Hypoglycemia, commonly known as low blood sugar, is a condition that occurs when your blood glucose level drops below the normal range. Glucose is the primary source of energy for your body, fueling everything from your brain to your muscles. When glucose levels become too low, it can impact your body’s ability to function properly.
While frequently associated with diabetes management, hypoglycemia isn’t exclusive to individuals with diabetes. Various medications and health conditions, many of which are rare, can also lead to low blood sugar in people without diabetes.
Prompt treatment for hypoglycemia is crucial. For many adults, a blood sugar level of 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L), or lower is generally considered a threshold for hypoglycemia. However, individual target ranges can vary, so it’s essential to consult with your healthcare provider to determine your specific blood sugar goals.
The immediate treatment for hypoglycemia involves raising your blood sugar back to the normal range, typically through consuming sugary foods or drinks, or in some cases, medication. Long-term management focuses on identifying and addressing the underlying cause of the low blood sugar episodes.
Symptoms of Hypoglycemia
When blood sugar levels decline excessively, a range of signs and symptoms can manifest. These can vary in severity and may include:
- Pale skin: A noticeable paleness can be an early indicator of low blood sugar.
- Shakiness or tremors: Involuntary trembling, particularly in the hands, is a common symptom.
- Sweating: Unexplained perspiration, even in the absence of heat or exertion.
- Headache: Persistent or sudden onset of headache.
- Hunger or nausea: Feeling excessively hungry or experiencing nausea.
- Heart palpitations: An irregular or rapid heartbeat, feeling like your heart is racing or pounding.
- Fatigue: Unexplained tiredness or weakness.
- Irritability or anxiety: Feeling unusually agitated, nervous, or anxious.
- Difficulty concentrating: Trouble focusing or thinking clearly.
- Dizziness or lightheadedness: Feeling faint, unsteady, or as if the room is spinning.
- Tingling or numbness: A pins-and-needles sensation, often affecting the lips, tongue, or cheeks.
As hypoglycemia progresses and blood sugar levels continue to fall, more severe symptoms can emerge:
- Confusion or unusual behavior: Difficulty thinking clearly, disorientation, or exhibiting behavior that is out of character, such as confusion or inability to perform routine tasks.
- Loss of coordination: Difficulty with balance and coordination, stumbling or appearing clumsy.
- Slurred speech: Trouble speaking clearly, speech may become mumbled or difficult to understand.
- Blurred or tunnel vision: Visual disturbances, such as blurry vision or a narrowing field of vision.
- Nightmares: Vivid and disturbing dreams during sleep.
In cases of severe hypoglycemia, critical symptoms can develop:
- Unresponsiveness (loss of consciousness): Inability to be awakened or respond to stimuli.
- Seizures: Uncontrolled muscle spasms and convulsions.
When to Seek Medical Attention
It’s important to seek medical help in the following situations:
- Hypoglycemia symptoms without diabetes: If you experience symptoms suggestive of hypoglycemia and you do not have a diabetes diagnosis.
- Hypoglycemia unresponsive to treatment: If you have diabetes and your low blood sugar symptoms do not improve after attempting standard treatments like consuming juice, regular soda (non-diet), candy, or glucose tablets.
- Severe hypoglycemia or loss of consciousness: Seek immediate emergency medical attention for anyone with diabetes or a history of hypoglycemia who exhibits severe symptoms or loses consciousness.
Causes of Hypoglycemia
Hypoglycemia arises when your blood glucose level drops too low to adequately support normal bodily functions. This can occur due to various reasons. The most prevalent cause of hypoglycemia is a side effect of medications used in the management of diabetes.
Blood Sugar Regulation Explained
When you consume food, your body breaks it down into glucose. Glucose, the body’s primary energy source, requires insulin to enter cells. Insulin, a hormone produced by the pancreas, facilitates glucose uptake by cells, providing them with the necessary fuel. Excess glucose is stored in the liver and muscles as glycogen.
Between meals, when blood sugar levels naturally decline, insulin production decreases. Another pancreatic hormone, glucagon, signals the liver to convert stored glycogen back into glucose and release it into the bloodstream. This process helps maintain stable blood sugar levels until your next meal.
The body also has the capacity to produce glucose de novo, primarily in the liver but also in the kidneys. During prolonged periods of fasting, the body can break down fat stores and utilize fat breakdown products as an alternative energy source.
Hypoglycemia in Individuals with Diabetes
For individuals with diabetes, the body may not produce sufficient insulin (type 1 diabetes) or may become less responsive to insulin (type 2 diabetes). This can lead to glucose accumulation in the bloodstream, resulting in elevated blood sugar levels. To manage this, individuals with diabetes may use insulin or other medications to lower blood sugar.
However, excessive insulin or other diabetes medications can inadvertently cause blood sugar levels to drop too significantly, leading to hypoglycemia. Hypoglycemia can also occur if meal intake is reduced after taking diabetes medication or if there is an increase in physical activity beyond the usual routine.
Hypoglycemia in Individuals Without Diabetes
Hypoglycemia in people without diabetes is less common. Potential causes include:
- Medications: Accidental ingestion of oral diabetes medications prescribed to someone else can induce hypoglycemia. Certain other medications, particularly in children or individuals with kidney failure, can also cause hypoglycemia. Quinine (Qualaquin), used to treat malaria, is one such example.
- Excessive alcohol consumption: Heavy alcohol consumption without adequate food intake can impede the liver’s ability to release stored glucose (glycogen) into the bloodstream, potentially leading to hypoglycemia.
- Certain critical illnesses: Severe liver diseases such as severe hepatitis or cirrhosis, serious infections, kidney disease, and advanced heart disease can sometimes cause hypoglycemia. Kidney dysfunction can also impair the body’s ability to eliminate medications properly, potentially leading to medication buildup and subsequent hypoglycemia.
- Prolonged starvation: Malnutrition and starvation due to insufficient food intake can deplete the body’s glycogen stores, which are necessary for glucose production, resulting in hypoglycemia. Anorexia nervosa, an eating disorder, exemplifies a condition that can lead to hypoglycemia through long-term starvation.
- Insulin overproduction: A rare pancreatic tumor known as an insulinoma can cause excessive insulin production, leading to hypoglycemia. Other tumors may also produce insulin-like substances. Additionally, abnormal pancreatic cells that secrete insulin can result in excessive insulin release and hypoglycemia.
- Hormone deficiencies: Certain disorders affecting the adrenal glands and pituitary gland can result in deficiencies of hormones that regulate glucose production or metabolism. Children with growth hormone deficiency can also experience hypoglycemia.
Reactive Hypoglycemia (Hypoglycemia After Meals)
While hypoglycemia typically occurs when meals are missed or delayed, some individuals experience symptoms after eating. This is termed reactive hypoglycemia or postprandial hypoglycemia. The exact mechanisms are not fully understood, but it is believed to be related to an exaggerated insulin release after a meal, causing a rapid drop in blood sugar.
Reactive hypoglycemia is more frequently observed in individuals who have undergone surgeries affecting stomach function, particularly gastric bypass surgery. However, it can also occur after other types of surgeries.
Complications of Untreated Hypoglycemia
If left untreated, hypoglycemia can have serious consequences, including:
- Seizure
- Coma
- Death
Furthermore, hypoglycemia can contribute to:
- Dizziness and weakness
- Falls
- Injuries
- Motor vehicle accidents
- Increased risk of dementia in older adults
Hypoglycemia Unawareness
Recurrent episodes of hypoglycemia can lead to a condition called hypoglycemia unawareness. In this state, the body and brain gradually lose their ability to recognize and trigger the typical warning signs and symptoms of low blood sugar, such as shakiness or heart palpitations. This significantly elevates the risk of severe, life-threatening hypoglycemic episodes.
For individuals with diabetes experiencing recurrent hypoglycemia and hypoglycemia unawareness, healthcare providers may adjust treatment plans, raise target blood sugar ranges, and recommend blood glucose awareness training to help improve symptom recognition.
Continuous Glucose Monitors (CGMs) are valuable tools for some individuals with hypoglycemia unawareness. These devices continuously track blood glucose levels and can alert users when levels drop too low.
Undertreated Diabetes and Fear of Hypoglycemia
For individuals with diabetes, experiencing low blood sugar episodes can be distressing and frightening. Fear of hypoglycemia can sometimes lead to intentionally taking less insulin to avoid low blood sugar. However, this can result in poorly controlled diabetes and its associated long-term complications. It is crucial to discuss any fears or concerns about hypoglycemia with your healthcare provider and to avoid making changes to diabetes medication dosages without professional guidance.
Prevention Strategies
Prevention for Individuals with Diabetes
Continuous Glucose Monitor and Insulin Pump
Alt text: Illustration depicting a continuous glucose monitor (CGM) on the left, a device for real-time blood sugar monitoring via a subcutaneous sensor, and an insulin pump on the right, an external device delivering programmed insulin doses through a subcutaneous catheter.
Adhering to your personalized diabetes management plan developed in consultation with your healthcare provider is paramount. When initiating new medications, altering dietary habits or medication schedules, or incorporating new forms of exercise, discuss these changes with your healthcare provider to understand their potential impact on your diabetes management and hypoglycemia risk.
Learn to recognize your individual pattern of hypoglycemia signs and symptoms. Early recognition enables prompt treatment before blood sugar levels become dangerously low. Regular blood glucose monitoring is essential for proactively detecting and addressing declining blood sugar levels.
Consider a Continuous Glucose Monitor (CGM). CGMs utilize a small sensor inserted under the skin to continuously measure glucose levels and transmit readings to a receiver. Many CGM models offer alerts that trigger when blood sugar levels are dropping too rapidly.
Certain advanced insulin pumps are now integrated with CGMs and possess the capability to automatically suspend insulin delivery when blood sugar levels are decreasing too quickly, helping to prevent hypoglycemia.
Always carry a readily accessible source of fast-acting carbohydrates, such as juice, hard candy, or glucose tablets, to promptly treat declining blood sugar levels before they become severely low.
Prevention for Individuals Without Diabetes
For recurrent hypoglycemia in individuals without diabetes, eating frequent, small meals throughout the day can be a temporary measure to help stabilize blood sugar levels. However, this is not recommended as a long-term solution. It’s crucial to work with your healthcare provider to identify and treat the underlying cause of the hypoglycemia.
