From the Guidelines
A hypoglycemic episode is commonly referred to as "low blood sugar" or simply "hypoglycemia," with levels categorized into three stages: level 1, level 2, and level 3 hypoglycemia, as defined in the 2023 standards of care in diabetes 1.
Definition and Classification
Hypoglycemia is a condition that occurs when blood glucose levels fall below a certain threshold, with level 1 hypoglycemia defined as a measurable glucose concentration <70 mg/dL (3.9 mmol/L) but ≥54 mg/dL (3.0 mmol/L), level 2 hypoglycemia defined as a blood glucose concentration <54 mg/dL (3.0 mmol/L), and level 3 hypoglycemia defined as a severe episode 1.
Key Points
- Level 1 hypoglycemia is considered clinically important due to impaired counterregulatory responses to hypoglycemia and/or hypoglycemia unawareness in people with diabetes 1.
- Level 2 hypoglycemia requires immediate action to resolve the hypoglycemic event, and if a patient has level 2 hypoglycemia without adrenergic or neuroglycopenic symptoms, they likely have hypoglycemia unawareness 1.
- The treatment plan should be reviewed and adjusted to decrease hypoglycemia, and hypoglycemia avoidance education should be triggered by hypoglycemia unawareness or one or more episodes of level 3 hypoglycemia 1.
Treatment and Prevention
- Glucose (approximately 15–20 g) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L) 1.
- Glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia, and caregivers, school personnel, or family members providing support to these individuals should know where it is and when and how to administer it 1.
From the FDA Drug Label
Severe hypoglycemia in pediatric and adult patients with diabetes Early symptoms of hypoglycemia may include: Hypoglycemia may happen again after receiving Glucagon for Injection treatment A hypoglycemic episode is also referred to as severe hypoglycemia or hypoglycemia reaction. Key points about hypoglycemic episodes include:
- They may happen again after treatment with Glucagon for Injection
- Early symptoms may occur
- Patients with diabetes are at risk, particularly pediatric and adult patients 2 2
From the Research
Definition of Hypoglycemic Episode
- A hypoglycemic episode is commonly referred to as hypoglycemia 3, 4, 5, 6, 7
- It is a condition characterized by abnormally low blood glucose levels 3, 4, 5, 6, 7
Terminology
- Severe hypoglycemia (SH) is a term used to describe a hypoglycemic episode that requires assistance from another person for recovery 3
- Hypoglycemia unawareness is a condition in which the autonomic and neuroglycopenic symptoms of hypoglycemia decrease, making it harder to recognize 6
Clinical Significance
- Hypoglycemic episodes can cause physical and psychological morbidity, and even death 3, 5, 7
- The fear of hypoglycemia can be a barrier to achieving good glycemic control 5
- Hypoglycemia-associated autonomic failure is a concept that describes the vicious cycle of recurrent hypoglycemia and further impairment of glucose counterregulation 7