Treating Hypoglycemia: How To Manage Low Blood Sugar Symptoms

by Cindy

Recognizing Low Blood Sugar And When You Need Hypoglycemia Treatment

Creative Commons License photo credit: (matt)
For patients with diabetes, especially those that are on oral hypoglycemic agents and insulin, the dangers of decreasing blood sugar levels too much is a very real risk.  Hypoglycemia is a serious complication of diabetes that is often overlooked because there is so much focus on reducing high sugar levels.  Low blood sugar levels can be extremely dangerous for the diabetic patients, which is why it is so important for all diabetics to understand what hypoglycemia is and what to do if it happens to them.

What is Low Blood Sugar?

Low blood sugar, clinically known as hypoglycemia, is a serious complication of diabetes.   In fact, hypoglycemia is a more common complication of type 1 diabetes than diabetic ketoacidosis (DKA).  Both conditions are equally dangerous.

Normal blood glucose levels range from 60 mg/dl to 100 mg/dl.  When levels drop below 60 mg/dl this is consider low blood sugar.  However, it is often not until blood sugar levels drop below 50 mg/dl that patients become symptomatic. To be officially diagnosed with low blood sugar, the patient has to have a documented blood sugar level that is lower than 50 mg/dl and symptoms of hypoglycemia that are reversed when the patient is given sugar.

What Are The Different Hypoglycemia Causes?

Hypoglycemia is most commonly seen in patients with diabetes.  There are many different causes of hypoglycemia, for diabetic patients the most common reason for low blood sugar is due to side effects of medications. 

Causes of Hypoglycemia Include:

  • Diabetes Pills: Oral hypoglycemic medications are designed to lower blood sugar levels in diabetic patients.  When these medications are incorrectly dosed or taken improperly it can cause a dangerous, rapid drop in blood sugar levels.
  • Insulin: Diabetic patients must be extremely careful with their insulin use.  If taken incorrectly blood sugar levels can drop quickly and dangerously low.  It is a good idea for diabetic patients to ask their physician if they should keep a supply of injectable glucagon on hand for emergency situations where patients become hypoglycemic.
  • Genetic Disorders:  Abnormal production of substances that process glucose can cause low blood sugars in patients.  These conditions are most commonly discovered during childhood.
  • Alcohol:  The use of alcohol can suppress the release of stored sugars for patients with diabetes, resulting in a decrease in blood glucose levels.
  • Insulin Producing Tumors 
  • Reactive Hypoglycemia:  Reactive hypoglycemia occurs in several different settings. Patients who have had gastrointestinal surgeries are at risk for reactive hypoglycemia that occurs within a few hours of meals.  Other causes of reactive hypoglycemia include childhood metabolic disorders, autoimmune disorders, infection, hormonal imbalance, and pregnancy.  Regardless of its cause, reactive hypoglycemia symptoms do not differ from other causes of low blood sugar and the importance of recognizing those remains just as important.
  • Idiopathic Hypoglycemia:  When there is no known cause of the hypoglycemia it is term idiopathic hypoglycemia. 

Recognizing Hypoglycemia: Low Blood Sugar Symptoms

It is extremely important to recognize the symptoms of low blood sugar quickly so that action can be taken to reverse the hypoglycemia.  Symptoms of low blood sugar levels include:

Minor Symptoms of Hypoglycemia: 

  • Shakiness
  • Sweating
  • Racing Heartbeat
  • Hunger

Moderate Symptoms of Hypoglycemia:

  • Sleepiness
  • Anxiety
  • High Blood Pressure
  • Confusion
  • Blurred Vision
  • Numbness and Tingling
  • Abnormal Behavior
  • Weakness

Severe Symptoms of Hypoglycemia:

  • Change in Mental Status
  • Seizure
  • Coma
  • Death

Hypoglycemia Unawareness: When Diabetics Cannot Recognize the Signs of Low Blood Sugar

Recognition of the signs of low blood sugar is largely dependent on natural hormones that the body uses to reverse the effects of hypoglycemia.  These hormones are glucagon and epinephrine.  These two hormones work together to stimulate the release of stored sugars in times of low blood sugar levels.  After years of fighting diabetes, patients, especially those with type 1 diabetes, begin to lose the ability to counteract hypoglycemia naturally.  These patients do not detect low blood sugar until levels are very low because their body no longer responds with the typical symptoms of hypoglycemia.  This hypoglycemia unawareness leads to severe complications.

Hypoglycemia Treatment

Now that you can recognize the warning symptoms, you may worry about what to do for low blood sugar.  Once you recognize that your sugars are dropping into a dangerously low range it is time to respond promptly.  Diabetic patients and their caregivers should understand what to do when hypoglycemia strikes because waiting for medical attention is often not an option.

Once symptoms of hypoglycemia are detected check blood sugar readings with your glucometer to determine if you have mild, moderate or severe hypoglycemia.

  • Mild Hypoglycemia:  This is defined as sugar ranging from 50-60 mg/dl.  Patient should be given 15 grams of carbohydrate, such as a four ounce juice three glucose tablets.  Patients should recheck blood sugar with your glucose meter in 15 minutes.
  • Moderate Hypoglycemia:  This is defined as less than 50 mg/dl.  Patients should use up to 30 grams of carbohydrates, such as 8 ounces of juice, for hypoglycemia treatment.  Glucose levels should be checked again in 15 minutes.  If sugar levels do not return to normal, the patient should then consume bread or crackers to keep glucose elevated. 
  • Severe Hypoglycemia:  This is defined as low blood sugar with changes in mental status, seizure or coma.  These patients should never be given anything by mouth due to the risk of choking.  Caregivers should immediately call 911. Patients with severe hypoglycemia should then be given injectable glucagon by a family member who has been trained to administer it.  For patients taking insulin or who are at risk for hypoglycemia unawareness, it is a good idea to keep a glucagon injection kit on hand for hypoglycemia treatment. 

If you have diabetes and are at risk for low blood sugar levels, keep the following 15 gram snacks on hand at all times so that you may stop hypoglycemia before it becomes severe:

  • 3 Glucose tablets (1 tablet=5 grams of sugar)
  • Fruit Juice (4 ounces)
  • Non-Diet Soda (1/2 can)
  • Sugar (1 Tablespoon)
  • Jelly (1 Tablespoon)

Hypoglycemia is a very serious diabetes complication that is often overlooked by clinicians and patients.  It is essential that all diabetic patients, especially those on medications and insulin, familiarize themselves with the symptoms of low blood sugar and the recommendations for treating hypoglycemia.  If you don’t know much about hypoglycemia, ask your doctor for more information at your next appointment!

Learn more about hypoglycemia from the National Diabetes Information Clearinghouse.

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