Investigations

1st investigations to order

blood glucose

Test
Result
Test

Urgently carry out a blood glucose level for any patient with suspected diabetic hypoglycaemia, which is a finger stick test that is performed at the bedside or in an outpatient setting. In practice, if finger stick testing is not available, start treatment if the patient has typical symptoms and signs of hypoglycaemia.

Confirm diabetic hypoglycaemia if blood glucose is <3.9 mmol/L (<70 mg/dL).​[1][3][4]​​​​ 

  • In clinical practice, this is used as the clinical alert or threshold value that should prompt treatment for hypoglycaemia in diabetes to prevent further fall in blood glucose.​[1][2][3]​​ However, be aware that hypoglycaemia is defined as any fall in blood glucose that exposes a patient to potential harm as there is no single numerical definition of hypoglycaemia for all patients and situations.[1]

  • Suspect nocturnal hypoglycaemia if the patient's pre-breakfast blood glucose is low.[1]

Take appropriate action according to the severity of hypoglycaemia. Start immediate treatment for any patient with level 2 or 3 hypoglycaemia.[3] Severity of diabetic hypoglycaemia is classified as follows:[3][4][17]​​

  • Level 3 (severe): no defined blood glucose. Severe event characterised by altered mental and/or physical status requiring assistance for treatment of hypoglycaemia.

  • Level 2 (clinically significant; also referred to as clinically important or serious): blood glucose <3.0 mmol/L (<54 mg/dL). This is usually the threshold at which neuroglycopenic symptoms occur.[3] In addition, be aware that a patient with impaired awareness of hypoglycaemia may not present with typical signs and symptoms of hypoglycaemia.​[1][3]

  • Level 1 (alert value): blood glucose <3.9 mmol/L (<70 mg/dL) and ≥3.0 mmol/L (≥54 mg/dL). Advise the patient that this value should alert them to the possibility of developing level 2 hypoglycaemia and can be used as a threshold to take appropriate actions to prevent this (e.g., carbohydrate ingestion, adjusting medication).[1][5]

Result

<3.9 mmol/L (<70 mg/dL)

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