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Autonomic symptoms occur as the body releases catecholamines in response to falling glucose levels and include: Trembling or shakiness Palpitations and rapid heartbeat Sweating (often profuse) Anxiety or feeling of impending doom Hunger sensations Pallor and cold, clammy skin Neuroglycopenic symptoms result from insufficient glucose delivery to the brain and may include: Confusion or difficulty concentrating Dizziness or light-headedness Blurred or double vision Weakness and fatigue Slurred speech Behavioural changes or irritability Headache In severe cases: loss of consciousness or seizures Patients may not experience all symptoms, and some individuals develop hypoglycaemia unawareness a dangerous condition where autonomic warning symptoms are diminished or absent, leading directly to neuroglycopenic features

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