a combination therapy of OHA’s as compared to monotherapy (37.5%). All hypoglycaemic patients received IV dextrose (25%) and responded well to treatment. Present study did not show any mortality due to hypoglycemia. Conclusion: Hypoglycemia is the most common acute metabolic complication of diabetes mellitus on treatment. Elderly diabetics, patients with chronic kidney disease and patients on long acting insulin/sulfonylureas (used either alone or in combination) are more prone to develop hypoglycemia. Diabetic patients should be familiar with hypoglycemia symptom profile so that they can perceive the early onset of hypoglycemia and an appropriate action can be taken immediately.