Low blood sugar (glucose). Hypoglycemia may be associated with symptoms such as anxiety, sweating, tremor, palpitations, nausea, and pallor. Hypoglycemia also starves the brain of glucose energy, which is essential for proper brain function. Lack of glucose energy to the brain can cause symptoms ranging from headache, mild confusion, abnormal behavior, loss of consciousness, seizure, and coma. Severe hypoglycemia can cause death. The causes of hypoglycemia include use of drugs (such as insulin), liver disease, surgical absence of the stomach, tumors that release excess amounts of insulin, and pre-diabetes. In some patients, symptoms of hypoglycemia occur during fasting (fasting hypoglycemia). In others, symptoms of hypoglycemia occur after meals (reactive hypoglycemia). Immediate treatment of severe hypoglycemia consists of administering large amounts of glucose and repeating this treatment at intervals if the symptoms persist. Treatment must also be directed at the underlying cause. Treatment of reactive hypoglycemia involves changing the diet, including eating fewer concentrated sweets and ingesting multiple small meals throughout the day.
Hypoglycemia occurs when your blood sugar (glucose) level falls too low. There are several reasons why this may happen, the most common being a side effect of drugs used for the treatment of diabetes. But to understand how hypoglycemia happens, it helps to know how your body normally regulates blood sugar production, absorption and storage.
Blood sugar regulation
During digestion, your body breaks down carbohydrates from foods — such as bread, rice, pasta, vegetables, fruit and milk products — into various sugar molecules. One of these sugar molecules is glucose, the main energy source for your body. Glucose is absorbed into your bloodstream after you eat, but it can’t enter the cells of most of your tissues without the help of insulin — a hormone secreted by your pancreas.
When the level of glucose in your blood rises, it signals certain cells (beta cells) in your pancreas, located behind your stomach, to release insulin. The insulin, in turn, unlocks your cells so that glucose can enter and provide the fuel your cells need to function properly. Any extra glucose is stored in your liver and muscles in the form of glycogen.
This process lowers the level of glucose in your bloodstream and prevents it from reaching dangerously high levels. As your blood sugar level returns to normal, so does the secretion of insulin from your pancreas.
If you haven’t eaten for several hours and your blood sugar level drops, another hormone from your pancreas called glucagon signals your liver to break down the stored glycogen and release glucose back into your bloodstream. This keeps your blood sugar level within a normal range until you eat again.
Aside from your liver breaking down glycogen into glucose, your body also has the ability to manufacture glucose in a process called gluconeogenesis. This process occurs primarily in your liver, but also in your kidneys, and makes use of various substances that are precursors to glucose.
Hypoglycemia is a common consequence of many diabetes treatments. As is true for many therapies for diseases with major pathologic consequences, the benefits and risks of treatment must be balanced. In intensified diabetes management, hypoglycemia is not an insurmountable problem but is unfortunately inevitable using the methods of glucose control currently available. Patients with type 1 diabetes seem to be at greater risk than patients with type 2 disease. The health care team must strive to help the patient maintain normoglycemia. The results of the DCCT and the United Kingdom Prospective Diabetes Study prove that near normoglycemia is clearly in the patient’s best interest. Patient education has become focused on minimizing hyperglycemia; counseling on the dangers of hypoglycemia has not been given the same stature. Emphasis must be placed on minimizing even minor subclinical hypoglycemia because it will contribute to a vicious cycle of hypoglycemia begetting hypoglycemia.
Most people feel symptoms of hypoglycemia when their blood sugar is 70 milligrams per deciliter (mg/dL) or lower.
Each person with diabetes may have different symptoms of hypoglycemia. You’ll learn to spot yours.
Early symptoms include:
- Feeling shaky
Pounding heart; racing pulse
- Pale skin
Without treatment, you might get more severe symptoms, including:
- Poor coordination
- Poor concentration
- Numbness in mouth and tongue
- Passing out
- Nightmares or bad dreams
- Low blood glucose level
- Symptoms of hypoglycemia at the time of the low glucose level
- Symptom relief with treatment of hypoglycemia
According to the textbook Henry’s Clinical Diagnosis and Management by Laboratory Methods, a blood glucose level equal to or below 50mg/dL (normal blood glucose is 80-120) without the presence of diabetes warrants proper medical assessment.
Fasting or reactive hypoglycemia is diagnosed by a blood test to measure blood glucose. The test may be performed after fasting overnight, physical activity, or between meals.
- Consume 15-20 grams of glucose or simple carbohydrates
- Recheck your blood glucose after 15 minutes
- If hypoglycemia continues, repeat.
- Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.
15 grams of simple carbohydrates commonly used:
- glucose tablets (follow package instructions)
- gel tube (follow package instructions)
- 2 tablespoons of raisins
- 4 ounces (1/2 cup) of juice or regular soda (not diet)
- 1 tablespoon sugar, honey, or corn syrup
- 8 ounces of nonfat or 1% milk
- hard candies, jellybeans, or gumdrops (see package to determine how many to consume)