In a diabetic patient presenting with altered mental status, anxiety, and tremors, which is the most likely acute complication?

• A. Hyperglycemia
• B. Lactic Acidosis
• C. Hypoglycemia
• D. Diabetic Ketoacidosis

Answer: (C)

When blood glucose drops, the body’s immediate response is to raise it back up, which releases catecholamines that cause adrenergic symptoms like anxiety and tremors. If glucose continues to fall, the brain isn’t able to function properly, leading to altered mental status. In a diabetic patient, especially someone on insulin or a secretagogue, this pattern—an abrupt onset of tremors and anxiety followed by confusion or AMS—is most characteristic of hypoglycemia.

Hyperglycemia can also cause altered mental status, but the tremors and anxiety without features of dehydration or fruity breath, Kussmaul breathing, or severe dehydration point away from diabetic ketoacidosis or hyperosmolar states. Lactic acidosis tends to occur in settings such as sepsis, shock, or certain medications and isn’t the typical acute trigger for AMS in the classic diabetes scenario. Therefore, the most likely acute complication here is hypoglycemia. If suspected, promptly check a point-of-care glucose and administer dextrose if needed.