Stepped Clinico-Investigative Diagnostic Algorithm [SCIDA] Approach To Hypoglycemia In Adults – A Review

Abstract

Introduction: Hypoglycemia, a common condition encountered in medicine practice manifests as metabolic consequences due to low plasma glucose levels. It can have varied presentations ranging from subtle asymptomatic episodes to gross neurological deficits manifesting dramatically. SCIDA [Stepped Clinico-Investigative Diagnostic Algorithm] offers a systematic protocol-based attempt towards stepped algorithmic approach to the etiological diagnosis of Hypoglycemia at wholistic ease.   Discussion: The sequential 7 steps in order includes 7 actions to be taken by the physician to arrive the diagnosis. It includes Suspect, Screen, Confirm, Classify, Categorize, Evaluate & Diagnose towards etiological cause of Hypoglycemia.  Key criteria for hypoglycemia confirmation includes Whipple’s triad. Among the types, Diabetic hypoglycemia is more common in clinical practice and mostly due to administration of exogenous insulin or oral hypoglycemic agent. On the other hand, Nondiabetic hypoglycemia is relatively rare but tends to occur due to varied causes and at times even multifactorial. It includes Insulinoma, MEN-1(Multiple Endocrine Neoplasia) associated islet cell tumors and many more.  Conclusion: Physicians should maintain a high degree of suspicion towards its diagnosis as early treatment would result in prompt reversal of symptoms and its associated morbidity and mortality. This stepped approach provides a guide in history taking, examination findings and selection of relevant investigations to aid towards etiological diagnosis. SCIDA would further help to validate targeted treatment selection options beyond dextrose administrations, thereby preventing recurrences and thus improving quality of life among patients with hypoglycemia.