Diabetic hypoglycemia

Diabetic hypoglycemia should be considered if a person with diabetes presents with life-threatening alterations in mental and/or physical functioning, such as seizure or loss of consciousness. Other, less severe features of diabetic hypoglycemia include sympathoadrenal and neuroglycopenic symptoms, which include irritability, shakiness, palpitations, and hunger. The person may also present with a fall or motor vehicle accident.

However, be aware that some people may not present with typical signs and symptoms of hypoglycemia, particularly if they have impaired awareness of hypoglycemia.

Urgently perform finger stick measurement of blood glucose. Confirm diabetic hypoglycemia if blood glucose is <70 mg/dL (<3.9 mmol/L).

Treatment includes oral glucose, intravenous dextrose, or glucagon (or dasiglucagon), depending on the severity of the hypoglycemia, whether the person is unconscious or unable to swallow, and availability of intravenous access.

Be aware that episodes of hypoglycemia can be life threatening, and can also significantly impact a person's quality of life. Identify any risk factors for hypoglycemia in order to prevent future occurrence. In addition, identification and management of the underlying cause (e.g., adjustment of antidiabetic treatment) and patient education are key to prevent future episodes of hypoglycemia and reduce complications.

​​Diabetic hypoglycemia is any abnormally low blood glucose that has the potential to cause harm to a person.​​​[1]Abraham MB, Karges B, Dovc K, et al. ISPAD Clinical Practice Consensus Guidelines 2022: assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2022 Dec;23(8):1322-40. https://onlinelibrary.wiley.com/doi/10.1111/pedi.13443 http://www.ncbi.nlm.nih.gov/pubmed/36537534?tool=bestpractice.com [2]Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013 May;36(5):1384-95. https://diabetesjournals.org/care/article/36/5/1384/29546/Hypoglycemia-and-Diabetes-A-Report-of-a-Workgroup http://www.ncbi.nlm.nih.gov/pubmed/23589542?tool=bestpractice.com ​​​​ There is no single numeric definition of hypoglycemia because this varies for different people and situations.[1]Abraham MB, Karges B, Dovc K, et al. ISPAD Clinical Practice Consensus Guidelines 2022: assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2022 Dec;23(8):1322-40. https://onlinelibrary.wiley.com/doi/10.1111/pedi.13443 http://www.ncbi.nlm.nih.gov/pubmed/36537534?tool=bestpractice.com [2]Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013 May;36(5):1384-95. https://diabetesjournals.org/care/article/36/5/1384/29546/Hypoglycemia-and-Diabetes-A-Report-of-a-Workgroup http://www.ncbi.nlm.nih.gov/pubmed/23589542?tool=bestpractice.com ​​ However, a blood glucose <70 mg/dL (<3.9 mmol/L), defined as level 1 hypoglycemia, is the threshold that should alert the person to take appropriate actions to prevent development of more significant hypoglycemia.[1]Abraham MB, Karges B, Dovc K, et al. ISPAD Clinical Practice Consensus Guidelines 2022: assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2022 Dec;23(8):1322-40. https://onlinelibrary.wiley.com/doi/10.1111/pedi.13443 http://www.ncbi.nlm.nih.gov/pubmed/36537534?tool=bestpractice.com [2]Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013 May;36(5):1384-95. https://diabetesjournals.org/care/article/36/5/1384/29546/Hypoglycemia-and-Diabetes-A-Report-of-a-Workgroup http://www.ncbi.nlm.nih.gov/pubmed/23589542?tool=bestpractice.com [3]ElSayed NA, Aleppo G, Aroda VR, et al; American Diabetes Association. 6. Glycemic targets: standards of care in diabetes - 2023. Diabetes Care. 2023 Jan 1;46(1 suppl):S97-110. https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes http://www.ncbi.nlm.nih.gov/pubmed/36507646?tool=bestpractice.com ​​​[4]Holt RIG, DeVries JH, Hess-Fischl A, et al. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2021 Dec;64(12):2609-52. https://link.springer.com/article/10.1007/s00125-021-05568-3 http://www.ncbi.nlm.nih.gov/pubmed/34590174?tool=bestpractice.com [5]Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017 Dec;40(12):1631-40. https://diabetesjournals.org/care/article/40/12/1631/37000/International-Consensus-on-Use-of-Continuous http://www.ncbi.nlm.nih.gov/pubmed/29162583?tool=bestpractice.com ​​​​ Diabetic hypoglycemia is categorized further with increasing severity into level 2 (clinically significant; also referred to as clinically important or serious) and level 3 (severe) hypoglycemia. See Diagnostic criteria.

This topic covers diabetic hypoglycemia in adults and children, and in pregnant women who have preexisting diabetes. It does not cover women with gestational diabetes.