Release of epinephrine is an early response to hypoglycemia in most patients, and this results in clinical findings commonly associated with hypoglycemia like sweating. An older adult or a patient with autonomic neuropathy may fail to show these findings. In these patients the neuroglycopenic findings may predominate and may be confused with other conditions, resulting in delayed diagnosis of hypoglycemia.

Neuroglycopenic findings may include:

(1) drowsiness

(2) confusion

(3) slurred speech

(4) poor coordination

(5) poor concentration or mental dullness

(6) visual disturbances

(7) bizarre behavior

(8) unsteadiness

(9) amnesia or forgetfulness

(10) seizures

(11) decreased level of consciousness, including coma


Common misdiagnosis:

(1) stroke

(2) intoxication

(3) early dementia


The presence of any of the neuroglycopenic findings in a diabetic should prompt an immediate check of the blood glucose.

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