Hypoglycemia is a common and serious effect of diabetes treatment, leading to significant morbidity, mortality, and healthcare costs. Identifying its causes and presenting symptoms in emergency settings is crucial for prevention and management strategies.

To determine the causes, clinical presentations and correlates of blood glucose level among patients with type 2 diabetes presenting to the emergency department (ED) with hypoglycemia

Prospective descriptive cross-sectional study

Emergency Department of major referral center in Northern Iran

T2DM patients aged ≥30 years with confirmed diagnosis who presented to the ED with symptoms consistent with hypoglycemia and a plasma glucose <70 mg/dL (n=60).

Demographics, clinical characteristics, medications, and etiology and symptoms were collected using a checklist. The primary outcome was blood glucose. Factors associated with lower glucose were identified using bivariate tests and multiple linear regression.

Mean age was 65.1±14.0 years, 55% female. Most frequent causes: incorrect drug use (63.3%) and inappropriate prescription (16.7%). Neuroglycopenic symptoms were more common (43.3%) with lower mean glucose than neuroadrenergic symptoms (24.7 vs 53.9 mg/dL, p<0.001). In multivariable analysis, older age (β=-0.714, p=0.001) and higher BMI (β=-0.492, p=0.004) were independent correlates of lower presenting glucose.

Inappropriate medication use is the leading cause of hypoglycemia-related ED visits. Neuroglycopenic symptoms predominate, particularly in older patients. Patient education and provider vigilance are essential to reduce this preventable complication.