Editing Hypoglycemia (section)

== Definition ==
''Hypoglycemia'', also called ''low blood sugar'' or ''low blood glucose,'' is a blood-sugar level below 70&nbsp;mg/dL (3.9&nbsp;mmol/L).<ref name="Jameson_2018" /><ref name=":2" />

Blood-sugar levels naturally fluctuate throughout the day, the body normally maintaining levels between 70 and 110&nbsp;mg/dL (3.9–6.1&nbsp;mmol/L).<ref name="Jameson_2018" /><ref name="Cry2009" /> Although 70&nbsp;mg/dL (3.9&nbsp;mmol/L) is the lower limit of normal glucose, symptoms of hypoglycemia usually do not occur until blood sugar has fallen to 55&nbsp;mg/dL (3.0&nbsp;mmol/L) or lower.<ref name="Jameson_2018" /><ref name="Cry2009" /> The blood-glucose level at which symptoms of hypoglycemia develop in someone with several prior episodes of hypoglycemia may be even lower.<ref name="Cry2009" />

=== Whipple's triad ===
The symptoms of low blood sugar alone are not specific enough to characterize a hypoglycemic episode.<ref name="Cry2009" /> A single blood sugar reading below 70&nbsp;mg/dL is also not specific enough to characterize a hypoglycemic episode.<ref name="Cry2009" /> ''[[Whipple's triad]]'' is a set of three conditions that need to be met to accurately characterize a hypoglycemic episode.<ref name="Cry2009" />

The three conditions are the following:

# The signs and symptoms of hypoglycemia are present (see section below on ''Signs and Symptoms'')<ref name="Cry2009" /><ref>{{Citation |last=Mathew |first=Philip |title=Hypoglycemia |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK534841/ |access-date=2024-08-16 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30521262 |last2=Thoppil |first2=Deepu}}</ref>
# A low blood glucose measurement is present, typically less than 70&nbsp;mg/dL (3.9&nbsp;mmol/L)<ref name="Cry2009" />
# The signs and symptoms of hypoglycemia resolve after blood glucose levels have returned to normal<ref name="Cry2009" />

===Age===
The biggest difference in blood glucose levels between the adult and pediatric population occurs in newborns during the first 48 hours of life.<ref name=":7">{{Cite journal |display-authors=6 |vauthors=Thornton PS, Stanley CA, De Leon DD, Harris D, Haymond MW, Hussain K, Levitsky LL, Murad MH, Rozance PJ, Simmons RA, Sperling MA, Weinstein DA, White NH, Wolfsdorf JI |date=August 2015 |title=Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children |journal=The Journal of Pediatrics |language=English |volume=167 |issue=2 |pages=238–245 |doi=10.1016/j.jpeds.2015.03.057 |pmc=11891912 |pmid=25957977 |s2cid=10681217 |doi-access=free}}</ref> After the first 48 hours of life, the Pediatric Endocrine Society cites that there is little difference in blood glucose level and the use of glucose between adults and children.<ref name=":7" /> During the 48-hour neonatal period, the neonate adjusts [[glucagon]] and [[Adrenaline|epinephrine]] levels following birth, which may cause temporary hypoglycemia.<ref name=":7" /> As a result, there has been difficulty in developing guidelines on interpretation and treatment of low blood glucose in neonates aged less than 48 hours.<ref name=":7" /> Following a data review, the Pediatric Endocrine Society concluded that neonates aged less than 48 hours begin to respond to hypoglycemia at serum glucose levels of 55–65&nbsp;mg/dL (3.0–3.6&nbsp;mmol/L).<ref name=":7" /> This is contrasted by the value in adults, children, and older infants, which is approximately 80–85&nbsp;mg/dL (4.4–4.7&nbsp;mmol/L).<ref name=":7" />

In children who are aged greater than 48 hours, serum glucose on average ranges from 70 to 100&nbsp;mg/dL (3.9–5.5&nbsp;mmol/L), similar to adults.<ref name=":7" /> Elderly patients and patients who take diabetes pills such as sulfonylureas are more likely to suffer from a severe hypoglycemic episode.<ref>{{Cite web |date=August 8, 2021 |title=Low Blood Sugar (Hypoglycemia) |url=https://www.diabetesdaily.com/learn-about-diabetes/understanding-blood-sugars/is-my-blood-sugar-normal/low-blood-sugar-hypoglycemia/ |website=diabetesdaily.com}}</ref><ref>{{Cite journal |vauthors=Ling S, Zaccardi F, Lawson C, Seidu SI, Davies MJ, Khunti K |date=2021-04-01 |title=Glucose Control, Sulfonylureas, and Insulin Treatment in Elderly People With Type 2 Diabetes and Risk of Severe Hypoglycemia and Death: An Observational Study |url=https://pubmed.ncbi.nlm.nih.gov/33541857/ |journal=Diabetes Care |volume=44 |issue=4 |pages=915–924 |doi=10.2337/dc20-0876 |issn=1935-5548 |pmid=33541857}}</ref> Whipple's triad is used to identify hypoglycemia in children who can communicate their symptoms.<ref name=":7" />