Hypoglycemia (Low Blood Sugar): Medical History

Medical history (history of illness) represents an important component in the diagnosis of hypoglycemia (hypoglycemia).

Family history

Social history

• What is your occupation?
• Do you work hard physically?

Current medical history/systemic history (somatic and psychological complaints).

• What symptoms have you noticed?
  • Paleness
  • Ravenous hunger
  • Palpitations
  • Sweating
  • Palpitations
  • Tremor
• How long have these symptoms been present?
• Have you been able to identify any other symptoms?
• When did you last eat/drink? What did you eat/drink?
• Has this symptomatology occurred more often? If yes, how long has the symptomatology been occurring? Was there a triggering moment?

Vegetative anamnesis incl. nutritional anamnesis.

• Are you overweight? Please tell us your body weight (in kg) and height (in cm).
• Do you eat a balanced diet?
• Do you get enough exercise every day?
• Do you drink alcohol? If so, what drink(s) and how many glasses per day?

Self history incl. medication history.

• Pre-existing conditions (diabetes mellitus; diseases of the nervous system; cardiovascular disease).
• Operations
• Allergies
• Environmental history / intoxications (poisonings) – fungal toxins; ackee fruit; alcohol excess, especially in the presence of severe concomitant diseases; alcohol in diabetes mellitus.

Medication history

• Analgesics (painkillers)
  • Opioids: propoxyphene (in renal insufficiency), tramadol.
• Antiarrhythmics
  • Quinidine
  • Disopyramide
• Antibiotics
  • Quinolones/fluoroquinolones/gyrase inhibitors (ciprofloxacin, moxifloxacin, nalidixic acid, norfloxacin, lomefloxacin, levofloxacin, ofloxacin): U.S. Food and Drug Administration warns of mental disorders and hypoglycemic coma
  • Ciprofloxacin, clarithromycin, levofloxacin, trimethoprim/sulfamethazole (in combination with sulfonylureas).
  • Trimethoprim/sulfamethazole in renal insufficiency (renal impairment).
• Antidiabetic drugs
  • Glinides (nateglinide, repaglinide)
  • Insulin overdose (esp. higher hypoglycemic tendency in women).
  • Overdose of sulfonylureas (SH) – glibenclamide, gliclazide, glimepiride, glipizide, gliquidone, tolbutamide.
  • SH (glipizide or glimepiride) in combination with a vitamin K antagonist (VKA; in this case, warfarin):
    • 22% increased risk of hypoglycemia (odds ratio [OR] 1.22); aged 65-74 years (OR 1.54) and in quarters with first-time warfarin use (OR 2.47).
    • 47% increased risk of fall-related fractures (broken bones) that brought patients to the emergency department or led to hospitalization (OR 1.47)
    • 22% increased risk for cognitive impairment (reductions in mental performance) (OR 1.22)
• Quinine (a naturally occurring chemical compound in cinchona bark from the group of alkaloids).
• Haloperidol (neuroleptic from the group of butyrophenones).
• Combination of several antidiabetic drugs
• Pentamidine (active ingredient from the group of antiparasitics).
• Salicylate

Literature

• See under hypoglycemia (hypoglycemia)/causes.