hypoglycemia hypoglycemia hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dl (3.9 mmol/l). whipple's triad is used to properly identify hypoglycemic episodes. it is defined as blood glucose below 70 mg/dl (3.9 mmol/l), symptoms associated with hypoglycemia, and resolution of symptoms when blood sugar returns to normal. hypoglycemia may result in headache, tiredness, clumsiness, trouble talking, confusion, fast heart rate, sweating, shakiness, nervousness, hunger, loss of consciousness, seizures, or death. symptoms typically come on quickly. not to be confused with the opposite disorder, hyperglycemia. hypoglycemiaother nameshypoglycaemia, hypoglycæmia, low blood glucose, low blood sugarglucose meterspecialtyendocrinologysymptomsheadache, blurred vision, shakiness, dizziness, weakness, tiredness, sweating, clamminess, fast heart rate, pounding heartbeat, nervousness or anxiety, hunger, nausea, pins and needles sensation, difficulty talking, confusion, loss of consciousness, unusual behavior, lightheadedness, pale skin color, seizures, deathusual onsetrapidcausesmedications (insulin, glinides and sulfonylureas), sepsis, kidney failure, certain tumors, liver diseasediagnostic methodwhipple's triad: symptoms of hypoglycemia, serum blood glucose level <70 mg/dl (3.9 mmol/l), and resolution of symptoms when blood glucose returns to normal treatmenteating foods high in simple sugars, dextrose, glucagonfrequencyin type 1 diabetics, mild hypoglycemia occurs twice per week on average, and severe hypoglycemia occurs one per year.deathsin type 1 diabetics, 6–10% will die of hypoglycemia. the most common cause of hypoglycemia is medications used to treat diabetes such as insulin, sulfonylureas, and biguanides. risk is greater in diabetics who have eaten less than usual, recently exercised, or consumed alcohol. other causes of hypoglycemia include severe illness, sepsis, kidney failure, liver disease, hormone deficiency, tumors such as insulinomas or non-b cell tumors, inborn errors of metabolism, several medications, and alcohol. low blood sugar may occur in otherwise healthy newborns who have not eaten for a few hours. hypoglycemia is treated by eating a sugary food or drink, for example glucose tablets or gel, apple juice, soft drink, or lollies. the person must be conscious and able to swallow. the goal is to consume 10–20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70 mg/dl (3.9 mmol/l). if a person is not able to take food by mouth, glucagon by injection or insufflation may help. the treatment of hypoglycemia unrelated to diabetes includes treating the underlying problem. among people with diabetes, prevention starts with learning the signs and symptoms of hypoglycemia. diabetes medications, like insulin, sulfonylureas, and biguanides can also be adjusted or stopped to prevent hypoglycemia. frequent and routine blood glucose testing is recommended. some may find continuous glucose monitors with insulin pumps to be helpful in the management of diabetes and prevention of hypoglycemia. definition blood sugar levels naturally fluctuate throughout the day, however hypoglycemia, also called low blood sugar or low blood glucose, is when blood sugar levels drop below 70 mg/dl (3.9 mmol/l). blood sugar levels are generally maintained between 70 and 110 mg/dl (3.9–6.1 mmol/l). although 70 mg/dl (3.9 mmol/l) is the lower limit of normal glucose, symptoms of hypoglycemia usually do not occur until 55 mg/dl (3.0 mmol/l) or lower. the blood glucose level at which symptoms of hypoglycemia develop in someone with several prior episodes of hypoglycemia may be even lower. whipple's triad the symptoms of low blood sugar alone are not specific enough to characterize a hypoglycemic episode. a single blood sugar reading below 70 mg/dl is also not specific enough characterize a hypoglycemic episode. whipple's triad is a set of three conditions that need to be met to accurately characterize a hypoglycemic episode. the three conditions are the following: the signs and symptoms of hypoglycemia are present (see section below on signs and symptoms) a low blood glucose measurement is present, typically less than 70 mg/dl (3.9 mmol/l) the signs and symptoms of hypoglycemia resolve after blood glucose levels have returned to normal age the biggest difference in blood glucose levels between the adult and pediatric population occurs in newborns during the first 48 hours of life. after the first 48 hours of life, the pediatric endocrine society cites that there is little difference in blood glucose level and the use of glucose between adults and children. during the 48-hour neonatal period, the neonate adjusts glucagon and epinephrine levels following birth, which may cause temporary hypoglycemia. as a result, there has been difficulty in developing guidelines on interpretation and treatment of low blood glucose in neonates aged less than 48 hours. following a data review, the pediatric endocrine society concluded that neonates aged less than 48 hours begin to respond to hypoglycemia at serum glucose levels of 55–65 mg/dl (3.0–3.6 mmol/l). this is contrasted by the value in adults, children, and older infants, which is approximately 80–85 mg/dl (4.4–4.7 mmol/l). in children who are aged greater than 48 hours, serum glucose on average ranges from 70 to 100 mg/dl (3.9–5.5 mmol/l), similar to adults. whipple's triad is used to identify hypoglycemia in children who can communicate their symptoms. differential diagnosis other conditions that may present at the same time as hypoglycemia include the following: alcohol or drug intoxication cardiac arrhythmia valvular heart disease postprandial syndrome hyperthyroidism pheochromocytoma post-gastric bypass hypoglycemia generalized anxiety disorder surreptitious insulin use lab or blood draw error (lack of antiglycolytic agent in collection tube or during processing) signs and symptoms hypoglycemic symptoms are divided into two main categories. the first category is symptoms caused by low glucose in the brain, called neuroglycopenic symptoms. the second category of symptoms is caused by the body's reaction to low glucose in the brain, called adrenergic symptoms. neuroglycopenic symptoms adrenergic symptoms headache blurred vision tiredness (also called fatigue) unusual behavior confusion lightheadedness difficulty speaking or slurred speech seizures loss of consciousness (sometimes called passing out) death, if severe hypoglycemia fast heart rate pounding heartbeat (also called palpitations) sweating clamminess shakiness or tremulousness nervousness (also called anxiety) hunger nausea pins and needles sensation pale skin color