Hypoglycemia (Low Blood Sugar): Signs, Causes, and What to Do

Hypoglycemia, or low blood sugar, occurs when the level of glucose in your blood drops below what's healthy for you. This condition is most often associated with diabetes treatment, but it can also occur in people without diabetes. Recognizing the signs and understanding the causes of hypoglycemia are crucial for timely intervention and prevention of serious complications. This article provides a comprehensive overview of hypoglycemia, including its signs, causes, and appropriate responses.

What is Hypoglycemia?

Hypoglycemia is defined as a blood glucose level below 70 mg/dL (3.9 mmol/L). Glucose is the primary source of energy for the body, particularly the brain. When blood sugar levels drop too low, the brain and other organs may not function properly.

Signs and Symptoms of Hypoglycemia

The symptoms of low blood sugar can vary from person to person and can range from mild to severe. It's important to be aware of these symptoms so you can take action quickly.

Mild to Moderate Symptoms

• Shakiness: Feeling shaky or trembling is a common early sign.
• Sweating: Profuse sweating, even without exertion, can indicate hypoglycemia.
• Hunger: Intense hunger that won't go away easily.
• Dizziness or Lightheadedness: Feeling unsteady or like the room is spinning.
• Headache: A persistent headache, often accompanied by other symptoms.
• Blurred Vision: Changes in vision, such as blurred or double vision.
• Irritability or Mood Changes: Sudden and unexplained mood swings.
• Confusion: Difficulty concentrating or thinking clearly.
• Rapid Heartbeat: Feeling like your heart is racing or pounding.
• Pale Skin: A noticeable paleness in the skin.

Severe Symptoms

If low blood sugar is not treated promptly, it can lead to more severe symptoms:

• Loss of Coordination: Difficulty walking or performing tasks requiring fine motor skills.
• Seizures: Uncontrolled electrical activity in the brain causing convulsions.
• Loss of Consciousness: Passing out or being unable to respond.
• Coma: A prolonged state of unconsciousness.

Important Note: Severe hypoglycemia can be life-threatening and requires immediate medical attention.

Causes of Hypoglycemia

Understanding the causes of hypoglycemia is essential for preventing it. Here are the common factors contributing to low blood sugar:

In People with Diabetes

• Excessive Insulin or Diabetes Medication: Taking too much insulin or oral diabetes medication is the most common cause of hypoglycemia in people with diabetes.
• Skipping Meals or Eating Too Little: Not eating enough carbohydrates or missing meals can lead to low blood sugar.
• Increased Physical Activity: Exercise can lower blood sugar levels, especially if not accompanied by adjustments in medication or food intake.
• Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, leading to hypoglycemia, especially when consumed without food.
• Timing of Medication and Meals: Mismatched timing between medication and meal times can cause blood sugar levels to drop.

In People Without Diabetes

Hypoglycemia in people without diabetes is less common but can occur due to several factors:

• Reactive Hypoglycemia: This occurs a few hours after eating a high-carbohydrate meal, leading to an overproduction of insulin.
• Fasting Hypoglycemia: This is less common and can be caused by:
  • Certain Medications: Some medications, such as quinine (used for malaria), can lower blood sugar.
  • Excessive Alcohol Consumption: As mentioned above, alcohol can lower blood sugar levels.
  • Critical Illness: Severe liver or kidney disease, sepsis, or severe heart failure can disrupt glucose regulation.
  • Hormone Deficiencies: Deficiencies in hormones such as cortisol or growth hormone.
  • Tumors: Rare tumors that produce insulin (insulinomas).
  • Post-Bariatric Surgery: Some individuals experience hypoglycemia after undergoing bariatric surgery.

What To Do When You Experience Hypoglycemia

Acting quickly is vital when you suspect low blood sugar. Here's a step-by-step guide:

1. Check Your Blood Sugar (If Possible): If you have a glucose meter, test your blood sugar immediately. If it's below 70 mg/dL (3.9 mmol/L), proceed to step 2. If you can’t check, assume it is low and treat it.

2. Treat the Low Blood Sugar: Consume 15-20 grams of fast-acting carbohydrates. Examples include:

   • Glucose tablets (follow package instructions).
   • 4 ounces (120 ml) of juice or regular soda (not diet).
   • 1 tablespoon of honey or syrup.
   • Hard candies (check labels to ensure correct amount).

3. Wait 15 Minutes and Recheck: After 15 minutes, recheck your blood sugar. If it's still below 70 mg/dL, repeat step 2.

4. Eat a Meal or Snack: Once your blood sugar returns to normal, eat a meal or snack to stabilize it and prevent another drop. Include a source of protein and complex carbohydrates (e.g., a sandwich, nuts and cheese).

5. Emergency Situations:

   • If you are with someone who is unconscious or having a seizure: Do not attempt to give them food or drink. Administer glucagon if available and you know how to use it, and call emergency services immediately (911 in the US).
   • Glucagon: Glucagon is a hormone that can quickly raise blood sugar levels. It’s available as an injectable medication or a nasal spray and is often prescribed for people with diabetes who are at risk of severe hypoglycemia. Family members and caregivers should be trained on how to administer glucagon.

Preventing Hypoglycemia

Prevention is the best approach to managing low blood sugar. Here are some tips to help prevent hypoglycemic episodes:

For People with Diabetes

• Work Closely with Your Healthcare Provider: Adjust your medication and meal plans under the guidance of your doctor or diabetes educator.
• Monitor Your Blood Sugar Regularly: Checking your blood sugar several times a day, especially before and after meals and exercise, helps you understand how your body responds to different activities.
• Eat Regular Meals and Snacks: Avoid skipping meals, and have a snack before engaging in strenuous activity.
• Adjust Insulin Doses: Learn how to adjust your insulin doses based on your activity level and food intake.
• Carry Fast-Acting Carbohydrates: Always have a source of fast-acting carbohydrates with you, such as glucose tablets or juice.
• Wear a Medical Alert Identification: Wearing a medical bracelet or necklace that identifies you as having diabetes can help ensure you receive appropriate treatment in an emergency.
• Educate Family and Friends: Teach your family and friends how to recognize the symptoms of hypoglycemia and how to administer glucagon, if needed.

For People Without Diabetes

• Eat Balanced Meals: Consume meals with a balance of carbohydrates, proteins, and fats.
• Avoid Excessive Alcohol Consumption: Drink alcohol in moderation and always with food.
• Consult Your Doctor: If you experience recurrent episodes of hypoglycemia, even if you don't have diabetes, see your doctor to determine the underlying cause.
• Consider Dietary Changes: If you have reactive hypoglycemia, you may need to make dietary changes to limit refined carbohydrates and sugars.

When to See a Doctor

It's essential to consult a healthcare professional if you experience frequent or severe episodes of hypoglycemia. They can help identify the underlying cause and recommend appropriate treatment. Even one episode of unexplained hypoglycemia (in a non-diabetic) merits medical attention to identify the cause.

Hypoglycemia and Diabetes Management

Conclusion

Hypoglycemia can be a serious condition, especially if left untreated. Recognizing the signs, understanding the causes, and knowing how to respond are essential for managing low blood sugar effectively. Whether you have diabetes or not, proactive measures can help prevent hypoglycemic episodes and ensure your overall well-being. If you experience frequent or severe episodes of hypoglycemia, seek medical advice to determine the underlying cause and receive appropriate treatment.