Hypoglycemia: Here’s What You Need to Know

Here’s all you need to know about the causes, symptoms, and treatments for hypoglycemia.

 

By Janice Baker, RD, CDE, CNSC, BC ADM

Hypoglycemia – also called low blood glucose or low blood sugar – happens when blood glucose drops below normal levels. Blood glucose comes from food and our liver and is an energy source for our body including our brain.

Hypoglycemia can come without warning. It’s often mild and can be treated by eating or drinking something that contains sugar, such as juice, regular soda, hard candy, or nonfat milk  (higher fat foods, like a candy bar or a peanut butter sandwich, can slow down the response needed to quickly correct low blood sugar).

If left untreated, hypoglycemia can cause confusion or fainting. Prolonged hypoglycemia can lead to seizures, coma, and even death.  It’s very important to know the symptoms of hypoglycemia and know how to correct it.

 The symptoms of hypoglycemia include:

• Hunger
• Shakiness
• Sweating
• Dizziness
• Sleepiness
• Confusion
• Difficulty speaking
• Anxiety
• Weakness

Hypoglycemia can also happen during sleep. Symptoms include:

• Nightmares and agitation
• Night sweats
• Feeling tired, irritable or confusion upon awakening

Causes of hypoglycemia:

People with diabetes who take certain glucose-lowering medications may be at risk for hypoglycemia for a variety of reasons:

• Meals or snacks that are delayed or inadequate for needs, such as higher than normal activity
• Taking too much insulin or other blood-glucose lowing medications, or a change in medical status
• Increasing exercise or physical activity
• Drinking alcohol

In less common cases, those who don’t have diabetes can experience symptoms of hypoglycemia.

• Reactive hypoglycemia, which occurs a few hours after meals. This may occur in those who have had weight loss surgery and sometimes occur years after the surgery. Those with reactive hypoglycemia should follow a nutritious eating plan recommended by a registered dietitian; in some cases, medication may be considered.
• Fasting hypoglycemia can be caused by inadequate food intake, excessive activity or an overly rapid metabolism. It may also be brought on by certain medications or illnesses. A physical exam/assessment and diagnosis by a physician is essential.

Symptoms of both reactive and fasting hypoglycemia are similar to diabetes-related hypoglycemia: hunger, sweating, shakiness, dizziness, light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness.

Treatment of hypoglycemia:

The American Diabetes Association recommends that people experiencing hypoglycemia consume glucose or simple carbohydrates.^[1] It is recommended that those treated with insulin or blood sugar lowering medications carry a fast-acting carbohydrate source with them at all times, including on their person, in the car, and next to their bed.

To quickly and easily raise blood sugar levels to their normal range, a quick acting and convenient source of glucose is recommended, such as glucose gels or tablets, easily available at most pharmacies. If this is not available, use of 4 ounces of regular soda, juice or 1 cup of nonfat milk, or 3 regular sugar packets can be an option. After waiting 15 minutes, check blood sugar, and if below 70 mg/dl (3.9 mmol/L), treat again, followed by a meal or snack.

Extra precautions are necessary when driving, biking or operating machinery:

Hypoglycemia can be very dangerous if it occurs while driving, biking or operating heavy machinery. Confusion, blurred vision, and other symptoms mentioned affect response time, mental status and can lead to dangerous consequences. Those at risk for hypoglycemia should check their blood glucose level frequently and eat snacks to maintain normal blood sugar levels.

Hypoglycemia unawareness:

Some people don’t experience the warning signs of low blood glucose, a condition called hypoglycemia unawareness. People with hypoglycemia unawareness may need to check their blood glucose level more often for safety reasons. They may also need a change in their medications, meal plan, exercise routine.

Reducing the risk of hypoglycemia:

Consult with your physician, registered dietitian, and certified diabetes educator, as you can take action to prevent hypoglycemia and be ready if it occurs. Keep these tips in mind:

• Learn what can increase the risk of low blood glucose levels
• Know your blood sugar range and check your blood sugar regularly with a blood glucose meter, especially if you’re about to drive or if you’re experienced hypoglycemia unawareness. For people living with diabetes, a blood glucose level below 70 mg/dL (milligrams per deciliter, 3.9 mmol/L) is considered hypoglycemia. However, people with diabetes can also experience symptoms of hypoglycemia at higher blood sugar levels if their blood sugar has not been well controlled and has been running high. This is referred to as “relative hypoglycemia” and can be just as distressing.
• Take your diabetes medications at the same time each day. Discuss medication management with your pharmacist. In some cases, medication types and/or dosing needs adjustment because of changes in how one’s body uses insulin or change in lifestyle.
• Eat regular meals and snacks to nourish your body and brain. Over restriction can also lead to overeating later in the day, contributing to erratic blood sugar levels
• Work with a registered dietitian to develop an individualized, sustainable meal plan. Most of us feel better with regular meals, having enough food at each meal, and not skipping meals or snacks. However, as life can be unpredictable, it is a good idea to have a backup plan of easy to access foods, fluids and quick carbohydrate sources in case of an emergency, in the car, at work and at home, as well as during travel
• Drinking alcohol, especially on an empty stomach, can cause hypoglycemia, even a day or two later. Heavy drinking can be particularly dangerous for people taking insulin or medications that increase insulin production. Always have a snack or a meal when drinking alcohol.
• Exercise can lower your blood sugar. Check your blood glucose level before and during physical activity. And have a snack if your level is too low. Hypoglycemia can occur as much as 12 hours after exercise, depending on intensity, duration, food intake, and medications.
• Wear a medical identification bracelet or necklace, as well as have the information listed in a phone application for emergency use.
• Inform and educate family, friends, and coworkers about symptoms of hypoglycemia and how they can help if needed.

In the case of a hypoglycemic event that may cause lack of responsiveness, besides calling for medical help, an injectable medication called glucagon can be given by a friend/family member to help the liver release glucose into the system. This is a prescription medication that can be kept on hand in case of emergency- especially valuable for those using basal/bolus insulin therapy.  Discuss this with your doctor.

When it comes to diabetes management, knowledge is key. We hope all of the information above will help provide some clarity about hypoglycemia, how to prevent it, and what you can do in case you experience a hypoglycemic event.