Podcast #245: Hypoglycemia

Author: Dylan Luyten, M.D.

Educational Pearls

• Hypoglycemia is very common in type 2 diabetics, and is often caused by insulin overdose or missed meals. Knowing the peak time of action for common diabetes medications can help inform treatment and disposition.
• Regular insulin’s action peaks around 60 minutes. By the time most of these patients present to the ED, the drug has had most of its effect.
• Lantis’ action does not peak, and will continue to exert its effect for 12 or more hours.
• Levamir has a peak around 6-8 hours.
• Metformin sensitizes tissues to insulin, so it cannot cause hypoglycemia alone.
• Glipizides have half-lives over 12 hours and work by increasing insulin release by the pancreas. Hypoglycemia in a patient taking a glipizide usually indicates there is another medical issue interfering with clearance

References: http://emedicine.medscape.com/article/122122-workup