Imagine feeling lightheaded, shaky, and suddenly overcome with a sense of confusion. Your body is sending out distress signals, urging you to take action. What could be the culprit? One possibility: low blood sugar, also known as hypoglycemia.

 

For people with diabetes, managing high blood sugar often means taking medicine regularly. But dealing with low blood sugar is different. You only need to treat it when it's low. That's why it's important to know the signs and symptoms so that you can catch them early and address promptly.

 

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Low blood sugar, also called hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. It's a medical condition characterised by abnormally low levels of glucose (sugar) in the blood. It typically occurs in individuals with diabetes who take insulin or certain oral medications to manage their blood sugar levels, but it can also occur in people without diabetes under certain circumstances.

 

Prompt treatment is essential to raise blood sugar levels to normal to prevent further complications. This often involves consuming fast-acting carbohydrates such as fruit juice, glucose tablets, or candy, followed by a more sustaining source of carbohydrates and protein to stabilise blood sugar levels. 

 

While hypoglycemia is often manageable with prompt treatment, severe or prolonged episodes can pose serious health risks, including seizures, loss of consciousness, and, in extreme cases, coma or death. Therefore, it's important for individuals experiencing symptoms of hypoglycemia to seek medical attention promptly to prevent complications and ensure proper management of their condition.

 

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Blood Glucose Levels

To determine if your blood glucose levels are within the normal range or if you have hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar), it's essential to be aware of the following ranges:

 

Normal Blood Glucose Levels:

• Fasting blood glucose (before eating): 70-99 milligrams per deciliter (mg/dL) or 3.9-5.5 millimoles per litre (mmol/L).
• Blood glucose 2 hours after meals: Less than 140 mg/dL (7.8 mmol/L).

 

Hyperglycemia (High Blood Sugar):

• Fasting blood glucose: Above 126 mg/dL (7.0 mmol/L) on two separate tests.
• Blood glucose 2 hours after meals: Above 200 mg/dL (11.1 mmol/L).

 

Hypoglycemia (Low Blood Sugar):

• Typically below 70 mg/dL (3.9 mmol/L).
• These ranges can vary slightly depending on individual circumstances, so it's essential to consult with a healthcare provider for personalised guidance and management.

 

Symptoms of Hypoglycemia 

• Rapid heartbeat
• Heart palpitations 
• Excessive hunger
• Sweating 
• Shaking
• Skin tingling 
• Blurry vision 
• Anxiety 
• Dizziness 
• Fatigue 
• Irritability 
• Colour draining from your skin
• Seizures 
• Loss of consciousness 

 

Causes of Hypoglycemia 

Possible Causes in People With Diabetes

• Taking higher doses of medication including insulin or medications that increase insulin production 
• Injecting insulin injection into your muscle instead of in your fat tissue 
• Eating meals later than usual 
• Skipping meals or fasting
• Engaging in physical activity without eating enough 
• Not balancing meals by including enough fats, protein and fibre.

 

Possible Causes in People Without Diabetes 

• Specific medications: Quinine, commonly used to treat malaria, can lead to low blood sugar by stimulating insulin release and increasing the uptake of glucose into cells, thereby reducing blood sugar levels.
• Kidney disorders: Impaired kidney function, affects the regulation of glucose levels in the bloodstream. This can lead to decreased glucose production or increased excretion of glucose in the urine.
• Endocrine disorders: Endocrine disorders can disrupt the balance of hormones involved in glucose regulation, leading to decreased production or increased utilisation of glucose, thus causing low blood sugar. 
• Alcohol consumption: Alcohol consumption can cause low blood sugar by inhibiting the liver's ability to release stored glucose into the bloodstream and by impairing the body's ability to produce glucose, particularly in individuals with diabetes who are taking insulin or certain medications.
• Adrenal insufficiency: Adrenal insufficiency can lead to low blood sugar due to insufficient levels of cortisol, a hormone that helps regulate glucose metabolism and maintain blood sugar levels.
• Severe infections: Infections that lead to sepsis can cause low blood sugar by triggering an inflammatory response in the body, which can increase insulin sensitivity and promote glucose uptake by cells, leading to decreased blood sugar levels.
• Certain tumours particularly those in pancreas,

 

Related Post: Sugar Substitute: Healthy Sweetener Alternatives For People With Diabetes

 

How Common is Low Blood Glucose?

Low blood sugar is commonly observed in individuals with type 1 diabetes and in those with type 2 diabetes who rely on insulin or certain other diabetes medications.

 

According to a 2016 global study published by Diabetes, Obesity and Metabolism, people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar episode at least once over a 4-week period.

 

Diagnosis of Hypoglycemia

The diagnosis of low blood sugar involves assessing both the symptoms experienced by the individual and measuring their blood glucose levels. For individuals with diabetes, particularly those on medication such as insulin or certain oral hypoglycemic agents, regular self-monitoring of blood glucose levels is essential. If they experience symptoms such as sweating, trembling, confusion, or palpitations, they should check their blood sugar levels immediately using a glucometer.

 

In a clinical setting, diagnosis may involve a combination of symptoms reported by the individual, medical history review, physical examination, and laboratory tests. If hypoglycemia is suspected in someone without diabetes, additional investigations may be necessary to identify the underlying cause. These investigations may include blood tests to measure glucose levels and assess hormone levels related to glucose metabolism, such as insulin and cortisol.

 

In some cases, doctors may perform other tests such as a fasting test or a mixed meal tolerance test to evaluate the body's response to changes in blood sugar levels over time. These tests can help differentiate between reactive hypoglycemia (which occurs after meals) and fasting hypoglycemia (which occurs after a period of fasting) and provide insights into the underlying mechanisms causing the low blood sugar levels.

 

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Effects of Hypoglycemia in the Body

Failure to address low blood sugar can result in increasingly severe effects, both in the short and long term.

Short-term Effects 

• Brain bleed
• Heart attack 
• Impairment to a person’s cognitive function 

 

Long-term Effects 

Hypoglycemia can also heighten the risk of various complications, such as 

• eye disease
• kidney disease
• nerve damage

 

In severe instances, inadequate glucose supply can result in nerve cell death, potentially leading to autonomic neuropathy if the nerves controlling internal organs are affected. Individuals with this condition may lose the ability to detect low blood sugar levels, potentially experiencing no symptoms and remaining unaware of their condition. This lack of awareness can delay intervention, increasing the likelihood of severe hypoglycemia development.

 

How to Treat Hypoglycemia

The American Diabetes Association recommends consuming at least 15g of carbohydrates immediately to increase your blood sugar.

 

These include:

• Soda or juices 
• Hard candies 
• Sugar or honey
• Sugary fruits or dried fruits

 

Also, for moderate to mild cases The American Diabetes Association recommends the “15-15 rule” to treat hypoglycemia:

• Eat or drink 15 grams of fast-acting carbs to raise your blood sugar.
• After 15 minutes, check your blood sugar.
• If it’s still below 70 mg/dL, have another 15 grams of fast-acting carbs.
• Repeat until your blood sugar is at least 70 mg/dL.

 

Some examples of foods that contain about 15 grams of fast-acting carbs include:

• 1 small piece of fruit, such as half a banana.
• Half a cup of fruit juice (not low-calorie or reduced-sugar juice)
• One tube of glucose gel
• Half a can of regular soda (not diet).
• 1 tablespoon of sugar, honey or corn syrup.
•  4 glucose tablets

 

Important Points to Note

• When addressing low blood glucose levels in young children, it's typically recommended to administer less than 15 grams of carbohydrates. Specifically, infants may require around 6 grams, toddlers approximately 8 grams, and small children about 10 grams. However, it's crucial to personalise this approach in consultation with your diabetes care team. 
• When treating a low, it's essential to consider the carbohydrate source carefully. Complex carbohydrates or foods containing fats alongside carbohydrates, such as chocolate, can delay the absorption of glucose and are not suitable for managing an emergency low.

 

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