Hypoglycemia in adults: Clinical manifestations, definition, and causes

Hypoglycemia in adults: Clinical manifestations, definition, and causes

Authors:
F John Service, MD, PhD
Philip E Cryer, MD
Adrian Vella, MD
Section Editor:
Irl B Hirsch, MD
Deputy Editor:
Jean E Mulder, MD

Contributor Disclosures

All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Feb 2018. | This topic last updated: Mar 14, 2017.

INTRODUCTION — In patients without diabetes, hypoglycemia is a clinical syndrome with diverse

causes in which low plasma glucose concentrations lead to symptoms and signs, and there is
resolution of the symptoms/signs when the plasma glucose concentration is raised [1]. 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 [2]. In patients with
diabetes, the hypoglycemia symptoms and signs occur as a consequence of therapy. The primary
task in a patient without diabetes is to make an accurate diagnosis, whereas the primary task in a
patient with diabetes is to alter therapy in an attempt to minimize or eliminate hypoglycemia.

This topic will review the clinical manifestations, definitions, and causes of clinical hypoglycemia. The
evaluation of patients with hypoglycemia, detailed information on specific causes, and the
management of hypoglycemia in patients with diabetes are reviewed elsewhere. (See "Hypoglycemia
in adults without diabetes mellitus: Diagnostic approach" and "Insulinoma" and "Factitious
hypoglycemia" and "Nonislet cell tumor hypoglycemia" and "Management of hypoglycemia during
treatment of diabetes mellitus".)

Patients who have only sympathoadrenal symptoms (anxiety, weakness, tremor, perspiration, or
palpitations) but normal concurrent plasma glucose concentrations have a low probability of having a
hypoglycemic disorder. This combination of normal glucose in the face of sympathoadrenal
symptoms occurs most commonly in the postprandial state. (See "Postprandial (reactive)
hypoglycemia", section on 'Postprandial syndrome'.)

EPIDEMIOLOGY — Hypoglycemia is common in type 1 diabetes, especially in patients receiving

intensive insulin therapy, in whom the risk of severe hypoglycemia is increased more than threefold in
the Diabetes Control and Complications Trial (DCCT). Plasma glucose concentrations may be less
than 50 to 60 mg/dL (2.8 to 3.3 mmol/L) as much as 10 percent of the time [3]. Patients with type 1
diabetes may suffer an average of two episodes of symptomatic hypoglycemia per week, thousands
of such episodes over a lifetime of diabetes, and one episode of severe, at least temporarily disabling
hypoglycemia per year. Severe hypoglycemia events, the most reliable values albeit representing only
a small fraction of the total hypoglycemic experience, have been reported to range from 62 to 320
episodes per 100 patient-years in type 1 diabetes [1,3,4].