From the Guidelines
Hypoglycemia typically presents with a combination of autonomic and neuroglycopenic symptoms, including shakiness, irritability, confusion, tachycardia, and hunger, as noted in the most recent guidelines 1. The autonomic symptoms occur as the body releases counterregulatory hormones like epinephrine in response to falling blood glucose. Neuroglycopenic symptoms develop when the brain becomes deprived of glucose and include confusion, difficulty concentrating, irritability, slurred speech, blurred vision, seizures, and in severe cases, loss of consciousness or coma.
Key Symptoms and Signs
- Autonomic symptoms: sweating, trembling, anxiety, hunger, palpitations, and paresthesias
- Neuroglycopenic symptoms: confusion, difficulty concentrating, irritability, slurred speech, blurred vision, seizures, and loss of consciousness or coma The classic "Whipple's triad" helps diagnose hypoglycemia: symptoms consistent with hypoglycemia, a documented low blood glucose level (typically below 70 mg/dL or 3.9 mmol/L), and resolution of symptoms after glucose administration.
Diagnosis and Treatment
- Documented low blood glucose level (typically below 70 mg/dL or 3.9 mmol/L)
- Resolution of symptoms after glucose administration
- Immediate treatment involves administering 15-20 grams of fast-acting carbohydrates (like glucose tablets or juice), followed by a reassessment of blood glucose after 15 minutes and repeated treatment if necessary, as recommended by recent guidelines 1. Notably, patients with recurrent hypoglycemia or long-standing diabetes may develop hypoglycemia unawareness, where the warning symptoms are diminished or absent, placing them at higher risk for severe episodes.
Special Considerations
- Hypoglycemia unawareness: diminished or absent warning symptoms, increasing the risk for severe episodes
- Recurrent hypoglycemia or long-standing diabetes: increased risk for hypoglycemia unawareness and severe episodes.
From the Research
Clinical Presentation of Hypoglycemia
The clinical presentation of hypoglycemia can vary, but common symptoms include:
- Sweating
- Tremor
- Palpitations
- Sensation of hunger
- Restlessness
- Anxiety
- Blurred vision
- Weakness
- Slurred speech
- Vertigo
- Difficulties in concentration 2
- Confusion/disorientation
- Shakiness
- Loss of consciousness
- Hospitalization 3
Symptoms and Consequences
Symptoms of hypoglycemia can be divided into two categories:
- Sympathetic symptoms, such as sweating, tremor, and palpitations, which are related to the release of catecholamines 2
- Neuroglycopenic symptoms, such as blurred vision, weakness, and difficulties in concentration, which are caused by an insufficient supply of glucose to the brain 2 Consequences of hypoglycemia can be severe, including:
- Confusion
- Loss of consciousness
- Hospitalization
- Death in rare cases if left untreated 4
Risk Factors and Prevention
Risk factors for hypoglycemia include:
- Old age
- Long duration of diabetes
- Certain concomitant medications
- Renal dysfunction
- Hypoglycemia unawareness
- Cognitive dysfunction 5 Strategies to mitigate the risk of hypoglycemia include:
- Awareness of the condition
- Education of patients, relatives, and healthcare providers
- Selecting appropriate glucose-lowering medication that judges the risk for hypoglycemia 5
- Avoiding hypoglycemia through flexible and individualized drug regimens, and considering risk factors for iatrogenic hypoglycemia 6