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Hypoglycemia is characterized by reduced plasma glucose to a level (usually less than 50 mg/dL) that may cause signs or symptoms (e.g., mental status changes). Hypoglycemia typically arises from abnormalities in the mechanisms involved in glucose homeostasis. For the diagnosis of hypoglycemia, the \'Whipple triad\' is generally observed as low blood sugar, presence of symptoms, and reversal of these symptoms when the blood sugar level is restored to normal. The true prevalence is 5-10% of patients who present with symptoms suggestive of hypoglycemia. Hypoglycemic symptoms are related to sympathetic activation and brain dysfunction due to the decreased glucose levels. This results in sweating, palpitations, tremulousness, anxiety, and hunger. Reduction in cerebral glucose availability (neuroglycopenia) may cause confusion, difficulty with concentration, irritability, hallucinations, focal impairment, coma and eventually death. Various forms and causes of hypoglycemia include: Drugs - ethanol, haloperidol, pentamidine, quinine, salicylates, sulfonamides (\'sulfa drugs\') and oral hypoglycemic agents have been associated with hypoglycemia as have numerous other drugs. Surreptitious sulfonylurea use/abuse - self-induced hypoglycemia that may be observed in healthcare workers or in relatives who care for diabetic family members. Exogenous insulin - for example, insulin-producing tumors of the pancreas (islet cell tumors), and non-beta-cell tumors. Reactive hypoglycemia - idiopathic, due to alimentary problems (e.g., patients with previous upper gastrointestinal surgery), or congenital enzyme deficiencies (e.g., hereditary fructose intolerance). Fasting hypoglycemia: Nesidioblastosis is a medical term for hyperinsulinemic hypoglycemia attributed to excessive function of pancreatic beta cells with an abnormal microscopic appearance.
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