From the Guidelines
Hypoglycemia in diabetic patients is defined as a blood glucose level below 70 mg/dL (3.9 mmol/L), which is considered the threshold for initiating treatment. This definition is based on the most recent and highest quality evidence from the American Diabetes Association standards of medical care in diabetes, as outlined in the 2018 guidelines 1. According to these guidelines, a hypoglycemia alert value of ≤70 mg/dL (3.9 mmol/L) is important for therapeutic dose adjustment of glucose-lowering drugs in clinical care and is often related to symptomatic hypoglycemia.
Key Points
- Hypoglycemia can be categorized as mild, moderate, or severe, with severe hypoglycemia defined as severe cognitive impairment requiring assistance from another person for recovery 1.
- Symptoms of hypoglycemia include shakiness, irritability, confusion, tachycardia, and hunger, and can be categorized into adrenergic and neuroglycopenic symptoms.
- The "rule of 15" is commonly used for treatment, involving consuming 15 grams of fast-acting carbohydrates, waiting 15 minutes, then rechecking blood glucose and repeating if necessary 1.
- For severe hypoglycemia, glucagon administration is required, and individuals at risk for hypoglycemia should be prescribed glucagon and educated on its use 1.
Treatment and Prevention
- Glucose (15–20 g) is the preferred treatment for the conscious individual with blood glucose ≤70 mg/dL (3.9 mmol/L) 1.
- Individuals at risk for hypoglycemia should be asked about symptomatic and asymptomatic hypoglycemia at each encounter, and their treatment regimens should be reevaluated if hypoglycemia unawareness or severe hypoglycemia occurs 1.
- Ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if low cognition or declining cognition is found 1.
From the FDA Drug Label
Hypoglycemia: All sulfonylureas are capable of producing severe hypoglycemia.
- Definition of Hypoglycemia: The FDA drug label does not provide a specific definition of hypoglycemia in terms of blood glucose levels.
- Hypoglycemia Risk: The label does mention that hypoglycemia may occur, especially in certain patient populations, such as the elderly, debilitated, or malnourished patients, and those with adrenal or pituitary insufficiency 2.
- Hypoglycemia Symptoms and Treatment: The label explains the importance of informing patients about the risks of hypoglycemia, its symptoms, and treatment, but does not provide a specific definition of hypoglycemia 2.
From the Research
Definition of Hypoglycemia
- Hypoglycemia is defined as a blood glucose level under 70 mg/dL (3.9 mmol/L) 3, 4.
- Severe hypoglycemia is defined as an episode requiring the assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions to assure neurologic recovery 3.
Factors Influencing Hypoglycemia Definition
- Symptoms of hypoglycemia may occur at higher blood glucose levels in individuals with poor glycaemic control 3.
- The definition of hypoglycemia may vary depending on the individual's glucose control and other factors 5, 6.
Importance of Hypoglycemia Definition
- Hypoglycemia is a major limiting factor in achieving glycaemic control among people with diabetes 3.
- Hypoglycemia is associated with physical and psychological morbidity, and the fear of hypoglycemia constitutes a barrier that impairs the patient's ability to reach good glycemic control 5, 6.
- Recognizing the signs and symptoms of hypoglycemia and initiating prompt intervention is crucial to reduce the risk of mortality, especially in hospitalized patients with diabetes 4.