Hypoglycemia Symptoms, Treatment, Causes & Prevention

Hypoglycemia occurs when a person with diabetes has a blood sugar level that is below their target range and requires action to raise it to a healthy level. There can be a variety of reasons why someone experiences hypoglycemia, and symptoms can range from being non-existent for people with hypoglycemia unawareness to recognizable and severe. Whether symptoms are present or not, hypoglycemia requires immediate action.

Read on to learn:

• What is hypoglycemia?
• Symptoms of hypoglycemia
• When to seek medical attention for hypoglycemia
• 5 Causes of hypoglycemia
• Treatment for hypoglycemia
• 4 Ways to prevent hypoglycemia

What is Hypoglycemia?

Low blood sugar, also known as hypoglycemia, occurs when blood sugar levels drop below your target range and require action to bring them up to a healthy level.

The American Diabetes Association (ADA) states that hypoglycemia typically occurs when blood sugar levels fall below 70 mg/dL. However, lows can mean something different for everyone. For example, if you have experienced high blood sugar for a certain amount of time, you may feel the effects of hypoglycemia at a reading higher than 70 mg/dL. It’s important to discuss your target ranges with your healthcare team so that you understand what a low reading is for you.

Symptoms of Hypoglycemia

Hypoglycemia symptoms can appear quickly and may be different for everyone. Some people with hypoglycemia may experience mild-to-moderate symptoms while others may not feel or recognize any symptoms, which is known as hypoglycemia unawareness. If a person with diabetes has hypoglycemia unawareness, they will need to test their blood glucose levels on a more frequent basis to check if hypoglycemia treatment or prevention is necessary. It is especially important for people with hypoglycemia unawareness to check their blood glucose levels before driving or operating equipment.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), mild-to-moderate hypoglycemia symptoms include:

• Weakness
• Fast or irregular heartbeat
• Difficulty concentrating
• Blurred vision
• Headache
• Fatigue
• Dizziness or lightheadedness
• Confusion or disorientation
• Nervousness or irritability
• Feeling argumentative or combative
• Feeling shaky or jittery
• Sweating
• Hunger
• Pale complexion

Severe hypoglycemia symptoms can also occur and need to be treated right away. Often, a person with severe symptoms is unable to treat themselves and will require help from another person. These symptoms are more common in people with type 1 diabetes and people with type 2 diabetes who are on glucose-lowering medication or insulin.

Severe symptoms of hypoglycemia may include:

• Inability to speak, eat, or drink
• Seizures or convulsions
• Unconsciousness

Some people may also experience hypoglycemia symptoms during sleep. These include:

• Falling out of bed
• Nightmares or crying out
• Sweating that makes your pajamas or sheets damp
• Feeling tired, irritable, or confused after waking up

When to Seek Medical Attention

Most commonly, people with hypoglycemia seek medical attention because they are experiencing severe symptoms, are unable to treat themselves, and the person they are with does not understand how to help. If you have diabetes, it is important to educate your support system (such as coworkers, classmates, family, or friends) on how to recognize and treat your hypoglycemia.

If a person with hypoglycemia is unable to speak, it is crucial that they do not have anything put in their mouth because it may be breathed into their lungs, which can cause additional distress. Instead, glucagon, a hormone that quickly helps raise blood glucose, can be administered by injection or nasal spray. Your healthcare team may recommend carrying a glucagon emergency kit with you at all times.

5 Causes of Hypoglycemia

Hypoglycemia is diagnosed based on symptoms and blood sugar readings. For many people with diabetes, no further testing is required.

There can be many reasons why a person with diabetes may experience hypoglycemia. Below are five of the most common causes:

1. Medication

Insulin or other types of diabetes medications that help the body release more insulin can cause hypoglycemia. There are two types of diabetes medications that can cause hypoglycemia:

• Sulfonylureas: These are prescribed to people with type 2 diabetes. Examples include glipizide, glyburide, and glimepiride.
• Meglitinides: These are also most commonly used to treat type 2 diabetes. Examples include repaglinide and nateglinide.

If you are concerned that your medication may be causing your hypoglycemia, contact your healthcare team. There are many options for medications and lifestyle changes that can help to manage blood sugar.

2. Exercise

According to the ADA, exercise increases insulin sensitivity and can lower your blood sugar for up to 24 hours or more after a workout. The side effects of exercise on your blood sugar will depend on the intensity and amount of time that you are active. Before you begin any type of exercise, check your blood sugar to help prevent hypoglycemia. Make sure to bring a rapid-acting source of glucose to your workout, and always wear a diabetes alert ID when working out. Your healthcare team can help you determine ways to prevent and treat hypoglycemia during and after exercise that fit your routine and lifestyle.

3. Illnesses

When you are sick, you may not be eating or drinking as much, or you may not be able to keep food down. As a result, your blood sugar levels can go low and may possibly lead to hypoglycemia. See this article for recommendations on staying healthy when you’re ill, Sick Days: How to Manage Your Diabetes.

4. Drinking Too Much Alcohol

Alcohol makes it difficult for your body to maintain a steady blood glucose level, especially if you haven’t eaten. The NIDDK notes that the effects of alcohol may also prevent you from noticing the symptoms of hypoglycemia, and this can lead to more severe side effects. The ADA recommends no more than one drink per day for women and two drinks per day for men. However, check with your healthcare professional to see if consuming alcohol is safe for you. Examples of one serving of alcohol are 4 ounces of wine, 1 ½ ounce hard liquor, or 12 ounces of light beer. Drinking with a meal can lower your risk of hypoglycemia.

5. Not Eating Enough

Your blood glucose can drop if you skip or postpone a meal. Similarly, not eating enough carbohydrate can also cause your blood glucose to drop. Hypoglycemia can also occur while you’re asleep, especially for those who inject insulin, since you are not eating for several hours.

Treatment for Hypoglycemia

The most well-known treatment for hypoglycemia is the 15-15 rule. This states that if you experience low blood sugar, you should have 15 grams of carbohydrate to raise your blood sugar, and then check your level again after 15 minutes. If your reading is still too low, you should repeat these steps until your blood sugar is at or above 70 mg/dL, or within the normal range determined by you and your healthcare provider.  Once your blood sugar is no longer too low, you should eat a meal or a snack to make sure it doesn’t drop again.

There are several options for the 15 grams of carbohydrate required by the 15-15 rule, as defined by the ADA:

• Hard candies
• Jellybeans
• Gumdrops
• 1 tablespoon of sugar, honey, or corn syrup
• 4 ounces (1/2) cup of juice or non-diet, regular soda
• Glucose tablets
• Gel tube

The ADA also notes that serving suggestions will be different for younger people. Small children may only need 10 grams of carbohydrate, while toddlers may need 8 grams and infants may need 6 grams.

4 Ways to Prevent Hypoglycemia

1. Check Your Blood Sugar Often

Make it a habit to test your blood glucose levels on a regular basis. This is especially important if you have hypoglycemia unawareness. With frequent testing, you can identify patterns, such as experiencing a low at a certain time each day or if environmental factors may cause your blood sugar to go low. If you use a continuous glucose monitor, you can observe how your glucose is changing and oftentimes anticipate a low glucose and treat before it becomes too low.

2. Stick to a Regular Meal Plan

The NIDDK recommends eating regular meals and snacks with a serving of carbohydrate that fits within your meal plan to prevent low blood sugar. If you are having an alcoholic beverage, be sure to have something to eat at the same time.

3. Stay Safe When Exercising

Test your blood sugar before, during, and after any physical activity. You may also need to work with your healthcare team to determine if you need to adjust your medication or carbohydrate intake.

4. Talk to Your Healthcare Team

As we’ve mentioned, hypoglycemia can affect everyone differently. That’s why it’s important to talk to your healthcare provider if you have experienced hypoglycemia. You may require a medication adjustment or alterations to your diabetes management plan. You can also inquire about a glucagon emergency kit.

With frequent testing, an individualized meal plan, and the guidance of your healthcare team, you can improve your blood sugar management and help keep levels within your target range. If you experience hypoglycemia and are unsure why, talk to your healthcare team about your diabetes management plan.