Unifying Concepts

Classification of Hypoglycemia

Hypoglycemia is the major limiting factor in the glycemic management of type 1 and type 2 diabetes. Recommendations from the International Hypoglycaemia Study Group regarding the classification of hypoglycemia considers a blood glucose <54 mg/dL (3.0 mmol/L) detected by self-monitoring of blood glucose (SMBG), continuous glucose monitoring (CGM) (for at least 20 min), or laboratory measurement of plasma glucose as sufficiently low to indicate serious, clinically significant hypoglycemia that should be included in reports of clinical trials of glucose-lowering drugs for the treatment of diabetes. However, a glucose alert value of </=70 mg/dL (3.9 mmol/L) can be important for therapeutic dose adjustment of glucose-lowering drugs in clinical care and is often related to symptomatic hypoglycemia. Severe hypoglycemia is defined as severe cognitive impairment requiring assistance from another person for recovery.

Classification of Hypoglycemia

Level  Glycemic criteria Description
Glucose alert value
(level 1)
</=70 mg/dL (3.9 mmol/L) Sufficiently low for treatment with fast-acting carbohydrate and dose adjustment of glucose-lowering therapy
Clinically significant hypoglycemia
(level 2)
<54 mg/dL (3.0 mmol/L) Sufficiently low to indicate serious, clinically important hypoglycemia
Severe hypoglycemia
(level 3)
No specific glucose threshold Hypoglycemia associated with severe cognitive impairment requiring external assistance for recovery




  1. American Diabetes Association. Glycemic Targets. Diabetes Care. 2017 Jan;40(Suppl 1):S48-S56. [Medline]
  2. International Hypoglycaemia Study Group. Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2017;40:155–157 [Medline]
  3. Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 2013;36:1384–1395 [Medline]


Created Jul 11, 2017.

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