Is your blood sugar low? (Hypoglycemia) Let's talk about this in detail!

Today we are going to talk about a condition that can affect many people, especially those with diabetes, and sometimes even those without diabetes. That is low blood sugar, or in medical terms, hypoglycemia. It is important to be aware of this because it can be quite serious.

What is hypoglycemia? Let's understand it simply.

Simply put, hypoglycemia occurs when your blood sugar, or glucose, drops below a healthy level. We also call this 'low blood sugar.' This is a fairly common condition in people with diabetes, especially those with type 1 diabetes.

In general, for someone with diabetes, hypoglycemia is considered when the blood sugar level drops below 70 mg/dL (milligrams per deciliter) or 3.9 mmol/L (millimoles per liter). For someone without diabetes, hypoglycemia is when the level drops below 55 mg/dL (3.1 mmol/L). At such times, you need to eat or drink something containing sugar or carbohydrates as soon as possible. However, if this condition becomes severe (severe hypoglycemia), it can be life-threatening. In that case, emergency glucagon treatment or medical help is needed immediately.

Why is 'blood sugar' so important to our bodies?

Our bodies get glucose, or sugar, from the food we eat, especially from foods that contain carbohydrates. This glucose is our body's main source of energy. It's like gasoline for a car. This glucose is carried by our blood to every cell in the body to produce energy. This glucose is especially essential for our brain. For the brain to function properly, it needs a constant supply of glucose.

If you don't have diabetes, your body naturally helps keep your blood sugar levels within a healthy range through a number of processes. The hormone insulin – produced by our pancreas – is the biggest contributor to this. Glucagon is another important hormone in this process.

However, people with diabetes need to take oral diabetes medications and synthetic insulin to control their blood sugar levels. They also need to make lifestyle changes. Low blood sugar is often caused by too much insulin in the body – either because it is produced naturally or because you have been given too much insulin. Low blood sugar can also be caused by other hormonal and metabolic problems.

If your blood sugar level drops below a healthy level, you start to experience symptoms like shakiness and a fast heartbeat. If it drops too low, it can be life-threatening. Because, as I mentioned before, the brain needs a constant supply of glucose to function properly. If there is not enough glucose, the brain will not be able to function.

How common is hypoglycemia?

Hypoglycemia is a fairly common occurrence for people with diabetes, especially those who use insulin. One study found that 4 out of 5 people with type 1 diabetes, and about half of people with type 2 diabetes who take insulin, reported having low blood sugar at least once in a four-week period.

People who take meglitinides or sulfonylureas for type 2 diabetes are also at increased risk of low blood sugar. You can get hypoglycemia even if you don't have diabetes, but it's very rare.

What are the symptoms of hypoglycemia (low blood sugar)?

Symptoms of hypoglycemia can start very quickly. They can also vary from person to person. Even in the same person, symptoms can vary from one episode to another.

These symptoms are a little tricky. But they give you a good warning to take action before your blood sugar drops even lower. Here are some of the symptoms:

• A trembling or shaking nature.
• A lifeless body.
• Sweating and feeling cold.
• Severe hunger (polyphagia).
• Heart rate increases.
• Dizziness or a feeling of spinning.
• Difficulty concentrating or confusion.
• Constant anxiety or irritability.
• Skin discoloration (pallor).
• Feeling like your lips, tongue, or cheeks are numb.

Symptoms of severe hypoglycemia include:

• Blurred vision or double vision.
• Slurred speech.
• Loss of balance or difficulty performing tasks.
• Being disoriented.
• Seizures.
• Loss of consciousness.

Severe hypoglycemia is life-threatening! It requires immediate medical attention. Although rare, if left untreated, it can lead to coma and even death.

Sometimes your blood sugar can drop while you're sleeping. We call this nocturnal hypoglycemia. Symptoms can include:

• Insomnia or restless sleep.
• Clothes or bedding getting wet from sweat.
• Screaming in your sleep.
• Bad dreams.
• Feeling extremely tired, confused, or disoriented upon waking.

When do symptoms of hypoglycemia appear?

The glucose level at which symptoms begin for people with diabetes varies from person to person. Typically, people with diabetes start to experience symptoms when their blood sugar drops to 70 mg/dL or lower. However, if your blood sugar drops rapidly, you may experience symptoms even earlier.

Some diabetics can experience symptoms of hypoglycemia even at relatively high glucose levels. This is because when blood sugar levels are high for a long time (chronic hyperglycemia), the body becomes accustomed to what is considered 'normal' levels. The level at which symptoms of low blood sugar are seen changes.

Some people have low blood sugar but don't experience symptoms, or they don't notice them. Doctors call this hypoglycemia unawareness . These people are more likely to have severe hypoglycemia and are more likely to need medical attention.

Hypoglycemia unawareness can occur in diabetics who have had low blood sugar levels for a long time. Their bodies stop showing symptoms when their blood sugar levels drop.

If you have hypoglycemia unawareness, it's important to tell your friends and family about it so they can help you if your blood sugar gets too low. You may also find these things helpful:

• Using a Continuous Glucose Monitoring (CGM) device that alerts you when your blood sugar is low.
• Check your blood sugar levels manually frequently.
• Diabetes alert dog – These dogs are specially trained to alert you when your blood sugar is low.

What complications can occur due to low blood sugar?

Severe hypoglycemia that lasts for a long time can be life-threatening. It can also lead to complications such as:

• Multiple organ failure.
• Cardiac arrhythmias.
• Cardiac arrest.
• Permanent brain damage.
• Coma state.
• Death.

Also, operating heavy machinery, such as driving, when your blood sugar is low is very dangerous. You are more likely to have an accident. If you have diabetes, always check your blood sugar levels before operating heavy machinery.

What causes hypoglycemia (low blood sugar) in people with diabetes?

Hypoglycemia occurs when your blood sugar level drops below a healthy level. This can happen for a number of reasons for people with diabetes. Hypoglycemia can occur if your diet, exercise, and diabetes medications are out of balance.

These are the most common situations in which people with diabetes can experience hypoglycemia:

• Taking too much insulin, taking the wrong type of insulin, or injecting insulin into muscle instead of fat tissue.
• Not timing insulin and carbohydrate intake properly (for example, waiting too long to eat after taking insulin for a meal).
• Taking too much or more than the prescribed dose of diabetes medication.
• Being more active (exercising) than usual.
• Drinking alcohol without eating.
• Eating late or skipping meals.
• Meals do not contain a balance of fat, protein, and fiber.

If you are pregnant and have type 1 diabetes, you are more likely to experience low blood sugar during the first trimester due to hormonal changes.

What causes hypoglycemia in people without diabetes?

There are two main types of hypoglycemia in people without diabetes: reactive hypoglycemia and fasting hypoglycemia.

Reactive Hypoglycemia

Reactive hypoglycemia is a low blood sugar level after a meal. It usually occurs within two to four hours of eating.

Researchers don't know exactly why this happens, but they think it's because eating certain foods, especially simple carbohydrates like white rice, potatoes, bread, cakes, and sweets, causes a sudden spike in blood sugar, followed by a sudden drop.

Also, some weight loss surgeries (bariatric surgery) can cause reactive hypoglycemia. After surgeries like gastric bypass surgery, the body absorbs sugar very quickly. This causes more insulin to be produced. This can cause hypoglycemia.

The body usually corrects this condition on its own, but eating some carbohydrates can quickly reduce symptoms.

Fasting Hypoglycemia

Most people without diabetes do not experience hypoglycemia even after fasting for a long time. This is because the body's hormones and stored glucose control blood sugar levels.

However, some diseases and conditions can cause fasting hypoglycemia in people without diabetes. These include:

• Excessive alcohol consumption: Alcohol inhibits the body's ability to make new glucose cells (gluconeogenesis). If you don't eat properly for several days and drink heavily, your body can deplete its stored glucose (glycogen). This can cause hypoglycemia, which is when your body can't properly regulate your blood sugar levels.
• Severe illness: Hypoglycemia can occur in severe illness, such as end-stage liver disease, sepsis, fasting, or kidney failure. This is because your body uses up existing glucose for energy faster than it can make new glucose from the food you eat.
• Adrenal insufficiency: In this condition, cortisol levels are lower than normal. Since cortisol helps control blood sugar by increasing it, low cortisol levels can lead to hypoglycemia.
• Non-islet cell tumor hypoglycemia (NICTH): This is a rare but serious condition. In this condition, a tumor releases too much of a hormone called Insulin-like Growth Factor 2 (IGF-2). This hormone acts like insulin. When IGF-2 is elevated, hypoglycemia occurs. NICTH can be caused by a variety of benign (noncancerous) and malignant (cancerous) tumors.
• Insulinoma: This is a rare cancer that develops in the pancreas. It produces too much insulin, which causes hypoglycemia – often in the early morning.

Although rare, hypoglycemia can also be caused by medications unrelated to diabetes, such as beta-blockers and some antibiotics.

If you experience hypoglycemia without diabetes, it's important to see a doctor.

How do people with diabetes recognize hypoglycemia?

The only way to know for sure if you have hypoglycemia is to test your blood sugar level with a glucometer. Most of these devices use a small needle called a lancet to take a drop of blood from the tip of your finger.

A continuous glucose monitoring (CGM) device is a great tool to help you identify and prevent low blood sugar. Because you can set it to alert you when your blood sugar is low. These CGM alerts are especially useful in situations where low blood sugar can be dangerous, such as when you're sleeping or driving.

If you have symptoms of hypoglycemia, but there is no way to check your blood sugar, treat the hypoglycemia.

How do people without diabetes recognize hypoglycemia?

If your doctor suspects that you have hypoglycemia, he or she may check your blood sugar every few hours while you are fasting for a few days. Other tests may be done to find the underlying cause of the hypoglycemia. For example, imaging tests may be done to see if cancer is causing the low blood sugar.

If you have reactive hypoglycemia, your doctor may recommend a test called a Mixed-Meal Tolerance Test (MMTT). In this MMTT, you first drink a special drink containing protein, fat, and sugar. This drink raises your blood glucose levels, which then causes your body to produce more insulin. Then, a doctor checks your blood glucose levels several times over the next five hours.

How is hypoglycemia (low blood sugar) treated?

Mild and moderate hypoglycemia is treated by eating or drinking something containing sugar (carbohydrates).

The American Diabetes Association recommends the "15-15 rule" to treat a mild or moderate hypoglycemia episode:

• Eat or drink 15 grams of fast-acting carbohydrates to increase your blood sugar levels.
• After 15 minutes, check your blood sugar level.
• If it's still below 70 mg/dL, take another 15 grams of fast-acting carbohydrates.
• Repeat this until your blood sugar level is at least 70 mg/dL.

To find out how many carbohydrates are in the foods you eat, read the nutrition labels. Here are some foods that contain about 15 grams of fast-acting carbohydrates:

• A small piece of fruit, for example half a banana.
• 4 ounces (half a cup) of fruit juice or regular soft drink (not diet).
• A tablespoon of sugar, honey or syrup.
• A tube of instant glucose gel (see instructions).
• 3 or 4 glucose tablets (see instructions).

If you have symptoms of hypoglycemia, but there is no way to check your blood sugar, use the 15-15 rule until you feel better.

Young children may need a smaller amount of carbohydrates to treat hypoglycemia. Ask your child's doctor about this.

How is severe hypoglycemia treated?

Severe hypoglycemia requires different treatment than mild or moderate hypoglycemia. If someone you know is having hypoglycemia and is slurring their speech, is confused, or has lost consciousness, do not give them food or fluids. They could choke.

In cases of severe hypoglycemia, emergency glucagon should be used. This is a type of synthetic glucagon. Depending on the type, it can be given as an injection or as a nasal powder (dry nasal spray). Synthetic glucagon signals your liver to release stored glucose. This causes your blood sugar level to rise.

If the glucagon is an injection, inject it into his buttock, arm, or thigh according to the instructions on the kit. If the glucagon is a nasal powder, put it into one nostril according to the instructions on the package.

Once he regains consciousness (usually within 5 to 15 minutes), he may feel nauseous and vomit. If he is lying down, turn him on his side to prevent choking if he vomits.

Don't hesitate to call 911 for help. If someone is unconscious, doesn't have glucagon, or you don't know how to use it, call 911 immediately.

Can low blood sugar be prevented?

Unfortunately, it's difficult to completely prevent low blood sugar when you have diabetes. But you can try to change your diabetes management plan to reduce the number of hypoglycemic episodes you experience.

This can be easily done once you and your doctor understand what is causing your low blood sugar. Give your doctor as much detail as possible about your low blood sugar episodes. Something as simple as changing the time you take your medication, eat, and exercise may be able to solve the problem.

These steps can help prevent low blood sugar:

• Take all your medications exactly as prescribed.
• Follow your doctor's advice about diet and exercise.
• Use a continuous glucose monitoring device (CGM), or check your blood sugar levels regularly – before and after meals, before and after exercise, and at bedtime.
• After you treat a low blood sugar episode, write down the details of the episode. Include details like the time, what you ate recently, whether you exercised, what your symptoms were, and what your glucose levels were. This will help you and your doctor develop a management plan to prevent low blood sugar in the future.

What happens if I have hypoglycemia?

The outlook for hypoglycemia in people without diabetes depends on the underlying cause. If you have diabetes, frequent hypoglycemia can be dangerous. It can lead to hypoglycemia unawareness. This means you may not recognize the warning signs of low blood sugar. If you have frequent low blood sugar, it is important to find a doctor who can help you manage your diabetes.

How do I take care of myself?

If you have diabetes or another condition that causes hypoglycemia, wear a medical alert necklace or bracelet, or carry a medical ID card with you so that others know how to help you in an emergency.

These are steps you can take to prevent severe hypoglycemia:

• Always keep snacks with you at home and when you go out – things like fruit snacks, glucose tabs, or juice boxes.
• Explain to those you spend time with about hypoglycemia and severe hypoglycemia, and how they can help you if you have an incident.
• Always carry emergency glucagon. Teach your loved ones how and when to use it.

If you have diabetes, don't try to over-treat your blood sugar by eating too many carbohydrates. This can cause your blood sugar to rebound high. It can be difficult to stop overeating because of your body's "fight or flight" response. After you've treated yourself with 15 grams of carbohydrates, set a timer for 15 minutes before eating any more sugar.

When should I see my doctor about hypoglycemia?

If you have diabetes and are having frequent low blood sugar episodes, talk to a doctor who helps you manage your diabetes. He or she can help you develop a management plan. This may include changes to your medication regimen, meal plan, or exercise routine.

If you have low blood sugar without diabetes, talk to your doctor. He or she will need to run tests to find the underlying cause. In some cases, the underlying condition can be serious. Therefore, it is very important to see your doctor.

What is the difference between Hypoglycemia and Hyperglycemia?

Simply put, hypoglycemia is low blood sugar. 'Hypo-' means 'low'. Hyperglycemia is high blood sugar. 'Hyper-' means 'high' or 'excess'.

Finally, things to remember (Take-Home Message)

Hypoglycemia is a common condition that affects people with diabetes. If left untreated, it can be life-threatening. It is important to learn your personal warning signs and to try to prevent severe hypoglycemia by checking your blood sugar levels regularly. If you are experiencing low blood sugar frequently, work with your doctor to develop a diabetes management plan. The more you know about what is causing your symptoms, the easier it will be to develop your plan.

If you have low blood sugar without diabetes, you should definitely see a doctor. Although it is rare for the underlying cause to be serious, it can happen. So, it is better to get tested sooner rather than later. Take care of your health!

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