From the Guidelines
The Whipple triad is the diagnostic criteria for hypoglycemia, consisting of three essential components: low blood glucose levels, symptoms of hypoglycemia, and resolution of these symptoms when blood glucose is restored to normal. Symptoms of hypoglycemia fall into two categories: adrenergic symptoms (sweating, trembling, anxiety, hunger, palpitations) caused by the body's stress response, and neuroglycopenic symptoms (confusion, dizziness, weakness, visual disturbances, seizures, loss of consciousness) resulting from insufficient glucose supply to the brain 1.
Key Components of the Triad
- Low blood glucose levels (typically below 70 mg/dL or 3.9 mmol/L)
- Symptoms of hypoglycemia
- Resolution of these symptoms when blood glucose is restored to normal This triad is important for diagnosing true hypoglycemia because many conditions can mimic hypoglycemic symptoms. When evaluating suspected hypoglycemia, healthcare providers should document blood glucose levels during symptomatic episodes and observe whether symptoms resolve with glucose administration 1.
Treatment of Hypoglycemia
- Immediate glucose administration (15-20g of fast-acting carbohydrates) for conscious patients
- IV dextrose/glucagon for unconscious patients Common causes of hypoglycemia include excess insulin or oral hypoglycemic medications, insulinomas, critical illness, alcohol consumption, and certain medications. According to the most recent guidelines, individuals at risk for hypoglycemia should be asked about symptomatic and asymptomatic hypoglycemia at each encounter, and glucose (15–20 g) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL [3.9 mmol/L] 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition of the Triad in Hypoglycemia
The triad in hypoglycemia refers to the three main components involved in the body's response to low blood glucose levels. These components are:
- Glucose counterregulation: the body's ability to increase glucose production and release it into the bloodstream to counteract hypoglycemia 2
- Hypoglycemia awareness: the ability to recognize the symptoms of hypoglycemia, such as sweating, shaking, and confusion 2, 3
- Counterregulatory responses: the body's automatic responses to hypoglycemia, including the release of hormones such as glucagon and epinephrine to increase glucose production and release 2, 3
Importance of the Triad in Hypoglycemia
Impairments in these counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia 2. Episodes of hypoglycemia are associated with physical and psychological morbidity, and the fear of hypoglycemia can impede a patient's ability to achieve good glycemic control 2.
Treatment and Prevention of Hypoglycemia
Treatment options for hypoglycemia include the administration of glucose, glucagon, and octreotide, a somatostatin analogue that can inhibit insulin secretion and minimize the amount of fluid being given 4, 5, 6. Prevention of hypoglycemia involves patient education on risk factors, warning signs, and treatment of hypoglycemia at an early stage, as well as setting personalized goals for glycemic control 2, 3.