So welcome back to the Internet Book of Critical Care podcast. I'm here with Adam Thomas, and we're going to explore hypoglycemia.

This is so important. I'm stoked we're doing this this week, Josh, because hypoglycemia is one thing we need to know pretty cool.

Yeah, it's a fun topic. I like hypoglycemia. So usually it comes

down to the neuroglycopenia, but let's start off today. We're going to cover symptoms,

diagnosis, treatment, the differential, and then of course, all things pitfalls. Why don't you start

off with some symptoms here, Josh? So first of all, you have your autonomic symptoms. This is basically like being hangary. So you get diaphoretic, tremulous, tachycardic, palpitations, and you're hungry. This happens to me

every day around 11 in the morning. You're a living Snickers commercial. That's what you're saying,

right? I am. But then more serious than that, you get your neuroglycopenic symptoms, including

confusion, visual changes, slurred speech, seizures, and coma.

And I think a really important point is to always think about hypoglycemic in any patient who has basically any sort of neurologic problem.

It's super easy to rule it out.

You just always want to just get it off the table up front.

And I have to say personally, even though I think about it all the time, it's often missed

a lot when you show up to chaotic resuscitation or something's crazy going on, someone's seizing, and no

one's checked to sugar in a long time.

So important just to ask where it right away, make it one of your first steps in every

scenario.

Absolutely.

It's like getting a urine pregnancy test.

It's one of those things that like DLE should happen up front and then you can just forget

about it.

So that's a good segue then. Diagnosis. How do we approach this? What are we going to use to explore it? In general, think a finger stick is usually what we use. It's quick. It's easy. It's not perfect though. So there are some things that can artificially elevate it.

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