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New guidelines released for evaluation, management of hypoglycemic disorders
Endocrine Society’s evidence-based guidelines describe recommendations for patients with, without diabetes.
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The Endocrine Society has published new clinical practice guidelines for the evaluation and management of hypoglycemic disorders in adults with and without diabetes.
“Hypoglycemia is an uncommon clinical event in people who do not have diabetes. Therefore, one of the challenges is to identify the patients in whom a thorough diagnostic workup is indicated,” said Philip Cryer, MD, an author of the guidelines and member of the Endocrine Today Editorial Board.
In adults without diabetes, “we recommend evaluation and management of hypoglycemia only in patients in whom Whipple’s triad — symptoms, signs or both consistent with hypoglycemia, a low plasma glucose concentration and resolution of those symptoms or signs after the plasma glucose concentration is raised — is documented,” the authors wrote.
Also when considering adults without diabetes, the guidelines recommend first reviewing the patient’s history and physical findings seeking evidence of relevant drugs, illness or hormone deficiencies. If a cause is not evident, the next recommended step is to document hypoglycemia and evaluate for endogenous hyperinsulinism. If it is suspected that the patient has endogenous hyperinsulinism, measurement is recommended for plasma glucose, insulin C-peptide, proinsulin, beta-hydroxybutyrate and circulating oral hypoglycemic agents during a hypoglycemic episode and the plasma glucose response to intravenous glucagon.
“On the other hand, hypoglycemia is common in patients with diabetes treated with insulin or an insulin secretagogue,” Cryer told Endocrine Today.
When managing patients with diabetes and hypoglycemia, the guidelines recommend using a blood glucose concentration of ≤70 mg/dL to become concerned about hypoglycemia in a patient followed by the lowest mean glycemic goal that can be accomplished safely. Further, the guidelines suggest necessary adjustments to the treatment regimen, avoidance of hypoglycemia and urgent ingestion of carbohydrates if immediate treatment is needed. – by Katie Kalvaitis
J Clin Endocrinol Metab. 2009;94:709-728.
These are sensible, cost-effective recommendations based on the data and extensive clinical experiences of the task force.
- David S. H. Bell, MD
Endocrine Today Editorial Board member
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