Selected topics of hypoglycemia care.
OBJECTIVE: To review 4 topics in hypoglycemia (HoG) care: diagnosis, circumstances predisposing to HoG, risk of adverse effects, and prevention. QUALITY OF EVIDENCE MEDLINE: was searched using the words hypoglycemia and diabetes mellitus. Other relevant sources were hand searched. Evidence was mostly level III and IV from consensus, from observation, and from the author's clinical experience. MAIN MESSAGES: Hypoglycemia can be diagnosed using clinical criteria or using a glucometer; it cannot be diagnosed after death. Capillary blood glucose testing for HoG is required only for patients taking insulin and insulin secretagogues. With intensified treatment of diabetes, a greater incidence of HoG is inevitable. Chronic morbidity and mortality resulting from HoG are believed to be rare. There are no reliable data on HoG-related mortality for idiopathic or accidental sudden death. Interventions by friends, family, colleagues, and teachers can prevent HoG. CONCLUSION: Clinical diagnosis of HoG deserves greater emphasis; when patients are unaware of having HoG, physicians must rely on blood glucose testing. Patients not taking insulin or insulin secretagogues need neither fear nor test for HoG. The risk of HoG should not preclude efforts to achieve best possible control of blood sugar. Patients with unstable cardiac arrhythmias, drivers of motor vehicles, and those in high-risk industrial occupations require special vigilance for HoG.