What are the latest guidelines for critical blood glucose levels. How do different healthcare institutions approach hypoglycemia thresholds. Why is there debate surrounding the American Diabetes Association’s new critical value recommendation. What factors should clinical laboratories consider when setting glucose critical values.

The American Diabetes Association’s New Hypoglycemia Guidelines

In January 2019, the American Diabetes Association (ADA) released updated guidance on critical blood glucose levels. This new recommendation classified level 2 hypoglycemia as a glucose value below 54 mg/dL. The ADA stated that this threshold marks the point at which “neuroglycopenic symptoms begin to occur and requires immediate action to resolve the hypoglycemic event.”

This change was based on a 2017 consensus report from the ADA and seven other organizations. The report aimed to standardize clinically meaningful outcome measures for type 1 diabetes beyond HbA1c. However, this new critical value has been met with some skepticism and disagreement among clinical laboratorians.

Concerns About the Evidence Base

One of the main points of contention surrounding the ADA’s new recommendation is the limited evidence supporting it. The chain of references cited for this change ultimately leads to a single study conducted 30 years ago. This study involved only 10 participants who did not have diabetes. For many professionals in the field, this sparse evidence base has raised questions about the necessity of revising the critical value.

Implications of Changing Critical Glucose Values

Adopting a new critical value for hypoglycemia could have significant implications for healthcare institutions. These potential impacts include:

• Substantial changes to existing protocols
• Shifts in workloads for laboratorians and healthcare providers
• Potential strain on already limited resources
• Alterations in patient care management

Given the critical role that glucose monitoring plays in various aspects of medical care, clinical laboratorians are carefully weighing the decision to implement this new critical hypoglycemia value.

Diverse Approaches to Critical Glucose Values Across Institutions

Healthcare institutions have taken varied approaches to the ADA’s new recommendation, demonstrating that there is no one-size-fits-all solution. Here are some examples of how different organizations have responded:

UNC Hospitals, Chapel Hill, North Carolina

UNC Hospitals decided to align their values with the ADA hypoglycemia protocols. Dr. Steven Cotten, co-director of clinical chemistry, explained that this decision was made to avoid future misunderstandings or miscommunications about patient care, despite acknowledging that the change wasn’t based on robust studies.

Bronson Methodist Hospital, Kalamazoo, Michigan

Bronson Methodist Hospital had already been considering changing their lower limit for hypoglycemia. The ADA’s update accelerated their plan to switch from ≤42 mg/dL to ≤55 mg/dL. This change aligned with their existing protocol for hypoglycemia, which was triggered above the critical value range.

Houston Methodist Hospital, Texas

Houston Methodist Hospital chose not to adopt the new ADA recommendation. After consulting with other organizations, they concluded that raising their critical value from 50 mg/dL to 54 mg/dL would not serve a clinical need. Dr. Roger Bertholf, director of clinical chemistry, noted that the proposed change wouldn’t even exceed the variability of glucose measurements on a glucometer.

Temple University Hospital, Philadelphia

Temple University Hospital uses a higher critical value of 60 mg/dL. Dr. Adil Khan, director of point-of-care testing and clinical chemistry, explained that this threshold reduces the number of patients experiencing negative outcomes, such as fainting or rapid, irregular heartbeat. They believe that 54 mg/dL is more appropriate for clinical trials than patient care.

LAC+USC Medical Center, Los Angeles

LAC+USC Medical Center has maintained its critical value at <40 mg/dL, while flagging any glucose level <65 mg/dL as abnormal. This approach allows them to strike a balance between identifying potentially concerning glucose levels and setting a threshold for immediate clinical intervention.

Factors to Consider When Setting Glucose Critical Values

When determining whether to adopt new critical values for blood glucose levels, clinical laboratories and healthcare institutions should consider several factors:

1. Clinical relevance: Does the proposed change align with observed patient outcomes and symptoms?
2. Resource allocation: How will the change impact workload and resource utilization?
3. Consistency with other institutions: What are peer institutions doing, and how might differences affect patient care across healthcare systems?
4. Evidence base: Is there sufficient high-quality research to support the proposed change?
5. Potential for improved patient care: Will the new critical value lead to better management of hypoglycemia and overall patient outcomes?
6. Instrument capabilities: Can existing glucometers and laboratory equipment accurately measure and report the new critical value?
7. Impact on clinical protocols: How will the change affect existing treatment algorithms and emergency response procedures?

The Debate Between Biochemical and Clinical Thresholds

One of the key points of discussion surrounding critical glucose values is the distinction between biochemically defined thresholds and clinically relevant cutoffs. The ADA’s recommendation of 54 mg/dL is often viewed as a biochemical threshold, marking the point at which physiological changes begin to occur.

However, many clinicians argue that a higher threshold is more appropriate for patient care. For example, Temple University Hospital’s use of 60 mg/dL as a critical value is based on clinical observations of patient outcomes. This highlights the ongoing debate between using strictly defined biochemical markers versus more flexible, clinically-driven thresholds.

Balancing Sensitivity and Specificity

When setting critical values, laboratories must balance the need for sensitivity (catching all potentially dangerous hypoglycemic events) with specificity (avoiding unnecessary alerts and interventions). A lower threshold may increase sensitivity but could lead to alarm fatigue and overtreatment, while a higher threshold may miss some cases but reduce false positives.

The Role of Technology in Glucose Monitoring and Critical Values

Advancements in glucose monitoring technology have implications for how critical values are defined and managed. Continuous glucose monitoring (CGM) systems, for instance, provide a more comprehensive view of glucose trends over time, potentially changing how hypoglycemia is identified and addressed.

Impact of CGM on Critical Value Determination

With CGM, healthcare providers can observe not just single point measurements but also the rate and direction of glucose changes. This additional context may influence how critical values are interpreted and acted upon. For example, a glucose level of 60 mg/dL might be less concerning if it’s stable or rising slowly compared to a rapidly falling glucose level approaching the same value.

Integration with Electronic Health Records

As healthcare systems increasingly integrate laboratory data with electronic health records (EHRs), the management of critical values becomes more sophisticated. EHRs can provide automated alerts based on laboratory values, patient history, and other clinical factors, potentially allowing for more nuanced approaches to critical value reporting and intervention.

International Perspectives on Hypoglycemia Thresholds

While the ADA’s recommendation has sparked debate in the United States, it’s important to consider how hypoglycemia is defined and managed in other countries. Different healthcare systems and diabetes organizations around the world may have varying approaches to critical glucose values.

European Approaches

The European Association for the Study of Diabetes (EASD) has generally aligned with the ADA’s recommendations in recent years. However, individual European countries may have their own guidelines based on local clinical practice and healthcare system structures.

Asia-Pacific Region

Countries in the Asia-Pacific region often face unique challenges in diabetes management due to differences in diet, lifestyle, and genetic factors affecting glucose metabolism. As a result, some countries in this region may adopt different thresholds for hypoglycemia based on population-specific data.

Future Directions in Critical Glucose Value Management

As our understanding of diabetes and glucose metabolism continues to evolve, so too will approaches to defining and managing critical glucose values. Several areas of research and development may shape future practices:

• Personalized medicine approaches that take into account individual patient factors when setting critical values
• Advanced analytics and machine learning algorithms to predict hypoglycemic events before they occur
• Improved integration of glucose data with other clinical parameters for more comprehensive patient monitoring
• Development of new biomarkers that may complement or replace glucose measurements in assessing hypoglycemia risk

As these advancements unfold, clinical laboratories and healthcare institutions will need to remain flexible and ready to adapt their practices to ensure the best possible patient care.

The Importance of Interdisciplinary Collaboration

The debate surrounding critical glucose values underscores the importance of collaboration between various healthcare disciplines. Effective management of hypoglycemia requires input from endocrinologists, laboratory professionals, emergency medicine specialists, and nursing staff, among others.

Creating Consensus Through Dialogue

To address the challenges posed by changing critical values, many institutions have formed interdisciplinary committees to review evidence, discuss clinical implications, and reach consensus on appropriate thresholds. This collaborative approach ensures that decisions about critical values are informed by diverse perspectives and aligned with overall patient care goals.

Education and Training

When changes to critical values are implemented, comprehensive education and training programs are essential. These programs should target all healthcare professionals involved in glucose monitoring and management, ensuring consistent understanding and application of new protocols across the institution.

By fostering open communication and collaborative decision-making, healthcare institutions can navigate the complexities of critical glucose value management more effectively, ultimately leading to improved patient outcomes and more efficient use of healthcare resources.

Critical Value Change | AACC.org

In January 2019, the American Diabetes Association (ADA) in its annual standards of medical care in diabetes released new guidance, classifying level 2 hypoglycemia as a glucose value <54 mg/dL, the threshold at which “neuroglycopenic symptoms begin to occur and requires immediate action to resolve the hypoglycemic event” (Diabetes Care 2019;42(Suppl. 1):S61–70). This change, representing a new critical value, was based on a consensus report issued in 2017 by ADA and seven other organizations on standardizing clinically meaningful outcome measures beyond HbA1c for type 1 diabetes (Diabetes Care 2017;40:1622-30). Although the healthcare community generally hews closely to ADA standards, this move has been met with some doubt and disagreement among clinical laboratorians.

Conversation around the updated value perhaps has been more animated than other ADA recommendations because of the scant evidence behind it. The trail of references cited for the change eventually leads to a single 30-year-old study that involved only 10 people who did not have diabetes (Am J Physiol 1991;260:E67–74). For many in the field, that has called into question the need for a revised critical value, especially as making this change could create significant protocol pivots and shift workloads for laboratorians and providers alike, potentially straining already stressed resources.

Because monitoring patients’ glucose can play a critical role in many aspects of their medical care, clinical laboratorians are carefully considering whether to institute this new critical hypoglycemia value. With many factors involved, the decision will not be one-size-fits-all.

To Change or Not to Change

Clinical laboratories and institutions will need to decide for themselves whether the new critical value is appropriate, said Steven Cotten, PhD, DABCC, NRCC, FAACC, co-director of clinical chemistry at UNC Hospitals in Chapel Hill, North Carolina. At UNC, adopting the new value helped avoid any future misunderstandings or miscommunications about patients’ care, according to Cotten.

“We ended up aligning our values with the ADA hypoglycemia protocols with the understanding that the change wasn’t based really on a study,” he explained. “But we felt it was best to eliminate confusion.”

The ADA update also fell in line with an existing policy at Bronson Methodist Hospital in Kalamazoo, Michigan, said compliance and point-of-care coordinator Erika Deaton-Mohney, MT(ASCP). Bronson’s existing protocol for hypoglycemia was triggered above the critical value range, and a conversation had already begun about potentially changing the lab’s lower limit. Consequently, news of the ADA’s updated value accelerated the lab and clinical teams’ plan to switch from ≤42 mg/dL to ≤55 mg/dL.

Other institutions arrived at different conclusions about making the change, Houston Methodist Hospital in Texas among them. Consultation with other organizations indicated that raising the hospital’s critical value from 50 mg/dL to 54 mg/dL would not serve a clinical need, according to Roger Bertholf, PhD, DABCC, FAACC, director of clinical chemistry.

“Our laboratory leadership, including the director of clinical laboratories, wanted to know what other hospitals were doing,” he said. “When they heard the switch wouldn’t even be a change that would exceed the variability of glucose measurements on a glucometer, they lost a lot of enthusiasm for making the change.”

Adil Khan, MSc, PhD, director of point-of-care testing and clinical chemistry at Temple University Hospital and Temple University Episcopal Campus in Philadelphia, echoed Bertholf’s comments, adding that 54 mg/dL is more appropriate for clinical trials than patient care. In fact, he said, Temple uses a higher critical value, 60 mg/dL, because this threshold reduces the number of patients who experience negative outcomes, including fainting or a rapid, irregular heartbeat.

“A level of 54 mg/dL is more of a biochemically defined value where a patient would start to feel a lot of physiological issues. They develop an impaired mental status and many other symptoms,” he said. “After our endocrinologists spoke with their clinical colleagues, we felt we wanted our level to be higher.” Khan emphasized that any change to glucose critical values—regardless of the threshold chosen—should be made with improved patient care management in mind.

LAC+USC Medical Center in Los Angeles also has followed its own path on hypoglycemic critical values. Although the hospital flags as abnormal any glucose level <65 mg/dL, the organization’s critical value remains at <40 mg/dL, according to Allison Chambliss, PhD, DABCC, director of clinical chemistry and point-of-care testing.

“I don’t want to discount the fact that a glucose below 54 is certainly very low, and we know patients can be symptomatic and need intervention,” she said. “But for us, this discussion really came down to diagnosis or clinical classification, and that does not equal a critical value notification limit.”

The Journey to a Decision

Chambliss emphasized that deciding whether to switch a hypoglycemia critical value requires discussion and research. Any change also would call for methodical preparation because many parties, including both laboratory and point-of-care testing personnel, will be affected.

She also stressed the value in reaching out to peer institutions to see how they’ve approached this issue, including how they quantify and the reasoning behind their low glucose threshold. Bertholf seconded this recommendation, as the results of his poll of other organizations factored into Houston Methodist’s decision to maintain its current critical value.

Chambliss and her lab colleagues also gathered feedback from committees that involve providers who would receive the critical value calls. For instance, they collected input from the chairs of internal medicine not only at LAC+USC but also all USC hospitals, as well as from the health system’s ambulatory cases committee comprised of primary internal medicine providers and medical directors of outpatient clinics.

At Bronson Methodist, the patient safety and quality committee, as well as the medical process improvement and critical care process improvement committees, contributed to the decision-making process, said Deaton-Mohney.

Back at UNC, Cotten recommended involving stakeholders from pharmacy and information technology to ensure the smoothest transition. “As a large health system, we tried to make the change globally, so it wasn’t just our laboratory that had to do this,” he explained. “It was every single other satellite location, ambulatory clinic, affiliated hospital. They all had to coordinate on a single date to make the switch.”

Deaton-Mohney recommended that labs provide knowledge-sharing documents filled with details about how to make the change. This can be a good way to ensure all providers—particularly nurses most directly involved in patient care—are aware of the new critical value and how to implement it.

“The challenge is getting the education and knowledge out there about the change,” she said. “You also need to make sure your instrumentation at the point-of-care can trigger and alert the operator on the main screen to any critical results with the patient.”

Another place to get the word out is in daily patient care huddles, added Deaton-Mohney. “It can be a hurdle to make sure all of your operators that aren’t in the main laboratory understand this change and know what the differences are from old to new,” she said. “It’s critical to have your nursing team work with you, making sure they follow their processes to train all their operators. ”

Chambliss also cautioned labs to consider how any changes to glucose critical values might impact their workflows. “Examine your retrospective data from your labs so you know what those glucose results have looked like in the past,” she said. “Having the data and being able to play with the numbers will let you know how many more patients you would be making calls for so you can assess any impact on both the lab and on providers.”

It’s also important, she added, to know not only who will be responsible for making the calls about patients with low values but also who will be asked to receive this information. The switch to a higher critical value could become burdensome on both ends of the exchange—clinical laboratory staff and clinicians. Workflow reviews also would need to consider any adjustments needed in systems to document critical value calls for regulatory purposes.

A solid plan based on detailed information-gathering will guide labs in their decision-making on this issue, Bertholf suggested. “If you’re starting from ground zero to establish a program, and you want to know what sort of procedures you will implement, it is always helpful to have some sort of guideline document to which you can refer,” he suggested. “That gives you some sort of basis for choosing a particular threshold—otherwise, it can be an arbitrary threshold based solely on clinical judgment rather than evidence.”

Whitney J. Palmer is a freelance journalist in Holly Springs, North Carolina. +Email: [email protected]

Assessment of a critical limit protocol for point-of-care glucose testing

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Comparative Study

. 1996 Sep;106(3):390-5.

doi: 10.1093/ajcp/106.3.390.

G Lum 
¹

Affiliations

Affiliation

• ¹ Pathology and Laboratory Medicine Service, Brockton/ West Roxbury Veteran Affairs Medical Center, Boston, Massachusetts 021326, USA.

• PMID:

  8816600

• DOI:

  10.1093/ajcp/106.3.390

Comparative Study

G Lum.

Am J Clin Pathol.

1996 Sep.

. 1996 Sep;106(3):390-5.

doi: 10.1093/ajcp/106.3.390.

Author

G Lum 
¹

Affiliation

• ¹ Pathology and Laboratory Medicine Service, Brockton/ West Roxbury Veteran Affairs Medical Center, Boston, Massachusetts 021326, USA.

• PMID:

  8816600

• DOI:

  10.1093/ajcp/106.3.390

Abstract

A critical limit protocol requiring that all point of care glucose meter readings > 22.2 mmol/L (400 mg/dL) and < 2.2 mmol/L (40 mg/dL) be immediately confirmed by the laboratory was assessed. A total of 193 (2%) of 9,523 glucose meter determinations (63 patients) were > 22.2 or < 2.2 mmol/L. One hundred twenty-two (63%) of critically high and low glucose readings were followed up, and 71 (37%) results were not. Seventy-seven percent (55 of 71) of results without follow up were in patients with multiple glucose meter/central lab comparisons, suggesting that users may have thought it unnecessary to confirm such results. Split sample quality control specimens showed good correlation (r = 0.927) between glucose meter and central lab results, whereas correlation for follow-up glucose results was poorer (r = 0.793), perhaps reflecting time delay in obtaining a lab sample. For follow-up results, only 18% of high/low critical limit glucose meter readings were confirmed by drawing a lab specimen within 10 minutes. Fifty-eight percent were in 17 patients with multiple previous glucose meter readings, suggesting that users may have though it less urgent to confirm a sequence of such results. Eleven follow-up results (9%) showed a > 50% discordance between glucose meter/central lab with three (27%) glucose meter errors, emphasizing the need to confirm critically high/low glucose meter results to avoid potential errors. The critical limit protocol now requires that only the initial critically high/low glucose meter reading be confirmed by the lab and that these patients now be followed with lab values until glucose levels are between 5. 6-16.7 mmol/L (100-300 mg/dL) before the glucose meter can again be used.

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Named signs indicating a dangerously low blood sugar level

• Health

Trembling in the hands and body, cold sweat, aggressiveness and severe hunger are some of the signs of low blood sugar. If you do not quickly increase its level, there may be fainting. Why is sugar reduction so dangerous and how to help in such a situation?

June 16, 2022

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Glucose (or blood sugar) plays an important role in the body’s metabolic processes. It is the main supplier of energy for tissues and a number of organs. First of all, the brain. Normally, the concentration of sugar in capillary blood should be from 3.3 to 5.5 mmol / l. When the glucose level is below the prescribed level, a person begins hypoglycemia (we habitually call this – low sugar).

This is a dangerous condition, accompanied by a sharp deterioration in health, disorders of the central nervous system and internal organs. Most often, hypoglycemia develops due to a rapid decrease in blood sugar levels, for example, with intensive insulin therapy in patients with diabetes mellitus. But this is not the only reason. Oksana Panova, endocrinologist, nutritionist at the SM-Clinic in St. Petersburg, Candidate of Medical Sciences, and Anna Shavinina, endocrinologist at the ABIA clinic, told Doctor Peter details about the causes and measures to help with hypoglycemia.

Why is hypoglycemia dangerous?

If measures are not taken in time and the body is not helped to restore the sugar deficiency, hypoglycemia will progress. A person begins to hallucinate and convulsions, loss of vision occurs, and the risk of fainting increases. The critical level of glucose in the blood is 2.2 mmol / l. When sugar drops below this mark, a person falls into a hypoglycemic coma. This condition is a medical emergency. Otherwise, cerebral edema may begin. Hypoglycemia is especially dangerous for the elderly, who can develop strokes and heart attacks.

Constant bouts of hypoglycemia harm the metabolic processes in the body and the normal functioning of the endocrine system. This is fraught with metabolic disorders and hormonal problems. Therefore, it is so important for people prone to hypoglycemia to constantly monitor the level of sugar and keep it at normal values.

See also

Symptoms of hypoglycemia

Hypoglycemia is easy to recognize. Her first symptoms:

• acute hunger,

• severe overexcitation with panic attacks,

• tremors in the hands,

• rapid heartbeat, irritability.

Behind these manifestations are stress hormones, which are released into the blood by a “hungry” organism. However, their actions do not last long. Excitation is very quickly replaced by loss of strength, weakness, headaches and dizziness – up to loss of consciousness . A person loses the ability to concentrate , and cannot normally coordinate movements .

Speech becomes slurred, behavior becomes sluggish, and breathing becomes irregular. Muscles either begin to tremble, or, on the contrary, seem to “stony”. Other characteristic symptoms include:

• nausea and vomiting,

• double vision,

• sweating,

• icon expansion,

• convulsions.

Causes of hypoglycemia: why does sugar drop sharply?

Hypoglycemia often occurs in association with other diseases. First of all, diabetes. For example, when a patient exceeds the dose of insulin injections or abuses drugs to reduce sugar. People with diabetes don’t actually have “their” store of glucose. Therefore, if you artificially reduce it too much, the body will simply be left without an energy source.

Low sugar is also characteristic of some diseases of the digestive system, when glucose is poorly absorbed from food. Hypoglycemia can also be one of the consequences of kidney failure. In this case, sugar is constantly excreted from the body with urine.

Other diseases include liver cirrhosis and liver failure, sepsis, congenital disorders of carbohydrate and hormonal metabolism.

See also

Sugar can be low in perfectly healthy people

However, hypoglycemia can also occur in a completely healthy person. For example, against the background of “hungry” diets, excessive physical exertion and dehydration of the body.

Women often experience a shortage of sugar during menstruation. In addition, alcohol abuse can provoke hypoglycemia: an excess of ethyl alcohol inhibits the production of glucose.

Special cases – reactive and neoplastic hypoglycemia

Hypoglycemia is low blood sugar. The determination of blood sugar less than 2.5 mmol / l is regarded as a hypo-state, proceeds with vegetative and cerebral symptoms. With a lack of glucose, stress hormones, catecholamines, are released into the blood, there is a feeling of fear, palpitations, trembling, chills. The brain is in dire need of glucose. Its deficiency contributes to the development of convulsions, loss of consciousness, weakness.

Improper nutrition, the predominance of light carbohydrates in the diet (sweet drinks, chocolate, cakes) can provoke reactive hypoglycemia . The numbers in the blood are slightly reduced: less than 4 mmol / l, but the symptoms are pronounced. Stimulation of insulin production by the consumption of sweets triggers a number of mechanisms. The amount of the amino acid tryptophan, the hormone of joy, initially prevails, and then it breaks down. Therefore, after eating “delicious”, the mood first improves, and then despondency sets in. You can fight reactive hypoglycemia with a sugar-free diet.

But it happens that a decrease in blood sugar is due to insulinoma – the formation of the pancreas. A rare disease occurs in about 4 people per 10 million per year. It can not be seen on CT, MRI, conventional ultrasound. Whereas endoscopic ultrasound helps to make a diagnosis. In the blood, we determine insulin and C-peptide. Insulinomas successfully operate, and quick help is the introduction of glucose, contrainsular hormones.

See also

Hypoglycemia can be artificial

“Insulin is an anabolic hormone popular among athletes. In bodybuilding, it is illegally used to increase muscle mass. The introduction of insulin to people without diabetes is fraught with the development of hypoglycemic coma. In my practice, there was a student who, before the competition, injected a significant dose of insulin and entered the intensive care unit with a sugar of 1.8 mmol / l.

Occasionally, diabetic patients experience hypoglycaemia on glucose-lowering therapy. The reasons may be skipping meals, large doses of drugs, physical activity. Confusion of consciousness in such cases is very similar to alcohol intoxication. So, one of my patients behaved inappropriately in a cafe, but after drinking juice, his condition improved – it turned out that he had a long period of time between meals, and he did not have time to dine, ”Anna Shavinina shared. Therefore, diabetic patients should always wear identifying marks.

Read also

First aid for hypoglycemia

Help with hypoglycemia can be not only a medical professional, but also any passerby. The main thing is that the patient is conscious. Easily digestible carbohydrates (banana, juice, candy) are needed. It is strictly forbidden to pour juice into an unconscious person. An ambulance should be called. In addition to intravenous administration of glucose, glucocorticoids, glucagon are used – hormones that increase sugar.

Symptoms of low blood sugar are similar to other diseases. Therefore, headaches, convulsive syndrome, wadded muscles are an indication for the determination of sugar.

Text author:Alena Paretskaya

The child’s blood sugar has dropped. At what level of sugar is hospitalization indicated?

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Danilycheva Lyubov Ivanovna Pediatric endocrinologist, pediatrician

20.04.2020

A decrease in blood sugar (glucose) is called hypoglycemia. This condition causes dysfunction of many body systems.

The brain is especially sensitive to hypoglycemia, since sugar compounds are the main source of energy and nutrition for brain cells. With a very sharp drop in glucose levels, brain function can be impaired.

Globally, the causes of hypoglycemia are divided into drug-related and non-drug related.

Basically, a low blood glucose level occurs with diabetes mellitus and inadequate treatment of the disease, primarily with insulin and other drugs prescribed to patients with diabetes mellitus to reduce blood glucose.

Also, hypoglycemia can be caused by other reasons: a violation of the diet (starvation or exclusion from the diet of foods containing carbohydrates, long breaks in food), excessive physical, mental and emotional stress, metabolic disorders, etc.

There is a kind of hypoglycemia that occurs in children of the first year of life. It is caused by foods containing fructose, galactose (milk sugar) or the amino acid lecithin. The result of this is a decrease in blood sugar some time after eating foods containing these substances.

Symptoms of low blood sugar: pale skin, sweating, irritability, “tearfulness”, restless behavior, weakness, fatigue, trembling, dizziness, headache, nausea, abdominal pain, blurred vision, confusion, anxiety.