Hypoglycemia

Hypoglycemia occurs when blood glucose falls below the level required to maintain normal physiological function. It is time-sensitive because the brain depends on a steady supply of glucose and can fail before the patient can explain what is happening. In Canadian diabetes care, Diabetes Canada uses an alert value of glucose below 3.9 mmol/L to classify hypoglycemia in people treated with insulin or insulin secretagogues, and the same value decides whether to treat again. You may see 4.0 mmol/L in target ranges: the usual fasting or premeal target for many adults with diabetes starts at 4.0 mmol/L. That is a goal for daily management, not the hypoglycemia threshold. Severity is not a number. A severe episode is defined by functional impairment and the need for assistance, not a particular glucose value. So the first question at the bedside is not only what caused the low glucose, but whether the patient can swallow safely. A conscious patient with a safe swallow receives fast-acting carbohydrate. A patient with reduced consciousness, a seizure, or an unsafe swallow receives nothing by mouth and needs...