i think bm is basal metabolic rate
the answer is probably yes as my understanding is that if they aren't producing enough insulin or if their insulin resistance is too high then they will have symptoms of hypoglycemia no matter what the serum glucose is because your serum levels measure how much stuff is circulating and available to the body but you don't have insulin driving the glucose into your cells, then the serum levels are not really a good indication
my method of thinking is based on the fact that you can have high serum potassium in dka but total body potassium is lower than normal. you're losing potassium from cells so your blood levels are high
True but remember that most of the symptoms from hypoglycemia are due to decreased glucose available to the brain.
This causes all the adrenergic symptoms (due to stimulation of epinephrine and glucagon release to raise blood glucose) and
neuroglycopenic symptoms (due to low glucose levels within neurons) that are generally seen during hypoglycemia.
The adrenergic symptoms typically precede the neurogylcopenic symptoms and provide an early warning signal of sorts.
Adrenergic - tachycardia, tachypnea, tremors, dilated pupils, and sweaty skin
Neurogylcopenic - confusion, fatigue, dizziness, blurry vision, numbness/tingling
As the old adage goes, check a glucose (POC/whole blood or BMP/venous) in every patient with altered mental status.
Neurons have GLUT3 transporters which don't require insulin. Plus, these are high affinity transporters that can still take up glucose even at lower blood levels. Because of this, even in diabetes patients with severe insulin resistance or low insulin production you shouldn't see the classic symptoms unless their BGL is actually low (usually due to taking insulin/sulfonylurea medications then not eating). Generally you get symptoms below 50 to 60mg/dL (however this varies based upon the measurement method, the person's age, and any coexisting medical conditions). POC (finger stick) measurements are not as accurate and can be as much as 15mg/dL off from the actual BGL.
That being said, in uncontrolled diabetes you can have down regulation of GLUT3 transporters leading to a relative hypoglycemia at the low end of normal levels (usually 70-90mg/dL). This usually only causes mild symptoms. At the same time, however, diabetes patients are also at increased risk for developing hypoglycemic unawareness due to hypoglycemic desensitization and autonomic neuropathy. In this case, you can have patients with very low glucose and no symptoms. That's why you always check a BGL in every diabetic patient. The same thing also occurs in patients taking beta blockers.
