### Instruction:  Disease name:

    Hypoglycemia

: Diagnosis

If a person with diabetes has severe hypoglycemia, he or she may not be able to answer the doctor's questions because of confusion or unconsciousness. In this case, a family member or close friend will need to describe the patient's medical history and insulin regimen. To help ensure effective emergency treatment, all people with diabetes treated with insulin or a sulfonylurea should consider wearing a medical alert bracelet or necklace. This potentially lifesaving jewelry will identify the patient as having diabetes, especially when the patient is far from home or traveling alone. Family members or friends of a person with diabetes should learn how to bring a patient out of severe hypoglycemia by giving the person orange juice or another carbohydrate, or by giving an injection of the drug glucagon, which can raise blood sugar. If a person with diabetes can answer questions appropriately, the doctor will want to know the names and doses of all medications, as well as recent food intake and exercise schedule. If the patient has been self-monitoring blood sugar with a glucometer (a hand-held device to measure glucose levels in blood from a finger prick) or with continuous glucose monitoring, the doctor will review the most recent blood sugar readings to confirm low blood sugar and to check for a pattern of hypoglycemia related to medication schedule, diet, or exercise. In people who do not have diabetes, the doctor will review current medications and ask about any history of gastrointestinal surgery (especially involving the stomach), liver disease, and the circumstances surrounding the epsodes. Patients should describe their symptoms and when they occur — whether they occur before or after meals, during sleeping, or after exercise. In a person with diabetes, the diagnosis of hypoglycemia is based on symptoms and blood sugar readings. In most cases, no further testing is necessary. In a person who is not diabetic, the ideal time for diagnostic testing is during an episode of symptoms. At that time, blood can be drawn to measure levels of glucose, and the patient's reactions to glucose intake can be tested. If these measures confirm the diagnosis of hypoglycemia, blood can be sent to a laboratory to measure insulin levels. In a person who is not diabetic, the ideal time for diagnostic testing is during an episode of symptoms. At that time, blood can be drawn to measure levels of glucose and insulin if an insulinoma is suspected. Other hormones, such as cortisol and thyroid levels, may also be measured. If the patient has no symptoms at the time of evaluation, the doctor may ask him or her to measure his or her blood glucose when hypoglycemic symptoms occur. If an insulinoma is suspected, the doctor may order a supervised 48-hour fast. During that period, blood levels of glucose and insulin will be measured when symptoms occur. A blood glucose level of less than 60 milligrams per deciliter at the time of symptoms and with a measurable level of insulin strongly suggests the person has an insulinoma. Accidental use of insulin or another diabetic drug may also cause hypoglycemia. If a person develops symptoms of hypoglycemia only after eating, the doctor may ask him or her to self-monitor blood sugar with a glucometer at the time the symptoms occur.