• Credits
  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

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• Q. What is the definition of Hypoglycemia in diabetics?
  • All episodes of abnormally low plasma glucose with or without symptoms that expose an individual to harm
  • People with diabetes should be concerned about hypoglycemia when the self-monitored BG is <70 mg/dl (remember it is the SMBG value)
• Q. What is the current ADA definition of Hypoglycemia?
  • ADA defines hypoglycemia as plasma glucose < 70 mg/dl
  • The ADA defines the levels of hypoglycemia as follows:
    • Level 1 Glucose <70 mg/dL (3.9 mmol/L) and ≥54 mg/dL (3.0 mmol/L)
    • Level 2 Glucose <54 mg/dL (3.0 mmol/L)
    • Level 3 - A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia
• Q. Why is 70 mg/dl chosen as the lower cutoff?
  • Counterregulatory response start at this level
  • Sympathoadrenal response to subsequent hypoglycemia occur at this level
• Q. What is the definition of hypoglycemia in non-diabetics?
  • Hypoglycemia is defined in a non-diabetic only when Whipple’s triad is fulfilled which is
    • Low plasma glucose
    • Symptoms of hypoglycemia at the time of low plasma glucose
    • Correction of symptoms with administration of Glucose or glucagon
• Q. At what glucose level are various counter-regulatory hormones activated which counteract the hypoglycemia?
  • Glucose 80-85 mg/dl- reduces serum insulin level
  • 65-70 – an increase of glucagon
  • 60-65- an increase of epinephrine
  • 50-55- symptoms of hypoglycemia- food-seeking behaviour
    • Cortisol and GH – late responses to hypoglycemia
  • <50 mg/dl- cognitive dysfunction
• Q. How does Adrenaline increase blood glucose?
  • Via alpha 2 receptor →  suppresses insulin production
  • Via beta 2 receptor → increase gluconeogenesis by liver and kidney
  • Via Beta 3- increase lipolysis → increase FA → increase peripheral insulin resistance
• Q. Why do diabetics have an increased risk of hypoglycemia?
  • Glucose-glucagon axis is blunted  glucagon released is impaired because of the impaired connection between glucose and glucagon
  • Use of insulin  - in normal cases reduction of blood glucose reduces insulin, which is not possible if exogenous insulin is used
  • Use of other drugs which cause hypoglycemia
  • Hypoglycemia associated with autonomic failure
  • Blunted sympathoadrenal response