The Lowdown on Low Blood Sugar: What is Hypoglycemia?

What is Hypoglycemia?

Hypoglycemia, also known as low blood glucose or low blood sugar, is a condition in which your blood glucose levels drop below the target range for a healthy individual. For most people, hypoglycemia is defined as a blood glucose level lower than 70 mg/dL (milligrams per deciliter).

Hypoglycemia is most common in people with diabetes. However, in rare cases, it can occur due to non-diabetic causes as well. Hypoglycemia that is not self-treatable and needs medical attention is referred to as severe hypoglycemia. 

What are the Causes of Hypoglycemia or Low Blood Sugar?

Among the causes of hypoglycemia, the most common is diabetes. 

• Diabetes

In Type 1 diabetes, you may not make insulin and in Type 2 diabetes, you may be less responsive to it. Due to this, your blood glucose levels can reach extremely high levels. To treat diabetes and lower your blood sugar levels, you may need to take insulin injections or other medications. Too much insulin or other diabetes medications may cause your blood sugar levels to drop extremely low, causing hypoglycemia. 

In diabetes, hypoglycemia can also occur if you eat less or later than usual or skip your meals after taking your regular dosage of diabetes medication. If you indulge in unusually high physical activity without eating enough or drink alcohol while you are on diabetes medications, it can cause hypoglycemia. 

• Non-Diabetes Causes

Less commonly, hypoglycemia can occur in people without diabetes as well. Causes include:

• Medications such as quinine, which is used to treat malaria.
• Excessive alcohol consumption
• Severe kidney, liver, or heart disease
• Long-term starvation
• A tumour in the pancreas that causes it to produce too much insulin
• Adrenal and pituitary gland disorders 
• Reactive, or postprandial hypoglycemia, wherein the pancreas produces too much insulin after a meal

What are the Symptoms of Hypoglycemia?

The symptoms of hypoglycemia can start quickly, and different people may have different symptoms. Also, as hypoglycemia worsens, its symptoms may change. 

The early signs and symptoms of hypoglycemia include:

• Paleness of skin
• Tremors
• Sweating
• Chills
• Headache
• Fatigue
• Hunger
• Nausea
• Irregular or fast heartbeat
• Irritability or anxiety
• Difficulty concentrating
• Dizziness or lightheadedness
• Tingling or numbness of the lips, tongue, or cheek

As hypoglycemia worsens, you may experience the following symptoms:

• Confusion
• Unusual behaviour
• Sleepiness
• Loss of coordination
• Slurred speech
• Blurred vision
• Restless sleep and nightmares

Hypoglycemia Unawareness

You may not have any symptoms when your blood sugar is low. This situation is called hypoglycemia unawareness. You may need to check your blood sugar levels more often or use a continuous glucose monitor (CGM) to alert you when your blood sugar level is too low.

How is the Diagnosis and Testing for Hypoglycemia Done?

If you are a diabetic, have the related symptoms, and suspect that you may be hypoglycemic, check your blood sugar levels with a blood glucose meter. People with hypoglycemia unawareness may need to use a continuous glucose monitor (CGM). It is a wearable device that measures glucose every few minutes, throughout the day and night. If your blood sugar drops too low, it sounds an alarm.

If you are not a diabetic and do not use any medications known to cause hypoglycemia, but are experiencing hypoglycemia symptoms, consult a doctor at the earliest. To diagnose hypoglycemia, your doctor may conduct a physical examination, review your medical history, and ask questions about your eating habits.

Your doctor may use three criteria, referred to as “Whipple’s triad,” to diagnose hypoglycemia:

• Low blood glucose levels
• Symptoms of hypoglycemia at the time of low blood glucose levels
• Relief from symptoms with the treatment of hypoglycemia

What is the Treatment for Hypoglycemia?

If you experience one or more symptoms of hypoglycemia and check that your blood glucose level is below 70 mg/dL, follow these steps. The American Diabetes Association (ADA) recommends the “15-15 rule” for an episode of hypoglycemia:

• Eat or drink 15 to 20 grams of fast-acting carbohydrates. These may include 4 glucose tablets or 1 tube of glucose gel or 1/2 cup of fruit juice or 1/2 can of regular soda or 1 tablespoon of sugar/honey/corn syrup.
• Recheck your blood sugar levels 15 minutes after treatment. If the reading is still under 70 mg/dL, eat or drink another 15 to 20 grams of fast-acting carbohydrate, and recheck your blood sugar level again in 15 minutes. 
• Repeat these steps until the blood sugar is above 70 mg/dL.
• Eat a healthy snack or meal once your blood sugar is back to the standard range, to prevent another drop in blood sugar levels and replenish your body's glycogen stores.
• Be sure not to overeat. This could lead to your blood sugar rising too high.
• If your blood sugar levels remain unchanged, contact your doctor immediately.

Treatment of Severe Hypoglycemia

Blood sugar below 55 mg/dL is considered severely low. You will not be able to treat yourself and will need external help to recover from severe hypoglycemia. Glucagon, a pancreatic hormone that stimulates your liver to release stored glucose into your bloodstream, is used to treat someone with diabetes when their blood sugar is too low to treat using the 15-15 rule.

Glucagon is available by prescription and is either injected, administered or puffed into the nostril. Your doctor can prescribe a glucagon kit for use in case of an emergency. Family and friends also need to know where to find the kit and how to use it. It is important to contact a doctor for emergency medical treatment immediately after receiving a glucagon injection.

If you are helping someone who is hypoglycemic, and there is no glucagon kit available, contact a doctor immediately. 

Treatment of Non-Diabetes Hypoglycemia

For recurrent hypoglycemia episodes when the cause is not diabetes-related, it is advisable to consult your doctor to identify the condition causing hypoglycemia and treat it. Depending on the cause, treatment may involve:

• Nutrition counselling
• Modification in medications
• Treatment of tumours

What are the Complications of Hypoglycemia?

If untreated, hypoglycemia can lead to complications such as:

• Inability to eat or drink
• Seizures
• Falls
• Injuries
• Motor vehicle accidents
• Loss of consciousness
• Coma
• Greater risk of dementia in older adults
• Death

How to Prevent Hypoglycemia?

If you are a diabetic, it is important to manage diabetes to prevent hypoglycemia. Remember to:

• Check your blood sugar levels regularly with a glucose monitor, including before and after meals, before and after exercise and before bed. Use a continuous glucose monitor (CGM) if needed. 
• Check your blood glucose levels before, during, and after physical activity and adjust your medicine or carbohydrate intake to prevent hypoglycemia.
• Do not miss or delay any prescribed medications.
• Follow your doctor’s instructions about food and exercise.
• Discuss with your doctor if any of your diabetes medicines can cause hypoglycemia and how to adjust your diabetes management plan.
• Note down details of hypoglycemic episodes, including the time, recent meals, exercise details, symptoms, and blood glucose readings. Discuss these with your doctor. 
• Follow a regular eating plan including meals, snacks, and beverages with enough carbohydrates to help keep your blood glucose level in your target range. 
• Carry a source of fast-acting carbohydrates, such as glucose tablets, fruits, or a juice box, with you. 
• Have a snack if there will surely be more than 5 hours until your next full meal or if your blood sugar levels are less than 100 mg/dL.
• Stick to the daily alcohol limits recommended by a doctor and avoid drinking alcohol without food.
• Carry a medical ID or bracelet with you to enable healthcare providers, emergency services, and others to know what to do for your condition.

If you do not have diabetes and get recurring episodes of hypoglycemia, eat small and frequent meals throughout the day to prevent your blood sugar levels from going too low. However, it is also important to consult a doctor at the earliest to identify and treat the cause of hypoglycemia.

Hyperglycemia and Hypoglycemia: What is the Difference?

Hypoglycemia and hyperglycemia are different conditions.

Hypoglycemia is when there is too little glucose in the blood, below 70 mg/dL.

Hyperglycemia is a condition in which the blood glucose levels are too high, more than 125 mg/dL when a person is fasting and more than 180 mg/dL two hours after eating. This happens when the body has too little insulin or cannot use the insulin properly. Hyperglycemia is most often present in diabetes.

When to Visit a Doctor?

Consult a doctor immediately for help if:

• You have diabetes and the hypoglycemia is not responding to treatment, such as drinking juice, eating candy, or consuming glucose tablets.
• You do not have diabetes but have symptoms that may be related to hypoglycemia. 
• You are helping someone with symptoms of severe hypoglycemia.