Hypoglycemia, or low blood glucose, may contribute to sudden cardiac death in anorexia nervosa patients. Serum glucose levels of 35mg/dl or below, and hemoglobin A1c levels of 5.0% or below are cause for concern. Anorexia nervosa patients are particularly susceptible to hypoglycemia as the disorder impairs gluconeogenesis, and refeeding in treatment may lead to paradoxical excessive insulin secretion. Furthermore, due to chronic malnutrition and hypoglycemia, anorexia nervosa patients may not notice symptoms indicating acute hypoglycemia and may not seek treatment or help in time.