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Cardio Diabetes Medicine 2017 265

Hypoglycemia How Critical it is?

Prof. Dr. S. Arulrhaj MD., FRCP., (Glasg.)
Chief Physician and Head Acute Medicine
Sundaram arulrhaj hospitals,Tuticorin

Dr. Aarathy Kannan MD., Dip Diabetes
Physician and Diabetologist
Dr. Manikandan. R & Dr. Vinodh Kumar. A. DNB (Med).,

Abstract: Association (ADA), the American Association of Clin-
- Hypoglycemic events are associated with the po- ical Endocrinologists (AACE), the Endocrine Society,
tential for harm and should be avoided. and by the Joint British Diabetes Society and Dia-
betes UK . This value is recommended because it
- Hospitalized patients suffering from hypoglyce- approximates the lower limit of normal postabsorp-
mia, particularly spontaneous hypoglycemia, carry tive plasma glucose concentration and the glycemic
a poor prognosis. threshold for activation of glucose counter regulatory
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- When hypoglycemia occurs, the cause needs to responses . The value is practical in that it is higher
be elucidated and treatment regimen adjusted ap- than the glycemic threshold for hypoglycemic symp-
propriately. toms in most patients, allowing time for caregivers to
respond and prevent a more severe clinical event. It
- More aggressive insulin regimens appear to be also provides some margin for the limited accuracy
beneficial in some patient populations, but should of glucose monitoring devices that exists at lower
be individualized. glucose concentrations .
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Introduction As not all patients experience a correlation between
symptoms and plasma glucose levels, the ADA work-
Hypoglycemia is defined by the American Diabetes shop on hypoglycemia has developed a new classi-
Association as a blood glucose less than 70 mg/dL, fication of hypoglycemia. This classification is useful
with symptoms of Hypoglycemia which are relived by to better define and better understand hypoglycemic
Glucose Administration. events.
This may result in a variety of symptoms including
clumsiness, trouble talking, confusion, loss of con- CLASSIFICATION OF HYPOGLYCEMIA
sciousness, seizures, or death . A feeling of hunger, Severe hypoglycemia
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sweating, shakiness, and weakness may also be • An event requiring assistance
present. Symptoms typically come on quickly.Defin-
ing a single measurement threshold for hypoglyce- Documented symptomatic hypoglycemia
mia is complex since the physiological thresholds • Symptoms and glucose ≤70 mg/dl (3.9 mmol/l)
vary with age, gender and health status. In addition, Asymptomatic hypoglycemia
recent hypoglycemic episodes will lower the thresh- • Absence of symptoms and glucose ≤70 mg/dl (3.9
old at which patients experience symptoms in re- mmol/l)
sponse to low blood sugar, while poorly controlled
diabetics with chronic hyperglycemia may experience Probably symptomatic hypoglycemia
symptoms at higher glucose levels from relative hy- • Symptoms without documented low glucose ≥70
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poglycemia . In hospitalized patients, hypoglycemia mg/dl (3.9 mmol/l)
unawareness is common and the healthcare pro- Pseudohypoglycemia
vider should be alerted by a value of blood glucose • Symptoms and glucose ≥70 mg/dl (3.9 mmol/l)
<70 mg/dl (3.9 mmol/l) . This level is pragmatic, data
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driven and recommended by the American Diabetes

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