Hypoglycemia Classification

American Diabetes Association

The ADA classifies a hypoglycemic event as Level 1, 2, or 3 (Table 1. American Diabetes Association - Classification of Hypoglycemia ).¹

Table 1. American Diabetes Association - Classification of Hypoglycemia¹

Level	Glycemic Criteria/Description
1a	BG <70 mg/dL (<3.9 mmol/L) and ≥54 mg/dL (≥3.0 mmol/L)
2b	BG <54 mg/dL (<3.0 mmol/L)
3c	A severe event characterized by altered mental and/or physical status requiring assistance for recovery.

Abbreviations: BG = blood glucose; DM = diabetes mellitus.

^a People without DM start to have diminished responses to decreasing glucose at a BG level of 70 mg/dL (3.9 mmol/L). Irrespective of the hypoglycemia symptom severity, a BG level of <70 mg/dL (<3.9 mmol/L) is deemed clinically important in people with DM who often have impaired responses to hypoglycemia and/or hypoglycemia unawareness.

^b A BG level of 54 mg/dL (3.0 mmol/L) is the threshold for neuroglycopenic symptoms to begin and requires immediate action for resolution of the hypoglycemia.   

^c Symptoms may be recognized or unrecognized and can lead to unconsciousness, coma, seizure, or death.

International Society for Pediatric and Adolescent Diabetes

The ISPAD classifies a hypoglycemic event as

• a clinical hypoglycemia alert

• clinically important or serious hypoglycemia, or

• severe hypoglycemia (Table 2. International Society for Pediatric and Adolescent Diabetes - Classification of Diabetes ).²

Table 2. International Society for Pediatric and Adolescent Diabetes - Classification of Diabetes²

Level	Glycemic Criteria/Description
Clinical hypoglycemia alerta	BG ≤70 mg/dL (≤3.9 mmol/L)
Clinically important or serious hypoglycemiab	BG <54 mg/dL (<3.0 mmol/L)
Severe hypoglycemiac	An event with severe cognitive impairment requiring assistance by another person.

Abbreviations: BG = blood glucose; DM = diabetes mellitus.

^a A BG level of ≤70 mg/dL (≤3.9 mmol/L) requires attention in children with DM due to the potential for BG levels to decrease further.  

^b Impaired hormonal counterregulation and hypoglycemia awareness, cognitive dysfunction, and neurogenic symptoms occur at a BG level of <54 mg/dL (<3.0 mmol/L). 

^c Severe cognitive impairment (including coma and convulsions) that requires help by another person to administer glucagon, carbohydrates, or assist with other measures. 

References

The published references below are available by contacting 1-800-LillyRx (1-800-545-5979).

1. American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(suppl 1):S61–S70. https://doi.org/10.2337/dc19-SINT01

2. Abraham MB, Jones TW, Naranjo D, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatric Diabetes. 2018;19(suppl 27):178-192. https://doi.org/10.1111/pedi.12698

Glossary

ADA = American Diabetes Association

ISPAD = International Society for Pediatric and Adolescent Diabetes