Delirium Following Hypoglycemic Events

Relationship Between Hypoglycemia and Delirium

Severe hypoglycemia can cause neuroglycopenic symptoms, including confusion, a key feature of delirium, particularly in cases of level 3 hypoglycemia, which is characterized by altered mental and/or physical functioning requiring assistance from another person for recovery, according to the American Diabetes Association 1, 2
The American Diabetes Association states that level 2 hypoglycemia, with blood glucose <54 mg/dL, is the threshold at which neuroglycopenic symptoms begin to occur 4
Level 3 hypoglycemia can progress to altered mental status, loss of consciousness, seizure, coma, or death, as reported by the American Diabetes Association 3, 4

Advanced age increases vulnerability to both hypoglycemia and delirium, according to the American Geriatrics Society 5
Pre-existing cognitive impairment increases the risk of both hypoglycemia and subsequent delirium, as stated by the American Academy of Neurology 6
African Americans are at substantially increased risk of level 3 hypoglycemia, according to the American Diabetes Association 4
Insulin use, poor glycemic control, albuminuria, and poor cognitive function are additional risk factors for hypoglycemia-related delirium, as reported by the American Diabetes Association 1

Symptoms of hypoglycemia include shakiness, irritability, confusion, tachycardia, and hunger, as described by the American Diabetes Association 1, 7
Hypoglycemia unawareness increases the risk of severe hypoglycemic episodes and subsequent delirium, according to the American Diabetes Association 4

The American Diabetes Association recommends treating hypoglycemia immediately with fast-acting carbohydrates when blood glucose is ≤70 mg/dL 1, 7
Pure glucose is the preferred treatment for hypoglycemia, but any form of carbohydrate containing glucose will raise blood glucose, as stated by the American Diabetes Association 1
For severe hypoglycemia with altered mental status, glucagon administration is indicated, according to the American Diabetes Association 6, 7

A history of severe hypoglycemia in older adults with type 2 diabetes has been associated with a greater risk of dementia, as reported by the American Geriatrics Society 5
Cognitive impairment at baseline or decline in cognitive function is significantly associated with subsequent episodes of severe hypoglycemia, according to the American Academy of Neurology 5

The American Diabetes Association recommends individualizing glycemic targets based on hypoglycemia risk 4
For patients with hypoglycemia unawareness or recent severe hypoglycemia, temporarily raising glycemic targets can help avoid further episodes, as stated by the American Diabetes Association 6, 8
Implementing ongoing assessment of cognitive function with increased vigilance for hypoglycemia in patients with impaired or declining cognition is recommended by the American Academy of Neurology 4, 8