Ophthalmologists treat patients with diabetes mellitus daily and therefore should be familiar with the management of a hypoglycemic episode. There are 2 types of hypoglycemia: postprandial hypoglycemia and fasting hypoglycemia. Causes of hypoglycemia are varied but include diabetes mellitus treated with insulin or insulin secretagogues; adrenal insufficiency; the presence of pheochromocytoma; hyperthyroidism; substance abuse, including alcohol, cocaine, and salicylate toxicity; nutritional deficiency; eating disorders; liver disease such as cirrhosis; and medications such as insulin, insulin secretagogues, methadone, and tramadol. Symptoms include perspiration, tremor, tachycardia, anxiety, hunger, dizziness, changes in vision, confusion, convulsions, and syncope. Management of these episodes depends on the severity of the hypoglycemia. It is important to recognize the signs of hypoglycemia; if possible, blood glucose should be tested, but treatment should not be delayed. Mild to moderate hypoglycemia can be treated orally with glucose gel or tablets, fruit juice, regular soda, milk, honey or corn syrup, and crackers. Unconscious patients with severe hypoglycemia should be treated with intravenous dextrose and intramuscular glucagon.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.