Causes of hypoglycemia in adult patients with type 2 diabetes mellitus in a tertiary hospital

Background: Hypoglycemia is a common medical emergency in diabetic patients, which is defined biochemically with blood glucose level 45-50 mg/dl with clinical features of adrenal over activity and neuroglycopenia. It is one of the preventable acute complications of diabetes mellitus through appropriate outpatient diabetes management. Our study aims to find out the causes of hypoglycemia in the patients with type-2 diabetes in a tertiary care hospital. Methods: This cross sectional observational study was performed in BIRDEM General Hospital on 100 adult type 2 diabetic hypoglycemic patients of both sexes to find out causes of hypoglycemia. and to determine the knowledge of overall diabetic education including dietary compliance (regular meal timing, consistency of day- to- day intake, meal spacing, sucrose limitation, calorie restriction and food exchange system etc), recommended way of exercise (aerobic, anaerobic, with complications etc.) and sick day management. Alterations of common biochemical parameters and presence of concomitant diseases in patients with hypoglycemia were studied. Results: Hypoglycemia occurred more in elderly (56%), with long duration of DM (56%) and frequency slightly more in male (66%) than female. Fifty percent of the patients presented with clinical features of severe hypoglycemia. Delay or omission of a snack or meal alone was the commonest (53%) cause in this study. Delay or omission of a snack or meal plus irregular diet habit emerged as 2nd important cause (22%). In 11% cases irregular dietary habit alone was responsible, and administration of excess insulin/secretagogues were responsible in only 4% cases. Hypertension (66%) was the most prevailing co-morbid condition. Others were nephropathy (38%), IHD (30%), diabetic neuropathy (19%), diabetic retinopathy (17%), dyslipidemia (12%), stroke (9%) and PVD (2%). Most of the hypoglycemic patients (69%) were on insulin when they had spells of hypoglycemia. The glycemic status was poor in most (87%) cases, having HbA1c>7%. Regarding overall diabetes care only 7% had some knowledge about diabetic education. Conclusion: In the present study, delay or omission of meal and irregular dietary habit were the causes of hypoglycemia in most of the cases, which signify lack of proper diabetic health education. Therefore, diabetic self management education is the most important element for the prevention of hypoglycemic events, and also to prevent long-term complications.