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Management of hypoglycemia during treatment of diabetes mellitus

Philip E Cryer, MD
Section Editor
Irl B Hirsch, MD
Deputy Editor
Jean E Mulder, MD


Hypoglycemia is an important problem in type 1 diabetes, especially in patients receiving intensive therapy in whom the risk of severe hypoglycemia is increased more than threefold (figure 1) [1-4]. Less commonly, hypoglycemia may also affect patients with type 2 diabetes who take a sulfonylurea or a meglitinide or who use insulin.

Identification of patients at risk for hypoglycemia and the prevention and management of hypoglycemia are reviewed here. The clinical manifestations of hypoglycemia and the physiologic response to hypoglycemia are discussed elsewhere. (See "Hypoglycemia in adults: Clinical manifestations, definition, and causes" and "Physiologic response to hypoglycemia in normal subjects and patients with diabetes mellitus".)


In 2013, a workgroup of the American Diabetes Association (ADA) and the Endocrine Society reconfirmed previously published criteria for the definition and clinical classification of hypoglycemia in patients with diabetes mellitus [3].

Definition — In patients with diabetes, hypoglycemia is defined as all episodes of an abnormally low plasma glucose concentration (with or without symptoms) that expose the individual to harm [3]. The workgroup recommended that people with diabetes become concerned about the possibility of hypoglycemia at a self-monitored blood glucose (SMBG) level ≤70 mg/dL (3.9 mmol/L). While that value is higher than the value used to diagnose hypoglycemia in people without diabetes, it approximates the lower limit of the physiologic fasting nondiabetic range, the normal glycemic threshold for glucose counterregulatory hormone secretion, and the highest antecedent low glucose level reported to reduce sympathoadrenal responses to subsequent hypoglycemia [1].

This cut-off value has been debated, with some favoring a value of <63 mg/dL (3.5 mmol/L) to avoid overclassification of hypoglycemia in asymptomatic patients [5-8]. However, when an SMBG value is ≤70 mg/dL, it does not mean that patients should always self-treat. Defensive options include repeating the measurement in the near term, avoiding critical tasks, such as driving, adjusting the subsequent treatment regimen, or ingesting carbohydrates. (See 'Treatment of hypoglycemia' below.)


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Literature review current through: Dec 2016. | This topic last updated: Tue Nov 08 00:00:00 GMT+00:00 2016.
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