Hypoglycemia (low blood sugar)

Low blood glucose levels present different symptoms from person to person. They tend to come on quickly and can worsen if not treated in time. These symptoms include:

• Mild to moderate anxiety
• Feeling shaky or having jitters
• Sweating
• Hunger
• Dizziness or lightheadedness
• Feeling confused
• Increased irritability
• Unsteady heartbeat
• Heart palpitations
• Inability to see or speak properly
• Tiredness

Prolonged hypoglycemia can affect brain function since the brain will stop receiving optimal glucose levels. This is a severe condition that requires immediate treatment. The symptoms include:

• Loss of consciousness
• Seizures

Note: If hypoglycemia is severe and prolonged, it can be life-threatening. You can also experience a drop in glucose levels during sleep, resulting in low blood sugar that lasts for several hours and can cause serious issues. Even if you don't wake up or notice these signs, low blood glucose levels can interfere with your sleep patterns and affect your quality of life, work, and mood. Low blood sugar during sleep makes it harder to notice the signs and symptoms of low blood glucose during the day. These symptoms include:

• Feeling irritated or foggy after waking up
• Sweating through your clothes or leaving your sheets damp
• Crying out or having nightmares

Your body gets glucose from food rich in carbohydrates, which are broken down by acids and enzymes into smaller pieces. In this process, glucose is absorbed from the intestine and passed into the bloodstream. Insulin, a hormone made by the pancreas, moves glucose from the bloodstream into the cells, where it is used for energy and storage. The body should maintain a constant state of blood glucose to facilitate normal functioning. After you eat, pancreatic cells release insulin to ensure that various body cells can uptake that sugar and use it optimally. The brain specifically relies on glucose to process information and function efficiently. After the body uses an optimal glucose level, it stores the excess in the form of glycogen that can be used later when needed. When blood sugar drops, the pancreas signals the liver to break down the stored glycogen and convert it into glucose. This travels through the bloodstream and replenishes the energy supply. Some conditions can disturb blood sugar regulation and cause hypoglycemia, including:

1. Diabetes
   • Blood sugar is supposed to circulate in the body and supply it with constant fuel. However, in conditions like diabetes, the body fails to produce enough insulin to move glucose into the cells, or the cells themselves become resistant to insulin. In type 1 diabetes, the body cannot produce enough insulin, whereas in type 2 diabetes, the cells become less responsive to the hormone. This results in high glucose levels in the blood that can lead to severe damage to your kidneys, nerves, eyes, and other organs. However, in diabetic patients, hypoglycemia can occur when blood glucose levels drop below 70 milligrams per deciliter. The causes for this include:
   • To manage diabetes, patients are prescribed insulin or other medications that effectively lower their blood sugar levels. Diabetic drugs such as sulfonylureas and meglitinides boost insulin in the body, enhancing blood glucose absorption.
   • If a patient takes excessive insulin or other drugs, blood sugar can drop too low, leading to hypoglycemia.
   • Skipping meals and exercising more than usual can lead to the body using more glucose than usual, further causing hypoglycemia in diabetic patients.
   • A diabetic patient taking insulin during fasting is also likely to develop hypoglycemia. If you are sick, you may not eat as much as needed to combat the insulin, lowering your blood glucose further.
   • Drinking alcohol can also have a detrimental effect and cause hypoglycemia. Alcohol makes it more challenging for the body to maintain its blood glucose levels, especially if there has been no food intake for a while. Alcohol also prevents you from identifying the symptoms of low blood sugar, leading to severe complications.
   • It is essential for people diagnosed with diabetes to be educated about the condition and balance their food intake, insulin, and daily activities. Working with a doctor is the best way to prevent the occurrence of hypoglycemia.
2. Specific medications
   • Hypoglycemia can be a side effect of certain medications such as:
   • Quinine, used to treat malaria, is a potent stimulator that leads to the release of insulin from the pancreatic beta cells. It increases the uptake of glucose by muscles and cells and stimulates the production of glycogen, which can lead to low blood glucose levels.
   • Antibiotics such as fluoroquinolones, used to treat pneumonia and urinary tract infections, can also cause low blood sugar or high blood sugar.
   • Other antibiotics linked with hypoglycemia include clarithromycin, linezolid, and doxycycline.
   • When diabetic patients take sulfonylureas and antimicrobials such as ciprofloxacin and metronidazole, they are at a high risk of developing hypoglycemia.
   • Children and people with kidney failure are at an increased risk of developing medication-induced low blood glucose.
   • Other commonly used drugs associated with hypoglycemia include antihypertensive medications such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, and painkillers like indomethacin.
3. Alcohol
   • If a person consumes excessive alcohol daily for a few days, coupled with reduced food intake, it can lead to alcohol-induced hypoglycemia.
4. Hepatitis
   • Hepatitis is a medical condition that causes inflammation of the liver. The liver is responsible for breaking down stored glycogen and converting it into glucose when the body needs energy. If the liver fails to produce or release adequate insulin, it can be difficult for the body to maintain blood glucose levels, leading to hypoglycemia. Any type of liver disease can lead to insulin resistance.
5. Adrenal or pituitary gland tumor
   • Disorders and tumors of the pituitary or adrenal gland can disturb the balance between the hormones that influence blood glucose levels, resulting in hypoglycemia.
6. Pancreatic tumors
   • Pancreatic tumors (especially insulinoma) can cause the organ to release too much insulin, leading to excessive glucose uptake by the cells. If insulin levels are too high, blood glucose levels will decline, resulting in hypoglycemia. This tumor continues to produce insulin even when blood sugar levels are too low, leading to serious side effects of hypoglycemia.
7. Kidney disorders
   • The kidneys are responsible for excreting waste and toxins from the body. Kidney failure can affect the clearance rate of waste products and cause the build-up of medications that can lead to hypoglycemia. Diabetic patients on insulin should be particularly cautious after developing diabetic nephropathy, as they have a higher risk of hypoglycemia due to reduced clearance of insulin. Hypoglycemia can sometimes be the initial presentation of new-onset diabetic nephropathy.
8. Critical illness
   • Among hospitalized patients, serious illnesses such as kidney disease, liver disease, cardiac failure, and sepsis are common causes of hypoglycemia.
9. Reactive hypoglycemia
   • Sometimes, if you eat food high in sugar, your body can produce excessive insulin to manage the extra sugar. This excessive insulin can lead to hypoglycemia and is referred to as postprandial or reactive hypoglycemia. It can also occur in individuals who have undergone stomach bypass surgery.

You may be at a higher risk of developing hypoglycemia if you:

• Use insulin or take oral anti-diabetic drugs such as sulfonylureas
• Are above 60 years of age
• Have impaired kidney or liver function
• Are unaware of the symptoms of hypoglycemia
• Take multiple medications that interact with each other
• Suffer from any disability
• Consume excess alcohol
• Suffer from diabetes for a long time
• Have a pancreatic tumor
• Suffer from eating disorders such as anorexia
• Have diabetic autonomic neuropathy

1. Blood glucose monitor (glucometer)
   If you have diabetes and suspect that you have hypoglycemia, check your blood sugar level right away. Diabetic patients are usually provided with a glucometer, which is a small electronic device that can check your blood glucose level within a minute. To use this device, prick your finger for a small drop of blood and place it on the test strip. This test strip is then inserted into the glucometer, which evaluates your blood glucose level. If you don't have your glucometer, talk to your doctor about getting one. These glucometers are great tools that help diabetic patients balance their insulin and food intake. If you experience repeated episodes of low blood glucose, visit your doctor to determine the reason. Your doctor can help you devise a more efficient plan to keep your diabetes in check without leading to hypoglycemia.
2. Physical examination
   If you don't have diabetes but suspect that you have signs and symptoms of hypoglycemia, talk to your doctor. Your doctor will perform a physical exam. Whipple's triad, which is a collection of three criteria that can suggest the presence of a pancreatic insulinoma, can also be evaluated. It consists of assessing:
   • Fasting hypoglycemia (<50 mg/dL)
   • Symptoms of hypoglycemia
   • Immediate relief of symptoms after the administration of intravenous (IV) glucose
3. Random blood glucose test
   A random blood glucose test measures the glucose level in the blood at the time of the test. The results of this test depend on the last time you ate and do not require fasting. For people with normal blood sugar regulation, the blood glucose level should be relatively stable at any time. However, if you have a disorder affecting your blood sugar level, the random blood glucose test will help your doctor determine the cause.
4. Fasting blood glucose test
   A fasting blood glucose test measures the blood glucose level present in your blood after an overnight fast. Usually, a fast of 10-12 hours is recommended before the test, and it can help diagnose diabetes, prediabetes, and hypoglycemia. A fasting blood glucose level below 70 mg/dL is an indication of hypoglycemia. Learn how to use blood glucose monitors and various tips to buy a glucometer. Read Here!

The key to preventing hypoglycemia is managing your diabetes.

Understanding the link between insulin and food will help you prevent a hypoglycemic episode.

It requires following the instructions of your healthcare provider and not skipping your meals.

Follow your doctor's orders about daily exercise and don't exceed the advised limit.

Diabetic patients should also measure their blood sugar before and after meals, during exercise, and before sleeping. Maintaining a logbook for this can be very helpful.

In case you experience a hypoglycemic event, note down what you ate before that and the amount of insulin you took, along with other relevant details. This will assist your doctor in developing a more effective plan for managing your diabetes.

If you don't have diabetes and experience infrequent hypoglycemic episodes, ensure you do not skip meals. Consume plenty of fruits and carbohydrate-rich foods to provide your body with sufficient carbohydrates to burn. If your symptoms do not improve, consult a doctor to rule out any underlying medical condition.

Hypoglycemia can be managed through various methods. The best approach is determined by an individual's age, overall wellbeing, symptoms, underlying cause, and severity of the disorder.

• Carbohydrate-rich diet: If your blood glucose level is low, immediate treatment involves consuming something rich in carbohydrates. Keep snacks high in carbs, such as glucose tablets, juices, honey, jelly beans, hard candies, gumdrops, or non-diet soda, readily available. The American Diabetes Association suggests that the snacks should contain around 15 grams of carbohydrates. Diabetic patients can use glucose tablets that act rapidly to increase blood sugar levels. After consuming a carbohydrate-rich snack, wait for 15 to 20 minutes and check your glucose level. If it hasn't increased, take another 15 grams of carbohydrate and repeat the procedure until blood sugar levels rise. Avoid overeating to prevent excessively high blood sugar levels.
• Glucagon hormone: Glucagon is a hormone administered in emergencies that rapidly raises blood sugar levels and can be life-saving for someone who is unconscious or unable to eat or drink. It is available only by prescription. Glucagon comes in an emergency syringe kit (for subcutaneous or intramuscular administration) or as a nasal spray. After 15 minutes of receiving glucagon, the person should be alert enough to eat. If the individual remains unresponsive after 15 minutes, call for emergency medical care.
• Octreotide: This somatostatin analogue can suppress insulin secretion in sulfonylurea-induced hypoglycemia. It raises plasma glucose concentrations only transiently, so the patient should be encouraged to eat as soon as possible to replenish glycogen stores.
• Treatment of underlying conditions: A tumor in the pancreas is treated through surgical removal. In some cases, partial removal of the pancreas may be necessary.

Tips for Diabetics

• Check your blood glucose level before and after a meal.
• Check your blood sugar before going to bed.
• Follow your doctor's instructions and take your insulin as directed.
• Do not take extra insulin without your doctor's advice.
• If you exercise more than usual, balance the loss of glucose by consuming the required carbohydrates.

Tips for Non-Diabetics

• Keep a record of the food you ate, the amount you exercised, the symptoms you experienced, and the time it took for the signs to resolve. These records will assist your doctor in diagnosing your issue.
• The most effective way to manage hypoglycemia is to identify the underlying cause.
• Avoid skipping meals and ensure you consume an adequate amount of carbohydrates.

Learn about the 15-15 rule and more about the prevention and emergency management of hypoglycemia.

Untreated hypoglycemia can affect brain functioning and lead to severe side effects.

• Seizures
  The brain needs glucose to function. Any significant change in blood sugar directly influences the signaling mechanism of the brain, allowing seizures to occur quickly. Prolonged hypoglycemia can lead to a seizure known as a tonic-clonic seizure, which involves the entire body and results in loss of consciousness and violent muscle contractions.
• Diabetic coma
  When the brain doesn't receive enough glucose to function properly, it can cause loss of consciousness. A diabetic coma occurs when a person with diabetes loses consciousness due to hypoglycemia, which can result from excessive insulin or inadequate food intake. This is a critical emergency medical situation that requires immediate attention. Symptoms of diabetic coma include headache, confusion, heart palpitations, vomiting, weakness, and dizziness. If you are diabetic and at risk of developing hypoglycemia, it is advisable to inform your loved ones and teach them how to administer treatment in such cases. Losing consciousness due to hypoglycemia means you will be unable to consume emergency glucose tablets. In such situations, injections like glucagon can be life-saving. After regaining consciousness or if there is no response to glucagon injection, contact your doctor immediately.
• Hypoglycemia unawareness
  The symptoms that alert you to hypoglycemia may be unpleasant but are essential for prompting you to consume carbohydrates that raise your glucose levels to normal. However, some individuals are unable to identify these symptoms, a condition known as hypoglycemia unawareness. This primarily occurs in people who have experienced repeated episodes of hypoglycemia, leading the body to adapt to the early warning signs and subsequently ignore them. Hypoglycemia unawareness is particularly dangerous because your body will cease to signal when your blood sugar level drops, preventing timely treatment. Individuals with hypoglycemia unawareness are also less likely to wake up when their blood sugar drops at night and must be extra cautious, checking their blood sugar frequently. This is especially important when performing tasks that require attention, such as driving. Such patients can use a continuous glucose monitor that will sound an alarm when blood sugar levels drop. Hypoglycemia unawareness is reversible with as little as 2-3 weeks of diligent avoidance of hypoglycemia in most affected patients.

1. Diet

Your diet plays a critical role in managing your blood sugar levels. Whether diabetic or non-diabetic, it is essential to maintain a balanced diet and avoid skipping meals. For diabetics, keeping carbohydrate-rich foods on hand can help prevent hypoglycemic episodes. Increasing your soluble fiber intake by consuming foods such as flax seeds and oat bran can slow the rate at which sugar enters the bloodstream, helping to manage blood sugar throughout the day.

2. Supplements

Nutritional deficiencies can be addressed by taking a daily multivitamin containing vitamins A, E, C, and B complex. Omega-3 fatty acids and alpha-lipoic acid can also provide antioxidant benefits. It is important to consult your doctor before starting any supplements.

3. Mid-meal Snacking

In cases of reactive hypoglycemia, the body may release excessive insulin in response to high-sugar meals, leading to hypoglycemia. To prevent this, it is advisable to reduce the intake of high-sugar meals and opt for small, frequent meals that are balanced and rich in protein and carbohydrates.

4. Fuel During Exercise

Light exercise is an effective way to manage blood sugar levels. The American Diabetes Association (ADA) recommends at least 150 minutes of moderate physical activity per week, spread over at least three days, with no gaps longer than two days. Follow your doctor's advice regarding your daily exercise limits. If you exercise more than usual, ensure you eat afterward or have a small snack during your workout to maintain blood sugar levels. For diabetics, it is crucial to avoid excessive workouts until you have a good understanding of balancing your sugar levels and insulin dosage.

Having episodes of hypoglycemia can cause stress and anxiety. Complications like losing consciousness are especially scary to experience. Diabetic patients who have repeated episodes of hypoglycemia may become apprehensive about taking insulin in the future and may attempt to reduce their dosage without proper medical advice. This can lead to further complications that can be life-threatening. Recognizing the signs of hypoglycemia and taking timely action is the best way to prevent hypoglycemic episodes.

Teach people how to help:

• Inform and educate those around you, such as co-workers, friends, and family, about hypoglycemia.
• If the people around you can identify and monitor signs of hypoglycemia, they can provide support and alert you to symptoms.
• It is equally vital to teach them how to administer emergency glucagon to avert a potentially life-threatening situation.

Plan your meals ahead:

• If you are traveling or aware of a busy day ahead, make sure to plan your meals in advance.
• Avoid skipping meals.

Carry glucose-rich snacks:

• Always have sugar candies or bars handy while traveling, or keep one near your bed to avoid panic during a hypoglycemia episode.
• If you are diabetic, carrying glucose-rich snacks to consume after taking insulin can help maintain your glucose levels.

Wear a medical ID:

• If you are prone to hypoglycemic episodes, your doctor may advise you to wear a medical ID to help others identify that you have diabetes.
• This can facilitate quick medical assistance, especially if you are not around people who know you.

Take extra care when you are sick:

• Being sick may reduce your appetite or make it difficult to keep food down due to nausea and vomiting.
• Make sure to adjust your insulin levels according to your food intake.