Severity of hypoglycaemia[105]Agiostratidou G, Anhalt H, Ball D, et al. Standardizing clinically meaningful outcome measures beyond HbA(1c) for type 1 diabetes: a consensus report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange. Diabetes Care. 2017 Dec;40(12):1622-30.
https://diabetesjournals.org/care/article/40/12/1622/36909/Standardizing-Clinically-Meaningful-Outcome
http://www.ncbi.nlm.nih.gov/pubmed/29162582?tool=bestpractice.com
Level 3 (severe)
No defined blood glucose.[3]ElSayed NA, Aleppo G, Aroda VR, et al; American Diabetes Association. 6. Glycemic targets: standards of care in diabetes - 2023. Diabetes Care. 2023 Jan 1;46(1 suppl):S97-110.
https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes
http://www.ncbi.nlm.nih.gov/pubmed/36507646?tool=bestpractice.com
[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
Severe event characterised by altered mental and/or physical status requiring assistance for treatment of hypoglycaemia.[3]ElSayed NA, Aleppo G, Aroda VR, et al; American Diabetes Association. 6. Glycemic targets: standards of care in diabetes - 2023. Diabetes Care. 2023 Jan 1;46(1 suppl):S97-110.
https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes
http://www.ncbi.nlm.nih.gov/pubmed/36507646?tool=bestpractice.com
[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
Level 2 (clinically significant; also referred to as clinically important or serious)
Blood glucose <3.0 mmol/L (<54 mg/dL).[3]ElSayed NA, Aleppo G, Aroda VR, et al; American Diabetes Association. 6. Glycemic targets: standards of care in diabetes - 2023. Diabetes Care. 2023 Jan 1;46(1 suppl):S97-110.
https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes
http://www.ncbi.nlm.nih.gov/pubmed/36507646?tool=bestpractice.com
[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
This is usually the threshold at which neuroglycopenic symptoms occur.[3]ElSayed NA, Aleppo G, Aroda VR, et al; American Diabetes Association. 6. Glycemic targets: standards of care in diabetes - 2023. Diabetes Care. 2023 Jan 1;46(1 suppl):S97-110.
https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes
http://www.ncbi.nlm.nih.gov/pubmed/36507646?tool=bestpractice.com
In addition, be aware that a patient with impaired awareness of hypoglycaemia may not present with typical signs and symptoms of 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
[3]ElSayed NA, Aleppo G, Aroda VR, et al; American Diabetes Association. 6. Glycemic targets: standards of care in diabetes - 2023. Diabetes Care. 2023 Jan 1;46(1 suppl):S97-110.
https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes
http://www.ncbi.nlm.nih.gov/pubmed/36507646?tool=bestpractice.com
Level 1 (alert value)
Blood glucose <3.9 mmol/L (<70 mg/dL) and ≥3.0 mmol/L (≥54 mg/dL).[3]ElSayed NA, Aleppo G, Aroda VR, et al; American Diabetes Association. 6. Glycemic targets: standards of care in diabetes - 2023. Diabetes Care. 2023 Jan 1;46(1 suppl):S97-110.
https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes
http://www.ncbi.nlm.nih.gov/pubmed/36507646?tool=bestpractice.com
[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
This value should alert the patient to the possibility of developing level 2 hypoglycaemia and can be used as a threshold to take appropriate actions to prevent this (e.g., carbohydrate ingestion, adjusting medication).[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
[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
Types of hypoglycaemia[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
A workgroup of the American Diabetes Association and The Endocrine Society has proposed a set of criteria for the types of hypoglycaemia, based on presence of symptoms and blood glucose.[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
Documented symptomatic hypoglycaemia
Symptoms of hypoglycaemia occur and measured blood glucose is <3.9 mmol/L (<70 mg/dL).[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
Asymptomatic hypoglycaemia
Symptoms of hypoglycaemia do not occur but measured blood glucose is <3.9 mmol/L (<70 mg/dL).[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
Probable symptomatic hypoglycaemia
Symptoms of hypoglycaemia occur.[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
Blood glucose is not measured but is presumed to be <3.9 mmol/L (<70 mg/dL).[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
Pseudo-hypoglycaemia
Symptoms of hypoglycaemia occur but measured blood glucose is not <3.9 mmol/L (<70 mg/dL), but is approaching that level.[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