Blood sugar, or glucose, is the body's main energy source. It's derived from food (primarily carbohydrates) and regulated by the hormone insulin. It also comes from stores of glucose and gluconeogenesis and is regulated by glucagon. So, when we consume carbohydrates, they're converted into glucose, which enters the bloodstream. Then, insulin helps cells absorb this glucose for energy or storage. This is what fuels our body and helps keep our energy levels high. However, when blood sugar levels drop too low, a condition known as hypoglycemia occurs. Here, we'll go over everything you need to know about hypoglycemia and what to do in an emergency.
What Is Hypoglycemia?
Hypoglycemia is a condition that occurs when your body's blood sugar levels drop below the standard range. Clinical hypoglycemia occurs when blood sugar is below 55 gm/dL (milligrams per deciliter). This is when neurologic function is impacted, and loss of consciousness is a risk. However, symptoms of hypoglycemia can occur at or below 70 mg/dL. This is considered the lowest safe blood sugar for people on blood sugar-lowering medications, as it provides a “safety buffer” to act before clinical hypoglycemia occurs.
Although it's commonly associated with a side effect or complication that occurs in people with diabetes, it can happen to anyone. Hypoglycemia can be extremely dangerous if left untreated, so it's important to understand the symptoms of low blood glucose and how to act fast.
What Causes Hypoglycemia?
Diabetes does not cause hypoglycemia, but it can increase your risk of experiencing it. This is because hypoglycemia is often a side effect of blood sugar-lowering medications used to treat diabetes. In fact, it’s been found that four out of five individuals with type 1 diabetes and about 50% of individuals with type 2 diabetes report episodes of low blood sugar at least once across a four-week period.
However, several other things can also cause hypoglycemia, such as:
- Bariatric Surgery — One leading cause of hypoglycemia is reactive hypoglycemia following bariatric surgery. This happens because of the alterations to the microbiome and gut after the surgery, which can affect how carbohydrates are digested and absorbed into the body.
- Overproduction of Insulin — Insulinomas, which are insulin-producing tumors, can result in the pancreas creating an overabundance of the hormone. This can increase the saturation of insulin in the bloodstream, which can cause low blood glucose levels.
- Certain Medications — Some medications can cause hypoglycemia, even in people who do not have diabetes. For example, quinine (used to treat malaria), certain antibiotics, and some heart medications may lower blood sugar levels.
- High Alcohol Consumption — Drinking large quantities of alcohol can cause blood sugar levels to drop, especially when consumed on an empty stomach. Alcohol interferes with the liver’s ability to release glucose into the bloodstream, leading to hypoglycemia.
- Certain Illnesses — Severe liver, kidney, or heart illnesses can interfere with glucose metabolism and lead to hypoglycemia. Conditions like hepatitis, kidney failure, and severe infections can reduce the body's ability to manage blood sugar levels.
- Malnutrition and Starvation — Prolonged insufficient food intake, especially carbohydrates, can lead to hypoglycemia. Blood sugar drops when the body doesn't receive the necessary glucose from food to maintain normal blood sugar levels.
- Hormone Deficiencies — Certain hormonal imbalances can cause hypoglycemia. For instance, adrenal insufficiency (Addison's disease) and other disorders affecting hormone production can disrupt glucose regulation and result in low blood sugar levels.
Symptoms of Low Blood Sugar
Several symptoms of hypoglycemia exist, ranging from mild to severe, and tend to have a fast onset. In general, episodes of hypoglycemia that result in symptoms occur when blood glucose levels are around 70 mg/dL or lower.
Low blood sugar symptoms may occur more quickly if the drop is rapid. Alternatively, individuals who experience chronic hyperglycemia (high blood sugar) may find that they have symptoms at a higher mg/dL because their body has created a skewed average of what "normal" levels are. Additionally, people with hypoglycemia unawareness or chronic hypoglycemia may not have symptoms at all or don't experience severe enough symptoms to notice.
It's important to familiarize yourself with these indicators to ensure you and your loved ones can recognize the warning signs of low blood sugar episodes. If your blood sugar gets too low, any of the following symptoms can occur:
- Fatigue
- Sweating
- Shakiness
- Headache
- Extreme hunger
- Nausea
- Looking pale or flushed
- Irritability
- Anxiety
- Difficulty concentrating
- Dizziness
- Lightheadedness
- Irregular heartbeat
- Fast heartbeat
- Tingling or numbness in the lips, tongue, or cheek
As blood sugar continues to decrease, hypoglycemia symptoms can worsen and include:
- Slurred speech
- Loss of coordination
- Disorientation
- Confusion
- Unusual behavior
- Blurry vision
- Tunnel vision
- Nightmares during sleep
If blood sugar continues to drop, it can become life-threatening. Signs and symptoms of severe hypoglycemia include the following:
- Seizures
- Loss of consciousness
- Unresponsiveness
Many people with diabetes understand the initial warning signs and can treat low blood sugar before it becomes severe. However, it's important to educate your friends and family so they understand what to do in an emergency. If you or a loved one experiences signs of severe low blood sugar, glucagon must be administered as quickly as possible.
Complications of Low Blood Glucose Levels
Chronic or prolonged episodes of low blood sugar can also have several health repercussions. As mentioned, the lower your blood glucose levels, the greater the risk of life-threatening situations. However, repeated episodes of hypoglycemia or prolonged instances of severe hypoglycemia can also result in the following complications:
- Cardiac arrhythmias
- Cardiac arrest
- Organ failure
- Irreversible brain damage
- Coma
- Death
- Increased risk of accident (e.g., while driving or operating heavy equipment)
Treating Hypoglycemia
Even if you start to have symptoms, the only way to know if you're experiencing hypoglycemia is to check your blood sugar levels. If you cannot check your blood sugar when symptoms appear, it's important to act fast. Promptly raising your blood sugar levels will reduce the risk of more serious complications. The most common treatment plan for low blood glucose is the 15-15 rule.
The 15-15 rule is simple. You need to eat 15 grams of fast-acting carbohydrates to raise your blood glucose and then check your readings again after 15 minutes. If you still get low blood sugar readings, repeat the process. You'll want to continue to do this until your blood sample results in glucose levels of at least 70 mg/dL.
Glucose tablets and gel tubes are available to help treat mild or moderate hypoglycemia. Before using them, thoroughly read the instructions to know how to act in an emergency.
It's also important to avoid eating too much food that raises blood sugar levels quickly. High blood glucose levels or spikes can also be problematic, so it's recommended to go slow and take the necessary steps until your blood sugar is stable.
Treating Severe Hypoglycemia
Individuals who experience severe hypoglycemia will need to have glucagon, a hormone that raises blood glucose, administered. This is most commonly injected and can be purchased with a prescription to act fast during medical emergencies at home.
Never use insulin injections if you or someone you love is experiencing hypoglycemia. This can lower blood sugar even more and create a dangerous situation. If you're unsure what to do or don't have glucagon, call 911 immediately.
How to Prevent Hypoglycemia When Living with Diabetes
There are ways to prevent low blood sugar and reduce the risk of serious symptoms or complications. The most important is understanding your risk of low blood sugar and learning how to mitigate natural dips throughout the day.
- Always check insulin before taking any dose of blood sugar-lowering medication
- You need to check your blood sugar both before and after meals
- Check blood sugar before and after exercising
- Check blood sugar before bed
- Check blood sugar in the middle of the night if you've undergone strenuous or intense exercises
- Always carry rapid-acting carbs, especially during physical activity
- Learn what causes low blood sugar
- Understand your unique risks for low blood sugar
- Keep an eye on how your blood sugar reading changes with a new routine
- Stay diligent when you travel
Individuals who are at risk of developing hypoglycemia unawareness should also talk to their doctor about preventative measures they can take. Certain measures can help reduce the risk of dangerously low blood sugar levels, which usually include:
- Wearing a continuous glucose monitor (CGM) with alerts for when your blood glucose level is too low.
- A service dog trained to alert you when your blood sugar levels are dropping.
- Increase the frequency of checking your blood glucose levels throughout the day using a traditional blood glucose meter.
If you or a loved one are living with diabetes and interested in trying a CGM system to help keep your blood sugar in a healthy range, schedule an appointment with your doctor. CGMs can be covered by your insurance, so it's worth looking at your options. Talk to your doctor about obtaining a prescription, and contact your insurance provider to learn more. For additional diabetes support and management, Byram Healthcare has a range of continuous blood glucose monitors. We also offer diabetes support and educational materials to give you everything you need for comprehensive care.
