Hypoglycemia
What is hypoglycemia?
Hypoglycemia is when your blood sugar (blood glucose) level is too low. Glucose is the body's main source of fuel. Carbohydrates (carbs) are the main source of glucose in our diet. They include rice, potatoes, bread, cereal, fruit, and sweets. The ideal range of fasting morning blood sugar is 70 to 99 mg/dL (milligrams per deciliter). Blood sugar levels lower than 70 mg/dL are too low. They are considered unhealthy. Talk with your health care provider about what level is too low for you.
Hypoglycemia may be a condition by itself, or it may be a problem caused by diabetes or another disorder. It’s most often seen as a problem caused by diabetes. This is sometimes called insulin reaction or insulin shock, which may be a possible side effect of diabetes treatment. Hypoglycemia can happen quickly and must be treated right away.
What causes hypoglycemia?
Causes of hypoglycemia in people with diabetes may include:
-
Too much medicine, such as diabetes medicines.
-
A missed meal.
-
A delayed meal.
-
Too little food eaten compared with the amount of insulin or other medicine taken.
-
When you take your insulin.
-
The amount and timing of physical activity.
-
What is in your diet, such as how much fat, protein, and fiber are in your meal. This can also affect how your body takes in sugars.
-
The type of food. Your body takes in liquid carbs like juices much faster than solid foods. So timing the insulin dose can be tricky.
-
Changes in your schedule that you did not plan for.
-
Going through puberty.
-
Menstruation.
Other causes of hypoglycemia are rare. But it may happen in early pregnancy, after strenuous exercise, or during prolonged fasting.
In people who do not have diabetes, hypoglycemia may result from heavy alcohol use, critical illness, and low levels of counter-regulatory hormones. These are hormones that help maintain blood sugar levels. Or it can be from rare causes, such as a tumor that makes insulin.
What are the symptoms of hypoglycemia?
Symptoms may be different for each person. A low blood sugar level triggers the release of epinephrine (adrenaline), also called the “fight-or-flight” hormone. It's responsible for symptoms like rapid and thumping heartbeat, sweating, tingling, and anxiety. Symptoms may include:
-
Shakiness.
-
Dizziness.
-
Sweating.
-
Hunger and upset stomach (nausea).
-
Headache.
-
Irritability.
-
Pale skin color.
-
Sudden moodiness or behavior changes, such as crying for no apparent reason.
-
Clumsy or jerky movements.
-
Trouble paying attention, or confusion.
-
Tingling feelings around the mouth.
-
Fast heartbeat.
-
Blurred vision or vision problems.
Hypoglycemia can also happen during sleep. It may be due to:
Some signs of hypoglycemia during sleep include:
-
Crying out or having nightmares.
-
Finding your clothing or bedding damp from sweating.
-
Feeling tired, irritable, or confused after waking.
-
Seizures or having trouble waking up.
How is hypoglycemia diagnosed?
The health care provider will ask about your health history and do a physical exam. You will also need blood tests to diagnose hypoglycemia.
If you have diabetes and symptoms of hypoglycemia, your provider will likely diagnose it as a problem caused by diabetes, or as an insulin reaction. If you don’t have diabetes and have symptoms of hypoglycemia, your provider may:
You may also have lab tests to measure how much insulin your body makes.
How is hypoglycemia treated?
Treatment will depend on your symptoms, age, and general health. It will also depend on the underlying cause and how severe the condition is.
If you have diabetes, the goal of treatment is to stay at a correct blood sugar level. This means testing your blood sugar often and being aware of the warning signs of low blood sugar. It also means treating the condition quickly. This will be based on past instructions from your health care provider.
To treat low blood sugar right away, eat or drink something that has concentrated sugar in it. This includes orange juice, regular soda (not diet soda), glucose tablets, a gel tube, raisins, or a hard candy. Complex sugars or foods that contain fats along with carbs (like chocolate) should not be used to treat low blood sugar. They can slow the absorption of glucose. Check your blood sugar again in 15 minutes to see if it's back in the normal range. If it's still low, take a repeat dose of concentrated sugar. When your blood sugar has returned to normal, eat a regular snack or meal.
Your provider may prescribe a medicine called glucagon to help treat hypoglycemia. Glucagon frees the glucose already stored in your body. It is available as an injection or as a powder that's put into the nose. Ask your provider which type of glucagon is best for you and how to use it. Make sure your friends and family know how to use it in case of an emergency.
If you don't have diabetes, your health care provider may advise:
-
Not eating foods high in carbs.
-
Eating smaller meals more often.
-
Having frequent snacks.
-
Eating a variety of healthy foods.
-
Getting regular exercise.
-
Drinking water instead of sugar-sweetened beverages, like juice or soda.
-
Having more testing, which can look for less common causes of hypoglycemia, such as tumors that make insulin.
-
Limiting how much alcohol you drink.
-
Quitting smoking.
If left untreated, hypoglycemia can get worse. It can cause confusion, clumsiness, or fainting. Severe hypoglycemia can lead to seizures, coma, and even death.
How can I prevent hypoglycemia?
If you have diabetes, your treatment plan should match the dose and timing of medicine to your usual schedule of meals and activities. Mismatches can result in hypoglycemia. For example, taking a dose of insulin (or other medicine that increases insulin levels) and then skipping a meal could result in hypoglycemia.
To help prevent hypoglycemia, always consider the following if you have diabetes.
Diabetes medicines
Your health care provider can explain which diabetes medicines can cause hypoglycemia. They can also explain how and when to take medicines. For good diabetes management, take your diabetes medicines in the recommended doses at the recommended times. In some cases, health care providers may suggest learning how to adjust medicines to match changes in your schedule or routine.
-
Do not stop taking the medicines or change the dose without checking with your provider.
-
Talk to your provider before taking any over-the-counter medicines for coughs, colds, pain, and fever. Also talk to your provider before taking herbal or dietary supplements. They may interfere with the action of insulin or change blood sugar levels.
Meal plans
A registered dietitian can suggest a meal plan that fits your personal preferences and lifestyle. Following this meal plan is important for managing diabetes. Eat regular meals and eat enough food at each meal. Your individual carb goal is based on your age, activity level, and any medicines you take. Try not to skip meals or snacks. Snacks are very important for some people before going to sleep or exercising. A dietitian can recommend snacks. And they can help you make an individualized meal plan.
-
Manage your food portions. You can use the plate method. Fill half your plate with non-starchy vegetables, a quarter with lean protein, and a quarter with a grain or starchy food.
-
If you’re eating out, have half of your meal wrapped up to go so you can enjoy it later.
-
At home, measure out snacks. Don’t eat straight from the bag or box.
-
While shopping for groceries, chose foods that fit your meal plan and budget.
-
Read the Nutrition Facts label on the food items to understand what the food contains.
A diabetic diet contains lots of fruits, veggies, healthy fats, and lean proteins. It is low in salt, sugar, and foods high in refined carbs, such as cookies, crackers, and soda.
Daily activity
To help prevent hypoglycemia caused by physical activity, your health care provider may advise that you:
-
Check your blood sugar before doing any sports, exercise, or other physical activity. Have a snack if the level is below 100 mg/dL.
-
Adjust medicine as needed before physical activity.
-
Check blood sugar often during and after long periods of physical activity. Have snacks as needed.
-
Keep track of how hard, how long, and when you exercise. The intensity, duration, and timing of exercise can all affect the risk of low blood sugar.
Alcohol
Drinking alcohol, especially on an empty stomach, can cause hypoglycemia. This can even happen a day or two later. Heavy drinking can be very dangerous if you take insulin or medicines that increase insulin production. Only drink alcohol with a snack or meal.
Diabetes management
You can help keep your blood sugar levels stable and avoid very high or very low blood sugar levels by:
Intensive diabetes management means keeping your blood sugar as close to the normal range as possible. This is done to prevent long-term problems. If you want tight control over your blood sugar, talk with your health care provider. Ask about ways to prevent hypoglycemia and how to best treat it quickly if it happens. Your provider may recommend a continuous glucose monitor to help monitor your blood sugar levels.
When to contact your doctor
Contact your health care provider right away if any of these symptoms of low blood sugar occur and they have not gone away with the above measures.
Call 911 if any of the following occur and don't resolve promptly with the above measures:
Key points about hypoglycemia
-
Hypoglycemia is when your blood sugar (blood glucose) level is too low.
-
It may be a condition by itself, or it may be a complication of diabetes or another disorder. It’s most often seen as a complication of diabetes.
-
Symptoms can include shakiness, dizziness, sweating, and headache.
-
To treat low blood sugar right away, eat or drink something that has sugar in it. This includes orange juice or a hard candy.
-
To help prevent hypoglycemia, people with diabetes should take diabetes medicine that is properly timed with meals, eat healthy, stay active, and limit alcohol.
Next steps
These tips can help you get the most from a visit to your health care provider:
-
Know the reason for your visit and what you want to happen.
-
Before your visit, write down questions you want answered.
-
Bring someone with you to help you ask questions and remember what your provider tells you.
-
At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
-
Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.
-
Ask if your condition can be treated in other ways.
-
Know why a test or procedure is recommended and what the results could mean.
-
Know what to expect if you do not take the medicine or have the test or procedure.
-
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
-
Know how to contact your provider if you have questions, especially after office hours or on weekends.