Updated Hypoglycemia Classifications

That the American Diabetes Association (ADA) and The Endocrine Society would undertake this project says that hypoglycemia has been of greater concern by doctors lately. Five members from each organization were called together by the Chair, who is a member of both. A planning conference call was held before a two-day meeting at which staff from both organizations attended. The writing group used data from recent clinical trials and studies to update a prior work group report. Some conclusions were developed from expert opinion.

The new report reviews the impact of hypoglycemia on patients with diabetes and provides guidance about using this information in clinical practice. Because this was developed for clinical practice, I will not approach that side of it. As a patient, I have many reservations and concerns about the definitions and lack of understanding for patients to help them determine the severity of a hypoglycemic episode. This is where I feel the professionals are writing only for each other, and not to assist patients or to help educate patients. This lack of concern for education of patients is probably why I become upset. If, only if, they had taken some extra time to have expanded some areas, and include more information about hypoglycemia in the report, they could have also provided some excellent advice and guidance for patients. Believe it or not, many of us do learn.

The information is contained in PDF files and three can be found in this article. This link will take you to the Diabetes Care site as part of ADA where you can click on the Full Text (PDF) and download and read the data and background. The same link also has a slide set which you will need to click on and this will take you to a second page where again you will need to click on Slide Set which will open a window on screen to download a Microsoft PowerPoint Presentation (1.3 MB). The image below (slide 5) in about the consensus process and process of finally bringing it to publishing where we are able to read it. I felt this could be interesting. What is disappointing is that it is only nine slides in length. 

 

 

In the on PDF file Hypoglycemia Classification there are only four classifications given; however, in reading the full text file, it lists five classifications. All are determined with a measured plasma glucose concentration less than 70 mg/dl (3.9 mmol/l). Since this is for clinical use, I can understand the plasma glucose being necessary. However, most patients do not have the facilities to do this test, unless they work in a lab and take equipment home with them. So we use blood glucose meters and hypoglycemia is still for us a reading below less than 70 mg/dl (3.9 mmol/l).

The following are the five hypoglycemia classes:

#1) Severe hypoglycemia.

#2) Documented symptomatic hypoglycemia.

#3) Asymptomatic hypoglycemia.

#4) Probable symptomatic hypoglycemia.

#5) Pseudo-hypoglycemia.

Please read the PDF files if possible as the discussion contained in the “Full Text” file at the Diabetes Care site is more meaningful than the short PDF files in the like above from Diabetes-in-Control. I would suggest that many people have what is termed #5 above, except they may have heard it as false hypoglycemia. This often happens when people are newly diagnosed and because of medications (insulin and oral diabetes medications) are taking effect. Because your body has become used to high levels of blood glucose, when it starts dropping, this can cause these false symptoms of hypoglycemia. This is when testing can be important to determine the actual level.

Then the authors say some things that may be necessary, but could cause added expense to physicians. They claim that there is a need for accurate meters in the less than 75 mg/dl range for treating insulin patients. True, insulin can drive blood glucose levels down faster than oral medications, but even these patients need accurate meters. The authors then continue that those outpatients who are taking medications that rarely cause hypoglycemia don't need the more accurate meters. A lot on the judgmental side in my opinion.

The last issue that concerns me is the instructions for bringing blood glucose levels back to normal. This is included in the “Treating Hypoglycemia” PDF in this Diabetes-in-Control article. I have seen many people with type 1 diabetes blog about keeping juice boxes for treating hypoglycemia, but even they are not as fast a glucose tablets. The authors seem to prefer juice over glucose tabs as they list their preference as juice, skim milk, Life Savors candies and then glucose tabs or gel. I will give them credit for their instructions for glucose tabs or gel. They advise checking the package, because doses vary from brand to brand.

Not to dispute their “experts,” but I prefer the list at cardio smart and the order recommended.