Clinical Diagnosis Of Hypoglycemia

It is not possible to specify a plasma glucose concentration that defines clinical hypoglycemia in people with diabetes because the glycemic thresholds for the manifestations of hypoglycemia shift to higher than normal glucose levels in poorly controlled diabetes and lower than normal glucose levels in well controlled diabetes. The diagnosis is made most convincingly by Whipple's triad: symptoms consistent with hypoglycemia, a low plasma glucose concentration and relief of those symptoms after the plasma glucose concentrations is raised to (or above) normal. Ideally, suggestive symptoms should prompt a monitor-measured glucose level to confirm that those symptoms are indicative of hypoglycemia. However, patients often self-treat on the basis of symptoms alone. On the other hand, low self-monitored glucose levels should not be ignored even in the absence of symptoms. The American Diabetes Association Workgroup on Hypoglycemia (11) recommended that people with diabetes should become concerned, and consider defensive actions, at a plasma glucose concentration < 70 mg/dL (3.9mmol/L).

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