Clinical profile of diabetics presenting with hypoglycemia at the Emergency Room (ER) in a tertiary care hospital: A prospective study

Dr Brijesh Mukherjee; Dr Subhradipta Bhattacharyya

Volume : VIII, Issue : IX, September - 2018

Clinical profile of diabetics presenting with hypoglycemia at the Emergency Room (ER) in a tertiary care hospital: A prospective study

Dr Brijesh Mukherjee, Dr Subhradipta Bhattacharyya

Abstract :

Background: The term hypoglycemia refers to a clinical condition resulting from an abnormally low plasma glucose level of <54 mg/dl (ADA recommendation). Clinically, it is characterized by varying degree of neurological dysfunction and is responsive to the administration of glucose. Hypoglycemia is most commonly caused by drugs used to treat diabetes mellitus.

Objective: To study the clinical profile and precipitating factors in the patients of hypoglycemia.

Material and Methods: This hospital based 2 years prospective study was conducted in the patients presenting in the Emergency Room (ER) of Hi–tech Medical College and Hospital, Rourkela. Clinical profiles of 134 diabetic patients on OAD’s or Insulin treatment with the diagnosis of hypoglycemia were analyzed.

Results:

Out of 134 patients, 41 (31%) patients were of type 1 diabetes mellitus and 93 (69%) patients of type 2 diabetes mellitus. The male:female ratio was 1:1.4. The most common precipitating factor was found to be delaying or skipping meals (48%) followed by insulin overdose (20%), alcohol intake (15%), excess OAD dose (8%), deficient meals (5%) and increased activity (4%). The most common autonomic symptom was sweating (90%) followed by palpitation (76%). Majority of hypoglycemic patients (57%) had blood glucose in the range 31–40 mg/dl. 66patients (49%) were on only insulin therapy and 28 (21%) patients were on OAD’s. 40 (30%) patients were on combination (insulin+OAD’s) 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 OAD’s, the frequency was much higher (62.5%) with a combination therapy of OAD’s as compared to monotherapy (37.5%). 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.