Diabetic hypoglycaemia

Diabetic hypoglycaemia 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 hypoglycaemia include sympathoadrenal and neuroglycopenic symptoms, which include irritability, shakiness, palpitations, and hunger. The person may also present with a fall or a motor vehicle accident.

Some people may not present with typical signs and symptoms of hypoglycaemia, particularly if they have impaired awareness of hypoglycaemia.

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

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

Be aware that episodes of hypoglycaemia can be life-threatening, and can also significantly impact a person's quality of life. Identify any risk factors for hypoglycaemia to prevent future occurrences. In addition, identification and management of the underlying cause (e.g., adjustment of glucose-lowering treatment) and patient education are key to preventing future episodes of hypoglycaemia and reducing complications.

Continuous glucose monitoring (CGM) is a transformative tool in preventing and managing hypoglycaemia. It provides real-time glucose readings, trends, and alarms for low glucose levels. CGM has been shown to significantly reduce the frequency and severity of hypoglycaemia in individuals with both type 1 and insulin-treated type 2 diabetes. As a result, its use is increasingly recommended for both groups.

Diabetic hypoglycaemia is any abnormally low blood glucose that can 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 numerical definition of hypoglycaemia 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 level <3.9 mmol/L (<70 mg/dL), defined as level 1 hypoglycaemia, is the threshold that should alert the person to take appropriate actions to prevent the development of more significant hypoglycaemia.[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]American Diabetes Association. Standards of care in diabetes - 2025. Diabetes care. 2025. Jan 1; 48(Suppl 1):S1-343. https://diabetesjournals.org/care/issue/48/Supplement_1 ​​​[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 hypoglycaemia is categorised further with increasing severity into level 2 (clinically significant; also referred to as clinically important or serious) and level 3 (severe) hypoglycaemia. See Diagnostic criteria.​

This topic covers diabetic hypoglycaemia in adults and children, and in pregnant women who have pre-existing diabetes. It does not cover women with gestational diabetes.