Hypoglycemia (also called a hypo) happens when blood sugar levels (also known as blood glucose levels) fall below 70 mg/dL (3.9 mmol/L). Your blood glucose levels naturally vary throughout the day. When the variation is within a healthy range, you probably won’t be able to tell. If it goes below a healthy range, you may get some symptoms associated with low blood sugar. If your blood glucose drops really low and is not treated, it can become dangerous.

How serious is a hypo?

A hypo has the potential to be a very dangerous situation, but you can take steps to treat and prevent it. If you have a hypo, quick action is needed.

What are the main symptoms of a hypo?

Being aware of early signs of a hypo will help you treat low blood sugar levels quickly and bring them back into a healthy range. Symptoms vary from one person to another. It is important that you learn to recognize your individual symptoms.

Hypos can happen quickly, so it’s important to know the signs and what to do if you have one.

Below is a list of common symptoms, ranging from milder symptoms to the most severe:

  • Trembling and feeling shaky
  • Feeling nervous or anxious
  • Sweating, chills and clamminess
  • Irritability or impatience
  • Confusion
  • Fast heartbeat
  • Feeling lightheaded or dizzy
  • Hunger
  • Nausea
  • Color draining from the skin (pallor)
  • Feeling sleepy
  • Feeling weak or having no energy
  • Blurred/impaired vision
  • Tingling or numbness in the lips, tongue, or cheeks
  • Headaches
  • Coordination problems, clumsiness
  • Nightmares or crying out during sleep
  • Seizures
  • Loss of consciousness

How do I know I have low blood sugar?

The only sure way to detect low blood sugar levels is to measure your blood with a blood glucose meter. If you have symptoms of a hypo and are not able to test your blood sugar at the time, it may be advisable not to wait and to treat your hypo straight away.

Why do hypos happen?

Low blood sugar is common for people with type 1 diabetes and can also occur in people with type 2 diabetes taking insulin or oral medicines.

Below are some of the most common reasons why you might have a hypo:

  • Taking more insulin or oral medication than you need; confusing morning and evening doses; multiplying medications
  • Prolonged fasting or skipping a meal
  • Drinking alcohol on an empty stomach
  • Doing more physical activity than usual without glucose monitoring
  • Eating too few carbohydrates, or less than usual

How do I treat a hypo?

You must do something as soon as you notice symptoms of a hypo or if a blood test shows your blood sugar levels are too low. A mild hypo can be treated through eating or drinking 15-20 gr of a fast-acting carbohydrate, this could be

  • Three glucose or dextrose tablets
  • Eight gummy bears
  • Half a cup of natural fruit juice
  • Three teaspoons of sugar dissolved in water

A blood sugar test with your Dario meter should be repeated after 15 – 20 minutes to check if your levels have returned to normal. If the sugar level is still below 70 mg/dL (3.9 mmol/L), repeat the treatment.

Once your blood sugar level is above 70 mg/dL  (3.9 mmol/L) it is recommended to eat a piece of fruit, a bowl of cereal or a slice of bread with fatty spread to prevent your blood sugars going down again.

Severe Hypoglycemia

This is an emergency that requires the help of another person for you to recover. It is important your family and friends know what to do if you have a severe hypo and become unresponsive.

They need to:

  • Put you in the recovery position and keep your airway clear
  • If available, give a 1 mg glucagon* injection
  • Call an ambulance if you don’t have a glucagon injection or if you haven’t recovered 15-20 minutes after the injection

If you are having a lot of hypos, it is important that you get in touch with your healthcare team to assess your treatment plan. Sharing your Dario progress and activity reports can help your healthcare team understand your diabetes better and work with you to prevent low blood sugars.

*Glucagon is used for the treatment of severe hypoglycemia in people unable to take carbohydrates by mouth. It is important that those in close contact with people with hypoglycemia-prone diabetes should be instructed on the use of glucagon kits, including where the kit is and when and how to administer glucagon.

Hypoglycemia unawareness

Some people don’t get the tell-tale signs and symptoms of hypoglycemia and can’t tell when their blood sugar gets low. This is called hypoglycemia unawareness. People with hypoglycemia unawareness need to test their blood sugar frequently, particularly before undertaking certain activities such as driving or operating machinery.

If you think you have hypoglycemia unawareness, you should speak with your healthcare provider.

Summary

Prevention is the key to effective management of hypoglycemia.

Here is a list of recommendations:

  • Know your personal hypo signs and symptoms and teach people close to you (close family, school or work colleagues) to identify these symptoms
  • Check your blood sugar levels before and after meals
  • If you are taking insulin, consult your doctor if hypos happen at night or after meals
  • Take your medication at the recommended time and dose
  • Monitor glucose levels frequently for early identification, especially if you are treated with multiple insulin injections
  • Make sure to eat carbohydrates when planning physical activity, and test your blood sugar before and after exercising
  • Drink alcohol in a controlled manner accompanied by a complex carbohydrate
  • Carry a hypo kit that includes: The Dario monitoring system, emergency carbohydrate, such as glucose tablets, complex carbohydrates, identification card with your details, treatment type and emergency contact phone number

1 https://diabetes.org/living-with-diabetes/treatment-care/hypoglycemia

2 “Complete nurse’s guide to Diabetes care” Belinda P. Childs et al American Diabetes Association

DAR-0140 RevA 12/2019