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TABLE 1

Physiologic responses to decreasing plasma glucose concentrations

ResponseGlycemic threshold (mg/dl [mmol/l])*Physiologic effectsRole in prevention or correction of hypoglycemia (glucose counterregulation)
↓ Insulin 80–85 [4.4–4.7] Ra (↓Rd) Primary glucose regulatory factor, first defense against hypoglycemia 
↑ Glucagon 65–70 [3.6–3.9] Ra Primary glucose counterregulatory factor, second defense against hypoglycemia 
↑ Epinephrine 65–70 [3.6–3.9] Ra, ↓Rd Involved, critical when glucagon is deficient, third defense against hypoglycemia 
↑ Cortisol and growth hormone 65–70 [3.6–3.9] Ra, ↓Rd Involved, not critical 
Symptoms 50–55 [2.8–3.1] ↑Exogenous glucose Prompt behavioral defense (food ingestion) 
↓ Cognition <50 [<2.8] — (Compromises behavioral defense) 
ResponseGlycemic threshold (mg/dl [mmol/l])*Physiologic effectsRole in prevention or correction of hypoglycemia (glucose counterregulation)
↓ Insulin 80–85 [4.4–4.7] Ra (↓Rd) Primary glucose regulatory factor, first defense against hypoglycemia 
↑ Glucagon 65–70 [3.6–3.9] Ra Primary glucose counterregulatory factor, second defense against hypoglycemia 
↑ Epinephrine 65–70 [3.6–3.9] Ra, ↓Rd Involved, critical when glucagon is deficient, third defense against hypoglycemia 
↑ Cortisol and growth hormone 65–70 [3.6–3.9] Ra, ↓Rd Involved, not critical 
Symptoms 50–55 [2.8–3.1] ↑Exogenous glucose Prompt behavioral defense (food ingestion) 
↓ Cognition <50 [<2.8] — (Compromises behavioral defense) 
*

Arterialized venous, not venous, plasma glucose concentrations.

Ra, rate of glucose appearance, glucose production by the liver and kidneys; Rd, rate of glucose disappearance, glucose utilization by insulin-sensitive tissues such as skeletal muscle (no direct effect on central nervous system glucose utilization). This table was prepared initially for Cryer PE: Glucose homeostasis and hypoglycemia. In Williams Textbook of Endocrinology, 11th Edition. Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, Eds. Saunders, Philadelphia, 2008, p. 1503–1533.

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