August 23, 2021

Hypoglycemia or low blood sugar commonly occurs in diabetic patients who are taking insulin or other medicine for diabetes because of a mismatch between insulin and carbohydrates intake, exercise, or alcohol consumption. Glucose is the main fuel for the body and brain. Hypoglycemia is defined as having a low blood glucose level, less than 70 mg/dl or 3.9 mmol/l. If you are having symptoms of low blood sugar, treat it even if it is not below 70 mg /dl. The general guideline for diabetic patients is to keep blood sugar around 80-130 mg/dl before meals and less than 180 mg /dl after meals.

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Normally the body has extensive counter-regulatory mechanisms to compensate for low blood glucose levels. Glucagon and epinephrine levels appear to be the first line of defense. Cortisol and growth hormone levels also increase and are important in the recovery from prolonged hypoglycemia. The threshold for the release of these hormones is usually above that for hypoglycemic symptoms.

Autonomic symptoms are early symptoms that begin at or below a plasma glucose level of about 60 mg/dl (3.3 mmol/l), whereas CNS symptoms occur at or below a glucose level of about 50 mg/dl (2.8 mmol/l).

Common Symptoms of Hypoglycemia

Pay attention to the early warning signs and treat them immediately.

  • Sweating, cold clammy skin
  • Nausea
  • Dizziness
  • Headache
  • Blurred vision
  • Weakness and tiredness
  • Inability to concentrate
  • Hunger
  • Drowsiness
  • Anxiety or nervousness
  • Agitation, irritability, and anger
  • Trembling
  • pounding heartbeat
  • Speech difficulty
  • Incoordination

Hyperglycemia is harmful in the long run but hypoglycemia even for a short while is dangerous and may even be fatal. If Hypoglycemia is not treated then severe Hypoglycemia can occur leading to loss of consciousness, seizures, cardiac arrhythmias, coma, and death. Hypoglycemia also has been associated with an increased risk of dementia.

Night Time Signs and Symptoms

If Hypoglycemia occurs while sleeping, signs and symptoms that may awaken you can be the following:

  • Increase sweating.
  • Nightmares
  • Tiredness
  • Irritability or confusion upon waking up.

Symptoms differ with age. Children exhibit behavioral changes such as irritability, while older people experience more prominent neurological symptoms such as visual disturbances and incoordination. In older patients, hypoglycemia may cause stroke-like symptoms of aphasia or hemiparesis and is more likely to precipitate stroke, myocardial infarction, and sudden death. Most people with hypoglycemia have no symptoms, and most people with symptoms have normal glucose levels, so always check your blood glucose level.

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How to treat low blood sugar

Treatment depends on its severity and on whether the patient is conscious and able to swallow. Patients who are able to eat or drink can drink juices or sucrose water, glucose tablets, or candy when symptoms arise. If you suspect having low blood sugar check your blood sugar. If it is 70 mg /dl or less, then follow this rule of 15.

  • Eat or drink 15-20 g of fast-acting carbohydrates.
  • Wait 10-15 minutes
  • Check blood
  • Less than 70 mg/dl (4 mmol/l) Repeat steps 1 to 4.

Target blood glucose after correction is 100-180 mg/dl. When glucose reading comes to normal levels then eat your routine meal. If blood glucose remains less than 4 mmol/l after the 3 cycles (30-45 minutes), consider glucagon injection or dextrose solution intravenously or contact a Health Professional.

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Examples of 15 -20 g of Fast-Acting Carbohydrates

Fast-acting carbohydrates absorb rapidly, raising glucose levels immediately. The following are examples of 15-20 g of fast-acting carbohydrates, any one of them can be taken:

  • Chew 4-5 glucose tablets
  • 3-4 heaped teaspoons of sugar dissolved in water.
  • 4-6 pieces of hard candies or jelly beans.
  • Half a cup of fruit juice or regular soda.
  • A small apple or an orange or half of a banana, or two tablespoons of raisins or 15 grapes.
  • One tablespoon of honey or jam or glucose gel, apply on the buccal mucosa or keep under the tongue for fast absorption.

In severe cases when a patient is either unconscious or unable to help themselves, treatment is usually given by a relative, friend, or medical staff. Glucagon 1 mg is given subcutaneously, intramuscularly, or by inhalation. 50 % dextrose solution, 50ml IV (25g) followed, if necessary 5 or 10% dextrose solution by IV infusion to maintain adequate plasma glucose level. Glucagon has little effect on plasma glucose in patients who have been fasting or who are hypoglycemic for a long period of time. Oral refined glucose is given as soon as the patient is able to swallow.


Risk Factors for Hypoglycemia

Some people have a greater risk of developing hypoglycemia. Risk factors for hypoglycemia are:

  • People taking insulin or oral diabetic medication such as Sulfonylureas
  • Those taking multiple sugar-lowering medicines.
  • Young children, the elderly, and the disabled.
  • Those with impaired liver and kidney functions.
  • People who have long-standing diabetes
  • Hypoglycemia unawareness. Some people especially those having long-standing diabetes do not feel symptoms of low blood glucose levels even when glucose levels get too low.
  • Alcoholics

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Prevention of Hypoglycemia

  • Check blood glucose regularly and injection glucagon should be readily available in case of emergency, especially for Type-1 diabetics.
  • Relatives and friends also need to be familiar with signs and symptoms and how to treat hypoglycemia when needed.
  • It is a sensible precaution to measure blood glucose before going to bed. If less than 110 mg /dl(6 mmol/l) then take a carbohydrate snack.
  • Do not skip or delay meals if you are taking diabetic medicine.
  • Take medication carefully as advised by the doctor on time.
  • Adjust medication or eat a snack in case of increased physical activity.
  • Record in a journal, so that it helps the doctor in adjusting treatment to prevent another episode of hypoglycemia.
  • Always keep a diabetes identification card in your wallet or wear an identification necklace or bracelet. So in case of emergency situations, others will know that you are diabetic.

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