SHM Converge Scientific Abstract ePoster Gallery-A Case Report of Pseudohypoglycemia in Severe Peripheral Artery Disease

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This case report describes pseudohypoglycemia in a 77-year-old man with end-stage renal disease, insulin-dependent type 2 diabetes, and severe peripheral artery disease (PAD). He was hospitalized for failed dialysis fistula access and made NPO for a fistulogram. A finger-stick point-of-care (POC) glucose reading showed severe hypoglycemia at 19 mg/dL, leading to rapid response activation and treatment with D50 and later D5W. However, the patient remained completely asymptomatic, with no mental status changes or other signs of hypoglycemia, and had not received insulin for 12 hours.<br /><br />Because the low bedside glucose readings did not match the clinical picture, pseudohypoglycemia was suspected. A simultaneous peripheral venous glucose measurement was 119 mg/dL, confirming that the finger-stick values were falsely low. The patient’s severe PAD was identified as the likely cause. When glucose was later checked using the earlobe, readings were consistently normal/high at about 200 mg/dL.<br /><br />The report emphasizes that pseudohypoglycemia is an important but uncommon phenomenon, previously associated with conditions such as Raynaud’s disease, Eisenmenger syndrome, and leukemia, and rarely reported in PAD despite PAD being common. The proposed mechanism is reduced blood flow in severely ischemic distal tissues, allowing greater local glucose extraction and causing falsely low capillary glucose measurements.<br /><br />The main clinical lesson is that severe hypoglycemia is a medical emergency, and misinterpreting pseudohypoglycemia can lead to unnecessary treatment, alarms, and escalation of care. In patients with severe PAD and unexpected finger-stick hypoglycemia—especially when asymptomatic—clinicians should confirm glucose with peripheral venous blood or consider alternative sampling sites such as the earlobe.

Asset Subtitle

Abigail B. Smith

Meta Tag

Author List Abigail B. Smith, Brittan Armstrong, Cody Moore, Harsha Jujjavarapu

Category Clinical Vignettes

Concept Pseudohypoglycemia

Concept Capillary Glucose Measurement

Concept Venous Glucose

Concept Hypoglycemic Symptoms

Concept Severe Peripheral Artery Disease

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Abigail B. Smith

Track Adult

Keywords

pseudohypoglycemia

peripheral artery disease

finger-stick glucose

end-stage renal disease

type 2 diabetes

hypoglycemia

dialysis fistula

earlobe glucose

capillary glucose

venous glucose

Pseudohypoglycemia

Capillary Glucose Measurement

Venous Glucose

Hypoglycemic Symptoms

Severe Peripheral Artery Disease