About hypoglycemia

What is hypoglycemia?

Hypoglycemia is the clinical syndrome that results from low blood sugar. The symptoms of hypoglycemia can vary from person to person, as can the severity. Classically, hypoglycemia is diagnosed by a low blood sugar with symptoms that resolve when the sugar level returns to the normal range. The medical term for blood sugar is blood glucose.



What are the symptoms for hypoglycemia?

If blood sugar levels become too low, signs and symptoms may include:

  • An irregular heart rhythm
  • Fatigue
  • Pale skin
  • Shakiness
  • Anxiety
  • Sweating
  • Hunger
  • Irritability
  • Tingling sensation around the mouth
  • Crying out during sleep

As hypoglycemia worsens, signs and symptoms may include:

  • Confusion, abnormal behavior or both, such as the inability to complete routine tasks
  • Visual disturbances, such as blurred vision
  • Seizures
  • Loss of consciousness

People with severe hypoglycemia may appear as if they're intoxicated. They may slur their words and move clumsily.

When to see a doctor

Seek a doctor's help immediately if:

  • You have what may be symptoms of hypoglycemia and you don't have diabetes.
  • You have diabetes and hypoglycemia isn't responding to treatment. Initial treatment of hypoglycemia is drinking juice or regular soft drinks, eating candy or taking glucose tablets. If this treatment doesn't raise your blood sugar and improve your symptoms, contact your doctor right away.

Seek emergency help if:

  • Someone with diabetes or a history of recurring hypoglycemia has symptoms of severe hypoglycemia or loses consciousness



What are the causes for hypoglycemia?

Hypoglycemia occurs when your blood sugar (glucose) level falls too low. There are several reasons why this may happen, the most common is a side effect of drugs used to treat diabetes.

Blood sugar regulation

But to understand how hypoglycemia happens, it helps to know how your body normally processes blood sugar. When you eat, your body breaks down carbohydrates from foods — such as bread, rice, pasta, vegetables, fruit and milk products — into various sugar molecules, including glucose.

Glucose is the main energy source for your body, but it can't enter the cells of most of your tissues without the help of insulin — a hormone secreted by your pancreas. When glucose levels rise, certain cells (beta cells) in your pancreas release insulin. This allows glucose to enter the cells and provide the fuel your cells need to function properly. Any extra glucose is stored in your liver and muscles in the form of glycogen.

If you haven't eaten for several hours and your blood sugar level drops, another hormone from your pancreas called glucagon signals your liver to break down the stored glycogen and release glucose back into your bloodstream. This keeps your blood sugar level within a normal range until you eat again.

Aside from your liver breaking down glycogen into glucose, your body also has the ability to manufacture glucose. This process occurs primarily in your liver, but also in your kidneys.

Possible causes, with diabetes

People with diabetes may not make enough insulin (type 1 diabetes) or may be less responsive to it (type 2 diabetes). As a result, glucose tends to build up in the bloodstream and may reach dangerously high levels. To correct this problem, someone with diabetes may take insulin or other drugs to lower blood sugar levels.

But too much insulin or other diabetes medications may cause your blood sugar level to drop too low, causing hypoglycemia. Hypoglycemia may also happen if you don't eat as much food as usual after taking diabetes medication, or if you exercise more than you normally would.

Possible causes, without diabetes

Hypoglycemia in people without diabetes is much less common. Causes may include the following:

  • Medications. Taking someone else's oral diabetes medication accidentally is a possible cause of hypoglycemia. Other medications may cause hypoglycemia, especially in children or in people with kidney failure. One example is quinine (Qualaquin), which is used to treat malaria.
  • Excessive alcohol consumption. Drinking heavily without eating can block your liver from releasing stored glucose into your bloodstream, causing hypoglycemia.
  • Some critical illnesses. Severe illnesses of the liver, such as severe hepatitis, can cause hypoglycemia. Disorders of the kidney, which can keep your body from properly excreting medications, can affect glucose levels due to a buildup of those medications. Long-term starvation, as may occur in the eating disorder anorexia nervosa, can result in the depletion of substances your body needs to generate glucose (gluconeogenesis), causing hypoglycemia.
  • Insulin overproduction. A rare tumor of the pancreas (insulinoma) may cause overproduction of insulin, resulting in hypoglycemia. Other tumors may result in excessive production of insulin-like substances. Enlargement of beta cells of the pancreas that produce insulin (nesidioblastosis) may result in excessive insulin release, causing hypoglycemia.
  • Hormone deficiencies. Certain disorders of the adrenal glands and the pituitary gland can result in a deficiency of key hormones that regulate glucose production. Children may experience hypoglycemia if they have a deficiency of growth hormone.

Hypoglycemia after meals

Hypoglycemia usually occurs when you haven't eaten (when you're in a fasting state), but that's not always the case. Sometimes hypoglycemia occurs after meals because the body produces more insulin than is needed.

This type of hypoglycemia, called reactive or postprandial hypoglycemia, may occur in people who have had stomach surgery. It may also occur in people who haven't had this surgery.



What are the treatments for hypoglycemia?

If you think your blood sugar may be dipping too low, check your blood sugar level with a blood glucose meter. If you have symptoms of low blood sugar but can't check your blood sugar level right away, assume your blood sugar is low and treat for hypoglycemia.

Hypoglycemic management

Eat or drink carbohydrates

Eat or drink something that's mostly sugar or carbohydrates to raise your blood sugar level quickly. Pure glucose — available in tablets, gels and other forms — is the preferred treatment.

Foods with more fat, such as chocolate, don't raise blood sugar as quickly. And diet soft drinks cannot be used to treat an episode of hypoglycemia because they don't have any sugar.

Examples of foods that do raise your blood sugar level quickly include:

  • Four glucose tablets (available without a prescription at most pharmacies)
  • A serving of glucose gel (read the label for amount)
  • Five to 6 pieces of hard candy or jelly beans (check the food label for the exact serving)
  • Four ounces (120 milliliters) of fruit juice or regular — not diet — soda
  • One tablespoon (15 milliliters) of sugar, corn syrup or honey

In general, food or drink with 15 to 20 grams of carbohydrates is often enough to raise your blood sugar levels back into a safe range.

Recheck your blood sugar level

Check your blood sugar level 15 minutes after eating or drinking something to treat your hypoglycemia. If your blood sugar is still low, eat or drink another 15 to 20 grams of carbohydrates. Repeat this pattern until your blood sugar is above 70 mg/dL (3.9 mmol/L).

Have a snack or meal

Have a snack or a meal to keep your blood sugar from dropping again. If you typically take insulin with food, you generally don't need additional insulin if you're eating a snack after having a low blood sugar level. If you're going to eat a meal, however, you may need a reduced dose of insulin to ensure that your blood sugar doesn't rise too quickly.

It's important to try not to overtreat your low blood sugar. If you do, you may cause your blood sugar level to rise too high, which will make you feel thirsty and tired.

Emergency treatment

Glucagon is a hormone that raises blood sugar quickly. It can be lifesaving if someone isn't alert enough to eat or drink something to raise his or her blood sugar. Glucagon is available only by prescription.

Glucagon comes in an emergency syringe kit or as a pre-mixed injection that is ready to use. Glucagon is also available as a powdered nasal spray given in one nostril. Store glucagon as directed on the packaging and be aware of the expiration date. When given to someone who is unconscious, the person should be turned on his or her side to prevent choking in case of vomiting.

About 15 minutes after getting glucagon, the person should be alert and able to eat. If someone doesn't respond within 15 minutes, call emergency medical care. If someone quickly responds to glucagon, it's still recommended that you contact his or her diabetes health care provider promptly.

If you've had a low blood sugar episode that was serious enough to require help from others, your health care provider will likely want to figure out if your insulin or other diabetes medication needs to be adjusted to prevent another serious episode.

Difficult-to-manage hypoglycemia

Some people have frequent and severe hypoglycemia despite medication adjustments. In these circumstances, your health care provider may recommend that you keep your blood sugar in a higher than usual range.

Your provider may also suggest that you use a continuous glucose monitor — a device that measures your blood sugar every few minutes using a sensor inserted underneath the skin. Your health care provider will also likely recommend that you have glucagon with you at all times. Teach people you trust, such as family, friends and close co-workers, how to use it.

Hypoglycemia unawareness

Some people don't have or don't recognize early symptoms of hypoglycemia (hypoglycemia unawareness). If you have hypoglycemia unawareness, your health care provider may recommend a higher glucose target range.

It's also very important to check your blood sugar consistently before going to bed and to have a snack containing carbohydrates before going to sleep if your blood sugar is lower than your bedtime target. Your health care provider may also recommend a continuous glucose monitor that can sound an alarm when your blood sugar is dropping.



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