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Why can severe hypoglycemia lead to seizures, coma, or death?

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An anatomical illustration of the human pancreas shows its location near the stomach and intestines, a detailed cross-section highlighting ducts and the islet of Langerhans, and an inset of pancreatic tissue histology with labeled alpha, beta, and delta cells. — diabetes mellitus The islets of Langerhans are responsible for the endocrine function of the pancreas. Each islet contains beta, alpha, delta, and pancreatic polypeptide (PP) cells that are responsible for the secretion of pancreatic hormones. Beta cells secrete insulin, a well-characterized hormone that plays an important role in regulating glucose metabolism.

Severe hypoglycemia, a common complication in the treatment of diabetes mellitus, leads to life-threatening conditions like seizures, coma, and death because the brain relies on glucose as its primary fuel source.12

When blood glucose levels drop drastically—typically below 45 mg per 100 ml—the brain experiences glucose deprivation. The resulting symptoms are known as neuroglycopenic symptoms, which reflect the brain's inability to maintain normal function due to a lack of energy. As the central nervous system is highly sensitive to these fluctuations, the deprivation manifests as impaired consciousness, confusion, and seizures. If the glucose supply is not restored promptly through administration of sugar, the brain's failure to function can progress to coma and, ultimately, death.13