- Credits - Section Writer: Dr. Om J Lakhani - Section Editor: Dr. Om J Lakhani Support us: 1. Support us by purchasing our book - Click here for more details: [[Volume 1- THE BEST OF NOTES IN ENDOCRINOLOGY BOOK SERIES]] 2. [Support you by Becoming a YouTube member (Click here)](https://www.youtube.com/channel/UC6zQSf7dLDqfQOeM4mNUBTQ/join) - 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