• Common complication in patients on insulin or sulfonylureas
• Causes:
o Missed/delayed meals
o Excess insulin or sulfonylurea dose
o Exercise, alcohol intake, renal impairment
• Symptoms:
o Autonomic: tremor, sweating, hunger, palpitations, anxiety
o Neuroglycopenic: confusion, drowsiness, seizures, coma
• Management:
o If conscious: rapid-acting oral glucose (e.g. juice, glucose tabs)
o If unconscious:
IV 10–20% dextrose
Or IM glucagon (ineffective in alcoholics/liver disease)
• Causes:
o Insulinoma (endogenous insulin secretion)
o Adrenal insufficiency (cortisol deficiency impairs gluconeogenesis)
o Severe liver disease (impaired glycogenolysis/gluconeogenesis)
o Alcohol excess (inhibits gluconeogenesis)
o Reactive (post-prandial) hypoglycaemia
o Sepsis, starvation, bariatric surgery
• Diagnostic criteria for true hypoglycaemia:
1. Symptoms of hypoglycaemia
2. Low plasma glucose
3. Relief of symptoms with glucose administration
• Deliberate or accidental misuse of hypoglycaemic agents
• Clues:
o Health care background
o Discrepancy between insulin levels and clinical picture
• Diagnosis:
o ↑ Insulin + low C-peptide → exogenous insulin
o ↑ Insulin + ↑ C-peptide → sulfonylurea or insulinoma
o Confirm with sulfonylurea screen (if C-peptide ↑)
• Consider psychiatric input (factitious disorder / Munchausen’s)
General principles of hormone action
Hormonal physiology in health and disease
The hypothalamic-pituitary axis disorders
Disorders of the adrenal medulla and MEN syndromes
Reproductive endocrinology and growth
Calcium, bone, and mineral metabolism
Diabetes mellitus and glucose homeostasis
Hypoglycaemia
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
