Hypoglycemia natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

If left untreated, patients with hypoglycemia may progress to develop anxiety, nervousness, tremor, palpitations, and sweating. Common complications of hypoglycemia include psychomotor retardation, epilepsy and prematurity in neonates. Complications in adults include increased risk of dementia, cardiovascular complications and may be death. Prognosis is generally good. Four to ten percent of death in patients with type 1 diabetes are due to hypoglycemia.

• The symptoms of hypoglycemia are usually developed in the second decade of life, and start with symptoms such as anxiety, nervousness, tremor, palpitations, and sweating.
• Without treatment, patient may develop symptoms of adrenergic manifestations such as confusion, amnesia, dizziness, delirium, double vision, slurred speech, generalized or focal seizures which may eventually lead to death.
• Lower values of plasma glucose may cause the following manifestations:
  • Values ≤55 mg/dL causes cognitive impairment and EEG (Electroencephalogram) changes.
  • Values <40 mg/dL causes drowsiness and change in behavior.
  • Values <30 mg/dL can cause seizures, permanent neurological deficits and even death.^[1]

• Psychomotor retardation
• Epilepsy^[2]
• Prematurity

• It depends on:
  • Duration of the attacks
  • Age of the patients
• Older patients show more complications than younger patients.^[3]
• Increased risk of dementia^[4]
• Episodes of dizziness increase the risk of falls and fractures.
• Severe hypoglycemia may increase the risk of cardiovascular complications in type 2 diabetes patients.^[5]

• Prognosis of hypoglycemia is generally good with treatment. Without treatment, hypoglycemia may be fatal.
• Four to ten percents of deaths of patients with type 1 diabetes are due to hypoglycemia.^[6]