Severe Hypoglycemia in Adults

Hypoglycemia is the most common endocrine emergency faced by practicing physicians, the most frequent complication of insulin-requiring diabetes, and the principal factor limiting optimization of glycemic control in diabetes. Hypoglycemia is defined arbitrarily as a blood glucose of less than 50 mg/dL (2.8 mmol/L) with neuroglycopenic symptoms or less than 40 mg/dL (2.2 mmol/L) in the absence of symptoms. Serious or severe hypoglycemia is usually defined as an episode where self-treatment is not possible, although the adjective “severe” is sometimes restricted to hypoglycemia which results in hospitalization, intravenous glucose or glucagon administration, seizure or coma. Severe hypoglycemia is a potentially lifethreatening crisis and the diagnosis of hypoglycemic coma should be considered in all unconscious patients. When severe hypoglycemia is not recognized and treated appropriately, significant morbidity including permanent neurological deficits and or death can result. Hypoglycemia in children is not discussed in this paper. The current review focuses on the frequency, pathophysiology, common causes, clinical presentation, diagnostic approach and management of severe hypoglycemia in adults.