Diabetic Hypoglycemia

Low blood sugar, or hypoglycemia, happens when someone with diabetes has too little sugar (glucose) in their blood. Glucose is the body's main energy source, so not having enough can make you feel unwell and affect how well your body works.

For most people, low blood sugar is when their blood sugar level drops below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L). However, the ideal range for your blood sugar may be different. Talk to your doctor or other healthcare provider to find out what your target blood sugar range should be.

It's important to be aware of the early signs of low blood sugar and treat it quickly. A simple way to raise your blood sugar quickly is to eat or drink something with a quick-acting sugar, like glucose tablets, hard candy, or fruit juice. Make sure your family and friends know what the symptoms of low blood sugar are and what to do if you can't treat it yourself. This way, they can help if you need it.

Early warning signs of low blood sugar (hypoglycemia)

The first signs of low blood sugar can be subtle but important to recognize. If you notice any of these symptoms, it's a sign your blood sugar is low and needs to be addressed right away.

Here are some common early warning signs:

• Pale skin: Your skin might look paler than usual.
• Shakiness: You might feel unsteady or tremble.
• Lightheadedness or dizziness: Feeling like you might faint or lose your balance.
• Sweating: This is a common response to low blood sugar.
• Hunger: Your body may signal that it needs more sugar.
• Nausea: Feeling queasy or sick to your stomach.
• Fast or irregular heartbeat: Your heart might beat faster or skip a beat.
• Trouble concentrating: It might be harder to focus or think clearly.
• Weakness or fatigue: Feeling tired and lacking energy.
• Irritability or anxiety: Feeling agitated, restless, or nervous.
• Headache: A headache can be a symptom of low blood sugar.
• Numbness or tingling: You might experience a prickling or numb feeling, often in the lips, tongue, or cheeks.

These symptoms can vary from person to person. If you experience any of these signs, it's crucial to take action to raise your blood sugar levels. This might involve eating a quick source of sugar (like a few pieces of candy or fruit juice), and checking your blood sugar levels to make sure they are rising. If the symptoms persist or worsen, seek immediate medical attention.

Low blood sugar (hypoglycemia) can be very dangerous. It can cause serious problems like seizures or passing out, requiring immediate medical help. Make sure your loved ones know what to do in an emergency.

Tell your close friends and family about your hypoglycemia. If they know the warning signs, they might be able to help you before things get worse. It's critical that they know where your glucagon is kept and how to use it. Glucagon is a medicine that quickly raises your blood sugar.

Here's what to do if someone you're with has low blood sugar and isn't responding or can't swallow:

• Don't give insulin. This will make the low blood sugar worse.
• Don't give them fluids or food. They could choke.
• Give glucagon. This can be done by injection or a nasal spray.
• Call 911 or your local emergency number immediately. If you don't have glucagon, don't know how to use it, or the person isn't responding, call for help right away. Emergency medical services are crucial.

If you experience low blood sugar regularly (several times a week or more), talk to your doctor. They might need to adjust your diabetes medicine or treatment plan. This is important to prevent further episodes.

Low blood sugar, sometimes called hypoglycemia, is a common problem for people with diabetes, especially those using insulin. It can also happen if you're taking certain pills to manage diabetes.

Several things can cause low blood sugar in people with diabetes:

• Taking too much insulin or diabetes medicine: This is a straightforward cause. If you're taking more medication than your body needs to process the available sugar, your blood sugar can drop. It's important to follow your doctor's instructions carefully regarding medication doses.

• Not eating enough: Your body needs fuel (food) to maintain a healthy blood sugar level. Skipping meals or snacks or not eating enough can lead to your blood sugar dipping too low.

• Skipping or delaying meals or snacks: If you're used to eating at certain times, changing this schedule without adjusting your medication can cause a significant drop in blood sugar. This is often related to the timing of meals and medication.

• Increased activity without adjusting your diet or medication: Exercise uses up sugar in your blood. If you exercise more than usual without eating more or changing your medication, your blood sugar can go down. This is particularly important for people who are physically active. It's crucial to adjust food intake and/or medication to match your activity level.

• Drinking alcohol: Alcohol can interfere with your body's ability to regulate blood sugar, potentially causing a drop. This is especially important to consider, as alcohol can affect blood sugar control in unexpected ways.

Certain factors increase a person's chance of experiencing low blood sugar (hypoglycemia) in diabetes. These include:

• People using insulin: Insulin is a medication that helps control blood sugar levels. If you take insulin, you need to be especially careful to monitor your blood sugar and adjust your insulin dose as needed, because insulin directly affects how much sugar is in your blood.

• People taking sulfonylureas: These are another type of diabetes medication. Sulfonylureas stimulate the body to release more insulin. This can lead to blood sugar dropping too low if not managed properly. Examples include glipizide (Glucotrol), glimepiride (Amaryl), and glyburide (Diabeta, Glynase).

• Children and older adults: Young children and older adults may be more vulnerable to hypoglycemia due to variations in their metabolism and how their bodies process medications. Their bodies might react differently to blood sugar fluctuations.

• People with liver or kidney problems: If your liver or kidneys aren't working optimally, your body might not process medications or regulate blood sugar correctly. This can make you more prone to hypoglycemia.

• People with long-standing diabetes: Over time, the body's ability to regulate blood sugar can change, potentially leading to a higher risk of hypoglycemia.

• People with hypoglycemia unawareness: Some people with diabetes don't experience the usual symptoms of low blood sugar, like sweating or shakiness. This makes it harder to recognize and treat the problem. This is called "hypoglycemia unawareness".

• People taking multiple medications: Taking many different medications can increase the risk of interactions that affect blood sugar control.

• People with disabilities: If a person has a disability that affects their ability to quickly recognize or respond to symptoms of low blood sugar, they may be at higher risk. This could impact their ability to take action if they experience these symptoms.

• People who drink alcohol: Alcohol can interact with diabetes medications and affect blood sugar levels. This interaction can lead to hypoglycemia.

It's crucial to discuss these risks with your doctor or healthcare provider to understand how to best manage your blood sugar levels and minimize the chances of experiencing hypoglycemia.

Low blood sugar, or hypoglycemia, can be dangerous if ignored. Your brain needs sugar (glucose) to work properly. If your blood sugar gets too low, you might not notice the early warning signs. But if you ignore these signs, serious problems can happen.

The symptoms of low blood sugar can be subtle at first, but if they're ignored, they can lead to:

• Seizures: Sudden, uncontrolled jerking movements.
• Loss of consciousness: Passing out.
• Death: In severe cases, untreated low blood sugar can be fatal.

It's important to pay attention to the early signs of hypoglycemia. If you have diabetes, low blood sugar can increase the risk of accidents, injuries, and even death. Don't delay in getting treatment if you think you might be experiencing low blood sugar. Prompt treatment is crucial to prevent serious complications.

Preventing Low Blood Sugar (Hypoglycemia) in Diabetes

Diabetes can sometimes cause your blood sugar to drop too low, a condition called hypoglycemia. Here's how to help prevent it:

1. Keep a Close Eye on Your Blood Sugar:

Regularly checking your blood sugar levels is essential. Your doctor will tell you how often to check it, and how to interpret the results. This might be a few times a week or even several times a day, depending on your treatment plan. The goal is to keep your blood sugar within a healthy range as determined by your doctor.

2. Stick to a Consistent Eating Schedule:

If you take insulin or medicine for diabetes, it's crucial to eat meals and snacks at roughly the same times each day. This helps your body regulate your blood sugar. The amount you eat also matters. Your doctor can help you figure out the right balance for you.

3. Take Your Medicine as Prescribed:

Take your diabetes medication exactly as your doctor instructs. Following the prescribed dosage and timing is vital for controlling your blood sugar levels.

4. Adjust for Exercise:

If you increase your physical activity, you might need to adjust your medication or eat extra snacks. The best way to figure out what's needed is to check your blood sugar before, during, and after exercise. Your doctor can help you understand how your activity level affects your blood sugar and how to adjust your treatment plan accordingly. Always follow your doctor's instructions.

5. Eat When You Drink Alcohol:

Drinking alcohol, especially on an empty stomach, can cause your blood sugar to drop. Even if you're not hungry, eat a meal or snack when you drink alcohol to prevent low blood sugar. Alcohol can also sometimes cause a delayed drop in blood sugar, so it's especially important to monitor your blood sugar if you drink alcohol.

6. Note Your Low Blood Sugar Episodes:

Keeping a record of your low blood sugar episodes (hypoglycemia) is helpful. This information can show patterns or triggers that might be causing these episodes. This information can help your doctor adjust your treatment plan.

7. Wear Diabetes Identification:

Always carry a medical identification necklace, bracelet, or wallet card. This way, if you experience a low blood sugar episode or other medical emergency, others will know you have diabetes and how to help you. This is crucial for your safety.

If you feel unwell and think your blood sugar might be low, use a blood glucose meter. This is a small tool that tells you how much sugar is in your blood. Low blood sugar, also called hypoglycemia, happens when the amount of sugar in your blood gets too low. A healthy blood sugar level is usually around 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L). If your reading is below this, you have hypoglycemia.

Managing Low Blood Sugar (Hypoglycemia)

If you think your blood sugar is too low (hypoglycemia), the first thing to do is check it using a blood glucose meter. If you have symptoms of low blood sugar but can't check your blood sugar right away, treat it as if it's low and take action.

Quick Fixes for Low Blood Sugar:

The fastest way to raise your blood sugar is to eat or drink something with sugar or carbohydrates. Pure glucose (available in tablets, gels, or liquids) is the best choice. Foods with lots of fat, like chocolate, raise blood sugar more slowly. Diet sodas won't help because they have no sugar.

Here are some examples of quick-acting foods and drinks that can raise your blood sugar:

• Glucose tablets: These are readily available at most pharmacies.
• Glucose gels: Check the label for the amount of glucose.
• Hard candy or jelly beans: Read the label for the carbohydrate content.
• Fruit juice (regular): Avoid diet drinks.
• Regular soda: Avoid diet sodas.
• Sugar, corn syrup, or honey: A tablespoon is about the right amount.

Generally, 15-20 grams of carbohydrates is enough to bring your blood sugar back to a healthy range.

Monitoring and Follow-up:

Check your blood sugar again 15 minutes after eating or drinking something to treat the low blood sugar. If it's still low, repeat the process until your blood sugar reaches above 70 mg/dL (3.9 mmol/L).

To prevent another low blood sugar episode, have a snack or meal. If you usually take insulin with meals, you might not need extra insulin after a quick snack. If you're eating a full meal, you might need to reduce your insulin dose to prevent your blood sugar from rising too quickly.

Important Note: Don't overtreat low blood sugar. This can cause your blood sugar to become too high, leading to thirst and tiredness.

Glucagon: An Emergency Treatment

Glucagon is a hormone that quickly raises blood sugar. It's a life-saving treatment if someone can't eat or drink something themselves because they're not alert enough. Glucagon is only available with a prescription.

Glucagon comes in emergency kits or pre-filled syringes. It's also available as a nasal spray. Always follow the storage instructions on the packaging and be aware of the expiration date. If someone is unconscious, place them on their side to prevent choking if they vomit.

About 15 minutes after receiving glucagon, the person should be alert enough to eat. If they don't respond within 15 minutes, call emergency medical services. Even if someone responds quickly, it's important to contact their doctor.

Preventing Future Episodes:

If you've needed help for a low blood sugar episode, your doctor will likely adjust your insulin or other diabetes medication to prevent future problems. Some people experience frequent or severe low blood sugar despite medication adjustments. In these cases, your doctor might recommend keeping your blood sugar a little higher than usual.

Continuous Glucose Monitoring (CGM):

Your doctor might recommend a CGM. This device measures your blood sugar every few minutes using a small sensor under your skin. They might also suggest carrying glucagon at all times and teaching trusted friends or family members how to use it.

Hypoglycemia Unawareness:

Some people don't experience or recognize early symptoms of low blood sugar (hypoglycemia unawareness). If this applies to you, your doctor may recommend a higher blood sugar target range.

Important Bedtime Habits:

It's crucial to check your blood sugar before bed and eat a carbohydrate-containing snack if your blood sugar is below your target level for bedtime. Your doctor might recommend a CGM that alerts you when your blood sugar is dropping.

Examples of quick-acting carbohydrate sources (15-20 grams):

• 4 glucose tablets
• 1 serving of glucose gel
• 5-6 pieces of hard candy or jelly beans
• 4 ounces of fruit juice
• 1 tablespoon of sugar, corn syrup, or honey

Insulin Pumps:

Some people use insulin pumps, which deliver insulin continuously and with meals. The insulin pump is worn outside the body, and a tube connects it to a catheter under the skin.

Remember to always discuss your treatment plan with your healthcare provider. They can help you create a personalized plan to manage your blood sugar effectively.

Tell trusted people about your hypoglycemia. This includes family, friends, and coworkers. If they know the signs, like shakiness, sweating, or trouble concentrating, they could help you catch problems early. It's also important that they know where your glucagon is stored and how to give it. Knowing this will help them respond quickly and safely in a low blood sugar emergency.

Always have a way to treat low blood sugar with you. This could be glucose tablets, hard candies, or gel. If your doctor prescribed it, also carry glucagon.

Consider wearing a medical alert necklace or bracelet, and carrying a wallet card that clearly states you have diabetes. This will help others quickly understand your condition and how to help you.