hypohyperglycemia

Hypohyperglycemia is not a formal medical diagnosis but a term sometimes used to describe rapid or frequent swings in blood glucose between hypoglycemic and hyperglycemic ranges. In current diabetes care, the concept is better described as glycemic variability or unstable glycemic control. It can occur in people with type 1 or type 2 diabetes and, in some cases, in hospital or critical care settings where glucose-lowering therapy is used.

Causes and contributors include mismatches between insulin or other glucose-lowering medications and food intake, missed or delayed meals, variations in physical activity, illness or infection, stress, hormonal changes, malabsorption, and inaccuracies or delays in glucose monitoring. Historical ideas such as nocturnal hypoglycemia followed by rebound hyperglycemia illustrate how complex rhythms of glucose regulation can be.

Clinical features may involve symptoms of hypoglycemia (sweating, tremor, palpitations, confusion) occurring around low glucose values, as well as symptoms of hyperglycemia (polyuria, polydipsia, fatigue, blurred vision) at high values. When fluctuations are rapid, patients may experience overlapping or sequential symptoms, and hypoglycemia unawareness can increase risk of severe events.

Diagnosis relies on glucose measurements and monitoring data. Documented low values (for example, <70 mg/dL) alongside higher values within a short interval indicate variability. Continuous glucose monitoring (CGM) provides metrics such as standard deviation, coefficient of variation, mean amplitude of glycemic excursions (MAGE), and time in range, which help assess instability.

Management aims to stabilize glucose through appropriate adjustment of insulin or other therapies, synchronized meals and snacks, and treatment of illness. For hypoglycemia, rapid correction with carbohydrates and, if needed, glucagon; for persistent hyperglycemia, therapeutic adjustments and hydration may be required. Reducing glycemic variability is associated with improved overall glycemic control and lower risk of complications.