Can agitation occur in hypoglycemia (low blood sugar)?

From the Guidelines

Yes, agitation can occur during hypoglycemia (low blood sugar). According to the most recent evidence from 2014 1, hypoglycemia can cause neurological symptoms including irritability, anxiety, and agitation, particularly when blood glucose levels fall below 70 mg/dL (3.9 mmol/L). Other common symptoms that may accompany agitation include confusion, sweating, shakiness, hunger, and heart palpitations.

Key Points to Consider

• Severe hypoglycemia is a medical emergency that requires immediate attention and can be associated with mental status changes, including confusion, incoherence, combativeness, somnolence, lethargy, seizures, or coma 1.
• Individuals with diabetes exhibiting signs and symptoms consistent with hypoglycemia, particularly altered mental status, agitation, and diaphoresis, should have their CBG levels checked immediately 1.
• Correctional institutions should have systems in place to identify patients at greater risk for hypoglycemia and ensure early detection and treatment 1.
• Immediate treatment with 15-20 grams of fast-acting carbohydrates is recommended for suspected hypoglycemia, such as 4 ounces of fruit juice, 3-4 glucose tablets, or a tablespoon of honey, with blood glucose rechecked after 15 minutes and treatment repeated if levels remain low 1.

Recommendations for Practice

• Agitation in the context of suspected hypoglycemia should be treated promptly with fast-acting carbohydrates to prevent progression to more severe manifestations like seizures or loss of consciousness 1.
• Patients with diabetes who take insulin or certain oral medications like sulfonylureas are at higher risk for hypoglycemic episodes and should be closely monitored 1.

From the FDA Drug Label

Early symptoms of hypoglycemia (low blood glucose) include: • sweating • depressed mood • drowsiness • tingling in the hands, feet, lips or tongue • dizziness • irritability • sleep disturbances • abnormal behavior • irregular heartbeat • lightheadedness • anxiety • unsteady movement • tremor • inability to concentrate • blurred vision • personality change • hunger • headache • slurred speech • restlessness

Agitation can occur in hypoglycemia, as indicated by symptoms such as irritability, abnormal behavior, anxiety, and restlessness 2.

From the Research

Hypoglycemia and Agitation

• Hypoglycemia, or low blood sugar, can cause a range of symptoms, including neurogenic (autonomic) and neuroglycopenic symptoms 3.
• Neurogenic symptoms, which are the result of the autonomic nervous system's response to hypoglycemia, can include tremulousness, palpitations, anxiety, sweating, hunger, and paresthesias 3.
• Neuroglycopenic symptoms, which are the result of brain glucose deprivation, can include confusion, sensation of warmth, weakness or fatigue, severe cognitive failure, seizure, and coma 3.
• Agitation can be considered a neurogenic symptom, as it is related to the autonomic nervous system's response to hypoglycemia.
• Studies have shown that hypoglycemia can cause significant distress and impairment, including cognitive dysfunction and mood changes 4.

Clinical Presentation of Hypoglycemia

• The clinical presentation of hypoglycemia can vary depending on the severity and duration of the episode 5.
• Mild hypoglycemia may cause symptoms such as shakiness, sweating, and hunger, while more severe episodes can lead to confusion, seizures, and loss of consciousness 5.
• Agitation can be a presenting symptom of hypoglycemia, particularly in cases where the individual is unable to communicate their needs or is experiencing significant distress 6.

Management of Hypoglycemia

• The management of hypoglycemia typically involves the administration of glucose or other carbohydrates to raise blood sugar levels 5.
• In cases where the individual is unable to take oral glucose, intravenous glucose may be administered 5.
• It is essential to recognize the signs and symptoms of hypoglycemia, including agitation, to provide prompt and effective treatment 7.